HomeMy WebLinkAboutPermit Mechanical 1995-9-18
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SPRINGFIELD
Preliminary Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge +
fee + $10.00 issuance = $26.20 total
Type of Inspection Requested: .-lflS //9//4776/7
Contractor: r (~ c_::/l{jUe.-
Address: J 27 L) C..j G~
Ci ty: P (./ c: "f?fl-e S ta te:
VOOD STOVE/INSERT INSPECTION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Job Location: 7/)!: .~a/r;7~'/7br7
Assessors Map #: /7 0'3 . 3~ /2-
Ovner: ~ /"')(j /-P m)7:e J(
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Address: /(jC; .//4./?7f/707
City: ~ State: dir
Value of Vood Stove/Pellet Stove/Insert: ~;I~~
Construction Contractors Registration
CJ/c
#: t/'( 5" CJ.5'
Office: 726-3759
INSPECTION LINE: 726-3769
Tax Lot #: nG)f(f()
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Phone: #: 7~/-'C.?S'7
Zip Code: 9'7V 77
$.45 administrative
Phone #: ij f? ;; -(J 5'5")
Zip C;ode: 97<;/02.
Expires: /1) -7 9- 9S"
By signing this permit/application, I agree to call for inspection(s) as required
(726-3769). I state that all the information on this permit/application is correct
and that I vas provided vi th the Vood Stove Safety information for vood burning
appliances and preliminary inspection standards. I further state that the appliance
I am installing meets smoke emission standards as set by the Oregon Department of
Environmental Quali ty or the Federal Environmental Protection Agency and I agree to
provide the testing approval number to the inspector at the time of inspection. I
also understand that if I am requesting a preliminary inspection, the vall covering
may be ~uired to be removed. ~
/Va:A~ I~~..::> 9-/7-95
t..S1gna ture Da te
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FOR OFFICE USE
REQUIRED INSPECTION(S): VOODSTOV&(?ELLE:::N~ER1)
Date of Application: 4?":l! ~.5
Total Amount collected:~ ;?~
PRELIMINARY
Job #: .q~ /~t:;;?::::>
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Receipt #: /'~~
Checked for Deliquencies:
Issued By: 4~.oI _ ..
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Checked for Historical ~atus: