Loading...
HomeMy WebLinkAboutPermit Mechanical 1993-10-21OREGO'VCITY OF SPF'"3FIELE, 0ffice: INSPECTION LINE: t IJOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, 0regon 97477 726-3759 7 26-37 69 Job Location:ZA Assessors ilap #:/?-..2-3./Tax Lot #: 0vner: Address:Phone *: Ci ty:State:Zipz Value of Uood Stov (please circl e appropriate app ance Preliminary rnspection is gi5.oo (prior to instarlation of insert)llood stove/Pel}et/rnsert permit is S15.00 + S1o.0o rssuance + S.1b state sureharge. Type of Inspection Requested:v. Con t rac tor: Address:v-r 7 ' z= , Phone +z eiET-*ra Ci ty:State #.zip: fr2?2. Construction Contractors Registration #:%Eixpires, /br3* €/ inspection(s) as required onlpermit is correct and for vood burning state that the applianee By signing this permit/application, I agree to call for an(726-3769). I state that a1I informat ion on this applicatithat I vas provided vith the Vood Stov e Safety information appJ.ianees and preliminary inspection standards. I furtherI am-installing meets smoke emission standards as set by the Oregon Department ofEnvironmental Quality or the Federal Environmental pro tection Agency and I agree toprovide the testing approval number to the inspector a t the time of inspection. Ialso understand that if I am requesting a preliminary inspection, the va1l covering may be ired to be ved. gnature Date FOR OFFICE USE ar-Stove/In ser REQUIRED INSPECTION(S): UOODSTOVE PRELIMINARY Date of Applicati on: /d, . Z/.q=Job #:a2 _ rii, Total Amount Collected: Receipt #:Issued By: l---Checked for Delinquencies:Checked for Historical Status: // -) /- /,5 \D