HomeMy WebLinkAboutPermit Mechanical 1999-10-6
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SPRINGFIELD
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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
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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
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Phone#:
7'1t,])/f
Q:rY77
Address:
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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:
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Phone#:
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City: l"q t""'--
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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
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~atur , Date
FOR OFFICE USE
REQUIRED INSPECTION(S): WOODSTOVElPELLETIINSERT
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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: