HomeMy WebLinkAboutPermit Mechanical 1999-7-14
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SPRINGFIELD
Job Location: -"-S '3 7 fiu;k' ~/ I L
/70'32(,2i
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City: Srr'''rhd) State: nIL
Value of Wood StovelPellet Stove{f!!!~!!).._it.l).lX)
~.. Inspecti~ 15,00 (prior to installation of insert)
ood St ellet/Insert Permit is $15.00 + 1.05 state surcharge + $.45 Administrative Fee + $10.00
Iss . . ,
/;rll -
Type of Inspection Requ~sted: I~
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10<1
WOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION.. BUILDING SAFETY
225 Fifth Street
Springfield, Oregon 97477
Assessors Map #:
Owner: r:L,frj~
Address: ~ '37
Office: 726-3759
INSPECTION LINE: 726-3769
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Tax Lot#:
O/IOD
Phone#:
74-/-'1/4/
OJ 7Lf77
Zip:
(please circle appropriate appliance)
Woo/ s--r~
.'. Contractor: / C ()
ATTENld@~pr~>I.' f) 'hbAc"
follow rules auu....:;- -, .
Notificat~&p~~t:~..:.hllr.aiin.." . State: () /L
'nOAR95~-vv ,"vv.- ....- .--
I nbta~' copies oj In.. " 72 0'/\ b
0090. YCCOmmrctlon tract'lrs,Registration#: -::> 0 U Expires: ANY 180 DAY PERIOD.
calling the cemi:r. 10(\>,.:'-" ",
, . ,tto.A QreQon Utility N01\T,. ' .
numblffX.'~rgniiigiJir~pelplit/application, I agree to call for an inspection(s) as required (726-3769). I state that
all'iRfif'riniition on this application/permit is correct and that I was provided with the Wood 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 Quality or the Federal Environmental Protection Agency and I agree to provide the testing
approval 'lumber to the inspector at the time of inspection. I also understand that if I am requesting a
prel~/,~speMe ?~covering may be required to be removed,
(~ ~ 7-/'1~fq
Signature
FOR OFFICE USE
REQUIRED INSPECTl07): mDSTOVElP9:tETIINSERT
" _.
Date of Application: 7 1'1 Job #:
Total Amount Collected: if/. (?>' Receipt#: 0 ~i/~) 7
Checked for Delinquencies:
NCTIC~: Cl?7- ~/P/f
p~fi'!=RMIT SHALL EXPIRE IFTHE WORI<
AUTHORIZED UNDER THIS PERMIT IS NO'!
~~~ihltNCCD on 10 ADAtJDONED FOR 17 '{ 3 (
Date
PRELIMINARY V
99rJ q Pi
JtJJ
Checked for Historical Status:
Issued By: