HomeMy WebLinkAboutPermit Mechanical 1993-03-17CITY OF OREGO'V
SP,rINGFIELE'
0ffice:
INSPECTION LINE:
lr
UOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
726-3759
726-3769
Job Location: 7 2Va 2an L 4osur
Assessors Map *:?-v./Tax Lot *:@=crc
Value,of llood Stove/pellet Stove/Insert z - c-b
(please circle appropriate appliancE).+-
Phone *:^Y-68)r
state, 2T zipz f2*2
is $15.00 (prior to installation of insert)Permit is 915.00 + 510.00 Issuance +W state surcharge'
Ovner:
Address:
Ci ty:
Preliminary I
lJood Stove/
Type of Inspection Requested:
Contractor:
Address:ab
Ci ty:
Cons t
By si
(726-
tha t
appl i
fam
Phone *:1P-4/+\
state, ffi- zipz22ZZ6j
ruction Contractors Registration #: 7ZA,ires: 5-/-?/
gning this permit/application , f agree to call for an ins pection(s) as required3769). I state that aII inf ormation on this application/permit is correct andI vas provided vith the Vood Stove Safety information for vood burni ngances and prelimin ary inspection standards. I further state that t he applianceinstalling meets smoke emission standards as set by the 0regon Department ofEnvironmental Quality or the Federal Environmental pro tection Agency and f agree toprovide the testi ng approval number to the ins Pe ctor at the time of inspection. I -also understand t hat if am requesting a prelim inary inspection, the vall coveringbe requir to ved.
av_
S gna ture Date
FOR OFFICE USE
REQUIRED INSPECTION(S): VOODS PRELTMINARY
Date of Applicati on. 7^-2-.a^: _ Job *:
TotaI Amount Collected:
Rece i p t S: 7.G7
-
Issued By:
Checked for Delinquencies:l---- Ch for Historical Status:+