HomeMy WebLinkAboutPermit Mechanical 1999-10-13SPFIIYGFIELt,
y,?f #l;J,HI;ffi rNspEcrroNAppl,rcArroN
COMMI.NITY SERVICES DIUSION. BUILDING SAFETT
225 Fifth Sreet
Springfield, Oregon 97477
Job Location. r q8
Office: 726-3759
INSPECTION LINE: 726-37 69
(\)or\l.'ricl \A
Assessors Map #: 17 O3 L |tz
_ Tax Lor#: O l,{/5'
Owner:
Address \t tr N).;
Type oflnspection
Contractor:
.^.J a -olo\
Phone#:-l qf "1G1o
oa_97tt 11
ValueofWoodStove/PelI.tstou.@(pleasecircleappropriateappliance)
i_leluninaV Inspection is $15.00 (prior to instaltation of insert)
,YrlfjJ:*"ellet/rnsert
permit ii $rs.oo *1. 05;t;:;;#*. + $.4s Adminisrrative Fee + g10.00
i ii52-uti1-
1t': iuies by
ttiitio{t€
otlticatlonktA
nurnhe
N
SHALLEXPIRE
FOR
By I agree to call for an inspection(s) as required (726-3769). I srate thatallinformation on this application/permit is correct and that I was provided with the Wood Stove Safetyinformation for wood buming appliances and preliminary inspection standards. I further state that the
appliance 'i am installing meets smoke emission standards as set by the Oregon Departrnent of
Enyironmental Quality or the Federal Environmental ftotection Agency and I agree to provide the testing
approval qumber to the inspector at the time of inspection. I also understand that if I am requesting a
preliminary inspection, the wall covering may be required to be removed.
\*x $;) \",..areJ-----r
FOR OFFICE USE
Checked for Delinquencies Checked for Historical
tollourrute
ir'
00c0
REQUIRED INSPECTION(S) :
Date of lo Job #: f 4 tcrol1
TotalAmountgo1L.L6. 7/. 17 n"."ipt s81 Issued ilu^r