HomeMy WebLinkAboutPermit Mechanical 1994-06-22CITY OF OREGON
I.IOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 91417
Job Location
As ses so s Map t:Tax Lot #:L
Phone: *:r)
:iPBI]lGFIELD
Office:
INSPECTION LINE:
7 26-37 59
725-37 69
0vner'
Addre
Ci ty:
SS:
Zip Code:
Value of ood Stov Stove
Prel iminarY Ins pec t ion is $15.00 (p rior to ins
75 state surchargetallaticn of insert)
$.45 administrative
Uood Stove/Pe1le t /In sert Permit is $1s.00 +$.+
fee +S10.00 issuance =s26 to I
Type of InsPection Request
State:
Contractor:hone *:
Address:Zip Code: '
State:
Ci tY:Expires:
Construction Contractors Registration *:
rovide the testing a pproval number to t he insPec tor at the
AgencY-
time ot insPec
va11
tion.IIamns talling mee ts smoke
Environmen ta1 Qual ity or the Federal Env ironmen taI Protect ion
1
p
also unders
B sign ing this P ermi t /aP p1 ication,I agree to ca1 1 for insPe ction(s)as required
is correct
(
v
7 26-376e).I sta te that vith the Voo
1 the inf ormationd Stove
on th
SafetY
is Permit/ainformat
p
i
plication
on for vo od burninga1
tandards 'Ifu rther sta te that the appl iance
appr iances and P
provided
reliminarY insPection s
and I agre etoandthat I vas
emission s tandards as set bY the 0regon Departmen tof
tand that iflam requesting a preliminarY insPec tion, the covering
may be requ ired to be removed.
Date
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?'
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USE
PRELI
Job *:
lssued BY:
Checked for Eistorical Status:
re
===========--=
REQUIRED INSPECTION(
Date of APPIication:
Total Amoun t Collected:
ReceiPt t:
S):IJOOD
ert
Checked for Deliquencies: