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HomeMy WebLinkAboutPermit Mechanical 1994-11-02u46 VOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFEILD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 SPRINGFIELD 0ffice: INSPECTION LINE: tz6-3759 726-3769 CITY OF SPR OREGO'V q r),q,,= SJob Location: Assessors MaP *: Ovner: 4 =?-Tax Lot #: A? Phone z *z '74 )-)roo Zip Code I q>Lt 77 Address: CIS q C,a,<[)n..I Ci ty:Soo,a.] \. r-r(gr-t') Value of Vood St State: L>^at,) -- PrelirninarY InsPection is $15 Uood Stove/Pe11et/Insert Perm fee + $10.00 issuance = 526'2 Type of InsPection Requested: .00 (prior to installation of insert) ii"ii'sri.oo-* $.25 state surcharge + $.45 administrative 0 total- + Contractor: Address: 57 sfl 1,r-R ^rS Phone *:r -o Ci ty:(.E-l-Je State:r(zip Code: q Construction Contractors Registration +; ?s.s- S. I Expires: By signing thi.s permi t/aPP lication, I agree to call for insPection()as required (726-376e).I state that a II the information on this Pe rmi t /apPIi cat ion is correct and that I vas P rovided vi th the Vood Stove Safety info rmation for vood burning app liances and Pre liminarY inspec tion standards.I further state that the aPPl lance Iam installing me ets smoke emis sion standards as set bY the Oregon DePartmen tof Environmental OualitY or the Federa I Environmental Protection AgencY and I agree to prov ide the testing a proval number to the insPeet or at the time of inspec t ion.I also understand that Pif I am reques ting a PreliminarY inspection, the valI cover ing may be required to be removed. lgna Yl REOUIRED INSPECTION(S): V00D Date of APPIication: Total Amount Collected: Receipt +, /?727 . ate OFFICE USE u-- PRELTMTNARY Job *: Issued BY: A =================--======= 7-7r S tove/Inseret /INSERT Checked for Deliquencies: 2o FOR Checked for Historical Status: Ar-r *(65[ (o c/(.Y 1/^ q 4--