HomeMy WebLinkAboutPermit Mechanical 1994-04-26CITY OF OBEGO'U
IIOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, 0regon 97 477
SP}ItNGFtELO
Offlce:
INSPECTION LINE:
I.-bb
726-3759
726-3769
Job Location:
Assessors Map il:
Owner:
Address:
Ci ty:
Value of l{ood S
(please ci
il
e app ance
State; Ci?
Tax Lot *. 4r/deO
Phone #:
zi p:+
53 3
rcle appropr a
Preliminary Inspection is $15.00 (prior to installatlon of insert)
I.lood StoveTpettetZlnsert Permit is $15.00 + $ .75 state surcharge + $10.00 Issuance.
Type of Inspectlon Requested:!r
Contrac tor:
Address z 19,15 \1-,('s,+( iv-[r Phone *:
Ci ty:State:Or zip:q,'74
Construction Contractors Registration #:Expires:li
By signing this permit/application, I agree to caII for an inspection(s) as required
(726-3769>. I state that all information on this application/permlt is correct and
that I vas provided wlth the l.Iood Stove Safety information for wood burnlng
appliances and preliminary inspection standards. I further state that the appllance
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 lf I am requestlng a prellminary lnspectlonl the vaII coverlng
may be required to be removed.
ture te
FOR OFFICE USE
'r'a>
Ilet Stove/Insert
REQUTRED TNSPECTT0N( S) :
Date of Applicati on, 4^,2C^V7 Job *:
Total Amount Collected:/;ao
Receipt *:/*y'e>i-4-
PRELIMINARY%aru
.<
Checked for Historical Status:Checked for Delinquencies:
Issued By:
I
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UOOD STOVE/INSERT TNSPECTION APPLTCATION
CITY OP SPRINGFIELD
BUILDTNG SAFETT DIVISION
225 Fifth Street
Springfield, Oregon 97477
SPRTI{GFIELE'
0ffice:
INSPECTTON IINE:
726-3759
726-3769
OFEGO'VCITYOF
rt
Assessors Map *:o>
t\
Tax Lot *:At ooo
0.,r,"r, "2r,,nr{,n D * L&l,tfa[,rnyrr,. JI'hnymp:,Drl)
Address:
Ci ty:
Value of lJood Stoie/
(please circle
State: Dp zip . qlrtTL1
g ()cth
eap
Preliminary.Inspection is $15.00 (prior to installation of insert)
Ilood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $.'f$ state surcharge.
Type of Inspection Reques ted: t y\s*q (,(.
Contractor:
Address:t?'Q-/Phone #:4 ?6-oe>s
Ci ty:State:cyz-Zipz 4t4c4
Construction Contractors Registration *:qb1fr lres 3
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/pernit is correct and
that I vas provided vith the good Stove Safety infornation for vood burning
appliances and preliminary inspection standards. I further state that the applianceI am installing meets smoke emission standards as set by the 0regon Department of
Envlronmental Quality or the Federal Envlronmental Protection Agency and I agree toprovide the testing approval number to the inspector at the time of inspection. Ialso understand that if I am requesting a preliminary inspection, the vall covering
may be required to be removed.
ture
FOR OFFICE USE
REQUTRED TNSPECTT0N(S) :/INSERT
Date of Application:-q -q Job *:
Total Amount Collected:26.7
Reeeipt fi:tLC, tt Issued By:
U/(
te
let Stove/Inse
Checked for Delinquencies:Checked for Historical Status t ,----
Job Location:
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