HomeMy WebLinkAboutPermit Mechanical 1995-3-22
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SPRINGFIELD
IIOOD STOVE/INSERT INSPECTION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Owner:
<640 J.-M"J?J.' AA'/)~~
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Address: ~~?~~...C,-~~. &.-~,
iSt&[. ~~ State: .>i?(, Zip Code:
Value ~d s~ellet Stove/Insert: "<.~D..,...o
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Tax Lot #: L::CJ2.0 E:>
Job Location:
Assessors Map #:
Phone: #:
1.f7-3tJ/2-
II:? ~rz7
'77-1-7'1
Ci ty:
Preliminary Inspection is $15.00 (prior to installation of insert)
Yood Stove/Pellet/Insert Permit is $15,00 + $,75 state surcharge + $.45 administrative
fee + $10.00 issuance = $26.20 total
Type of Inspection Requested:
\IlI~ 9-z,v~
Con nac tor:
C) W 41 rY7L
-
Address:
Phone #:
City:
State:
Zip C;ode:
Construction Contractors Registration #:
Expires:
By signing this permit/application, I agree to call for inspection(s) as required
(726-3769). I state that all the information on this permit/application is correct
and that I was provided with the \lood Stove Safety information for wood burnin1?;
appliances and preliminary inspection standards. I further state that the appliance
I am installing meets smoke emission standards as set by the Oregon Department o-f
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
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Sign'yore ,Da ty p
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FOR OFFICE USE
REQUIRED INSPECTION(S~OODST~ELLET/I~SERT .~ PRELIMINARY
Date of Application: '" /'2.2../.1' r- Job #: '?J .5D,.s'!5~
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Total Amoun t Collec ted: "* _ .//~ '-7_ _
Receipt #:.L~0~.j- -;2tP?-eJ Issued By: /f(',/P'J/L..
Checked for Deliquencies: ~ Checked for Historical Status: