HomeMy WebLinkAboutPermit Mechanical 1993-12-28
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YOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
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225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: "5""7~ ~77>4:- .~. t?-~c,.._
Assessors Hap #: n-C~~2t!/;--:a/ Tax Lot #: c::::lc::>~G
Ovner: /7t~T~F-,! /~LF,;JY
Address: ~r~. Phone #: ?Y,/-7?St"./
City: 5}!'~ .State: ~A. Zip: "7?Y'?-::>
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Value(olf Yood Sitovle/pellet ~tove/Insl~rt: ~~ h~~/",!/7" ~V&;-? ~/ ,t!F,
pease c rc e appropnate app lance ...J I -;J7" ;1' _, '~
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Preliminary ,Inspection is $15.00 (prior to installation of insert)
Yood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $.75 state surcharge.
Type of Inspection Requested: ~ .R,;::,~,/ &~~~~~~}".)I.
Contractor: ~ei'::-;!!:j/..:;<.. ~, ._,'><<- ~,':' v.."::.....,,.. , , .'
Address: ?..../.f?.~ ~t;;;; Phone #: ~<:;'_:-::-- ~
City: I,#'-~/~ _ State: ~/'=i":, ,Zip: ~::::>cY'5''':>
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Construction Contractors Registration #: .q --:-~ '2...""" Expires: 7 -:Jey- .
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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 vas provided vith the Yood Stove Safety information for vood 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 vall covering
may be required to be removed.
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Date
FOR OFFICE USE
REQUIRED INSPECTION(S):
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YOODSTTWE/PECLETiINSnt',/ r RELIHINARY it' ~ - _
Date of Application:-L:7'-Z"9_9~
Job #: ~ '7~y--
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Total Amount Collec ted: '"2.:e;: /"-:>
Receipt #: //~'5'3 Issued By: .......----~~ ,r
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Checked for Delinquencies: C ecked for Historical Status: