Loading...
HomeMy WebLinkAboutPermit Mechanical 1999-7-14 . . SPRINGFIELD Job Location: -"-S '3 7 fiu;k' ~/ I L /70'32(,2i /), VJ1<DY\ IL,J"n &-r;j~p tL 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~ f-hA If . f 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 \ 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: