Loading...
HomeMy WebLinkAboutPermit Mechanical 1995-9-18 -e . 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( - ,- 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() ," 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 ======================================================================================= FOR OFFICE USE REQUIRED INSPECTION(S): VOODSTOV&(?ELLE:::N~ER1) Date of Application: 4?":l! ~.5 Total Amount collected:~ ;?~ PRELIMINARY Job #: .q~ /~t:;;?::::> ,. - ~\ Receipt #: /'~~ Checked for Deliquencies: Issued By: 4~.oI _ .. ./' r./"'" Checked for Historical ~atus: