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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:+