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HomeMy WebLinkAboutPermit Mechanical 1993-12-28 ."'.......1.. '" ,.,~....c......... YOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION i 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'?-::> t' /1IIA;:Z~~;- ' ' - Value(olf Yood Sitovle/pellet ~tove/Insl~rt: ~~ h~~/",!/7" ~V&;-? ~/ ,t!F, pease c rc e appropnate app lance ...J I -;J7" ;1' _, '~ ? "/'/9 <=-/J ij' ~ // '-'=7' 1 . 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''':> ' , r ' Construction Contractors Registration #: .q --:-~ '2...""" Expires: 7 -:Jey- . . 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. ~...~-~.../L--- S!ii'na tli . . ! (:J.-::+r -q:~ Date FOR OFFICE USE REQUIRED INSPECTION(S): ~~#iS: '.8~c;;r-?,,~, -" "9!'~-"~e=;;;;' YOODSTTWE/PECLETiINSnt',/ r RELIHINARY it' ~ - _ Date of Application:-L:7'-Z"9_9~ Job #: ~ '7~y-- - Total Amount Collec ted: '"2.:e;: /"-:> Receipt #: //~'5'3 Issued By: .......----~~ ,r c---- r.~ - Checked for Delinquencies: C ecked for Historical Status: