HomeMy WebLinkAboutPermit Mechanical 1994-10-19l|^
C.
CITY OF SPF OREGO'V
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fif.th Street
Springfietd, 0regon 97477
SPFI]tlGFIELO
0ffice:
INSPECTION LINE:
7 26-37 59
726-3769
aJob Location:
Assessors MaP *:Tax Lot #:t(/7 0 O
Ovner:{4-A
address)6,22 -f^r/i t'E Phone: f:-2
State:ob zip code, f7?-7
Vood Stove/Pe}let Stove/'7 oo -oo
PreliminarY
Vood Stove/P
fee + 510.00
Inspection is $15.00 (pIi9r^to installation of insert)
ellet/Insert permii ii'$15.00 * $'ZS state surcharge + $'45 administrative
issuance = $26.20 total
6-7-
Ci ty
Value of
rTL
Type of InsPection Requested:
*Contractor:
Phone #:?sz -3735Address:a
State:L-Zip Code:? lqoz-
Ci ty:
Constructi Contractors Registration *:) 3tr,n0 Expires:5/q5
By signing this permi t/aPP lication, I agre e to call for inspection(s) as required
(726-3769).f state that aI 1 the informati on on this Permit/aPP lication is correct
and that f vas P rovided vith the Vood Sio ve SafetY information for vood burning
app liances and Pre liminary insPec tion standards.I further state that the aPPliance
Iam installing mee ts smoke emis sion standards as set bY the Oregon Department of
Environmental QuaIitY or the Federal- Env ironmental Protection AgencY and I agree to
also und
rovide the testing
erstand tha
app
t if
roval number to the insPe ctor at the time of inspection. I
p I am requesting a Prelimi nary inspection, the vall covering
may ui. red to
gnature
REQUIREDINSPECTI0N(S):VOODSTOVE/PELLET/INSERT
Date of Applicati.on:O-
Total Amount Collected
Reeeipt t:,/3
be req
clY tkultr
be removed.
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te
= = = = = == == = = === = = = = = = =-- ==== = = == = = == = = = = == = = = = == === = = = ===== = === =
FOR OFFICE USE
U
-/ PRELIMINARY
Job #:?qt53 7
Issued
Checked for Deliquencies:
1
Checked for llistorical Status:
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