HomeMy WebLinkAboutPermit Mechanical 1994-4-19
VOOD STOVE/INSERT .INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
5?L'j/ fl4U()L"~^-! f?e I!III 7?M?~
Assessors Map II: \" 0 3A:.\.rS. \
. "
Owner: --./oh./.-J '9" ~ dA?/Pr? .&~,...?{?
Address: S-M' ..JIA-UOFA} t<.R ,{lcf&e Phone II:
City: . C::;::;~/"o,:::;~--:c/ State: ~A""r-?
Value of V~od Sto~;;Glet S~~ /~OO. c;C7
(please circle appropriate ~~~e)
Job Location:
Tax Lot II:
<<fJ.tJfL
7.PC - 2/YS--
Zip: 9"7~77
Preliminary,Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance +. $.15. ~ate surcharge.
Type of Inspection Requested: ~b~;;.....,_J/I7..eG,...~ Po ~O~~~
Contractor: /..//.Jr-k~;"?7//;~ ~. .'
Address:
Phone II:
City:
State:
Zip:
Construction Contractors Registration II:
Expires:
By signing this permit/application, I agree to call for an inspection(s) as required
(726-3769). I state that all information on this application/permit 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 Quality 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 wall covering
may be required to be removed.
N0/7.t2.--'8bJh/ /7':'_
Signature /
l///C}/qi/
Date
FOR OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVE/~LET/I~~,
Date of Application: 4.\Q .C\4-. ~ Job II:
Total Amount Collected: 4-() ,rn ()
Receipt II: \ ~3r') (') Issued By9Jtl:L>,,--
PRELIMINARY ~
GAD ~~-
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Checked for Delinquencies:
Checked for Historical Status: