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:
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