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HomeMy WebLinkAboutPermit Mechanical 1999-10-6 . ~ SPRINGFIELD . ,. WOOD STOVElINSERT INSPECTION APPLIC~TIONHION;OrZilon law reqUires you t" CITY OF SPRINGFIELD follow rules adopted by the Oregon UVllY COMMUNITY SERVICES DIVISION - BUILlSllW!l(SAI'E:nYenter. Tnose 'ules are set forth in OAR 952-001-0010 through OAR 852'001- 00!'l0. You may obtain copies 01 thCOffice: b726-3759 calling the center. (NINSPEGTI01\li!!,INE: 726-3769 nllmhmforthe Oreaon Utili;, Notilication ~r,' ~~'~i.ldO-332-2144). ~ Tax Lot#: {)O ~ 00 225 Fifth Street Springfield, Oregon 97477 Job Location: \L...\~ <., \-\o...\AdeV'\ /7t;1 2-)2-"2- Assessors Map #: Owner: DOVi\"'S 1'1't , ~fJt( t! {YlO/Z...S e ~o&.. . (?~ I Phone#: 7'1t,])/f Q:rY77 Address: ,~8thcftf- Value of Wood StovelPellet Stov~ ~T SHALijllilffillillfdfe~~filJiI!<appliance) ~ AUTHORJZED UNDER THIS PERMIT IS NOT Preliminary Inspection is $15.00 (prior to instlillat('1.1) iIf.im~ ARANDONED FOR Wood StovelPelletlInsert Permit is $15.00 +l.~~lIIt'iiM~I'l.I~.<I);';:iliiiimstrative Fee + $10.00 Issuance. ANY 1BO DAY PERIOD. City: Zip: Type of Inspection Requested: CJ Address: / 'f 7 f Contractor: / t!/S ez. T f.bt,.,TH' ~ j.t./N1 J../ t: -s r r;.;6( Phone#: LfrS" {" s7 t.f City: l"q t""'-- 1 Construction Contractors Registration#: State: oil- Zip: 1'7tfO? 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 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 n,umber to the inspector at the time of inspection. I also understand that if I 8m requesting a rl;r,ir;c:'''''''''''''.''~'''' If) - (, - CfCf ~atur , Date FOR OFFICE USE REQUIRED INSPECTION(S): WOODSTOVElPELLETIINSERT lo/tlt;', , Total Amount Collected: Zc..)1) Receipt #: () ~S"'7 <j S'" PRELIMINARY Date of Application: Job #: 1'1 /5 ~I Issued By: ' d tJJ Checked for Delinquencies: Checked for Historical Status: