Loading...
HomeMy WebLinkAboutPermit Mechanical 1995-9-6 . . YOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFEILD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Job Location: 70b //'/7;?7//lO/J Assessors Map #: l-r 0 ~ '3 "=t I L Owner: /:"()(/Jf>.- Fa5kK Address: /(")h /.//7/??// /0/7 City: r C/~ State: -J Value of Vood Stove/Pellet Stove/Insert: on. / /on Office: 726-3759 INSPECTION LINE: 726-3769 Tax Lot #: Q(t7~ .. Phone: #: 70'-:22S9 97V'77 Zip Code: Preliminary Inspec t ion is $15.00 (prior to ins talla tion of insert) Vood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge + $.45 administrative fee + $10.00 issuance = $26.20 total Type of Inspection Requested: O.rJi'M/ l?J9tlV Contractor: cr4/! ..sToVe . Address: / f?ZS u (,7J Ci ty: CcI5f!7e.- State: ore #: L/t~a5 Construction Contractors Registration Ins-P Phone #: I/J?S-n.533 Zip C;ode: 971/0-:2.. Expires: /0-:22- 9s By signing this permi tlapplication, I agree to call for inspection(s) as required (726-3769). I state that all the information on this permit/ap~lication is correct and that I was provided with the Vood Stove Safety information for wood 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 preJjminary inspection, the wall covering ma~:A:o b~ AA- 5?- 6- 9s S~ature . Date FOR OFFICE USE ccc==================================================================================== REQUIRED INSPECTION(S): VOODSTOVE/~ET/INSERT Date of Application: g ~ (P-Cf, Total Amount Collected:,,1/, IS. OD ReceiPt#:DIKCf37 ", Checked for Deliquencies: ~ Checked for Historical Status: Job #: PRELIMINARY qSI450 Issued By: " ~