HomeMy WebLinkAboutPermit Mechanical 1998-01-0212/ 3L/97 09 : 31 0503 'r 3689
UOOD STOVE/INSERT rNS
CITY OF SPRINGFEILD
EUILDINC SAFETi- DIVI t80
225 Fifth Srreer
Springfield, 0regon 97471
O4
Job Loca cion:
Assessor -< |lap 'l:1. QZ
Ovner
ON Qfr
4s ' Ottice: ')26-3759
ECTION LfNE;- 726-3?69/g
PS 33 rar:Lot'f:3S ri O
SPFD DEV. SER.
<.
SP6rINCFIELO
@ ool
sibtr
. Address::r^d # rr
is S15.00
ral
Phone: f:
Ci ry:5 la te:
VaI ue of Uood Pel.Iet Stove/Insert:
is S15.00 (pripr t
14q -l c87
Zip Code:L{7o\
-Prelidirrary Inspection
;XUooa'S tove/PeI1e t /fnse( fee * S10.00 issuance
Type of Inspec
con(racror: I 1
fi.
o insrallation of. inser.t) N6ri\l€d '
+ S.75 state surcharge + g.t5 adminiitrative
rv\ "
(
tion Requesred:Q.,\
L'J
Address:Phone i:
Ci ry:State:zip Code:'
Cons(ructionCont.ractors.R.eg!strationltlExpires.-
8y signing .rhis leumi t/appl.ication, I agree to call fob inspection(s) as required(726-3769)- I srate thar aII rhb info rmation .on this perrnit/apblicatition for on is correct
and .tha t I uas provided vi ttr the Vood Stovc Safety' intorma vood burning
appliances and preliminary inspec tion standards. I {drther..state,.that-the appli ancef arn ins talli ng'areets smoke.emission standards 'as set by rhe O regon Departuen t..of..
tnvi6ennqntal Quality or the Federal Environarental Frotection Agency and I agree toprovide tha. testing approval number to (he irrs pec tor aI rhe time of i tion" I
also understand that lns pection, th coveringe
nsPec
vaII
may be reouired
Cc,trr.Lr rul}- *he to be J one5 .n-ll|,r,&;, fh
@{.)
if I am reguesting a pr:climinary
reoloved. ftlf Recdlsr, rv\,chrilecc tl6!". (L4d. "Cor\ect pCfr,,*CfK ort lnny)
h.aS 4
tcena.-lt.
ttJ
(
r Y\S
e
REOUIRED INSPECTION(S) : uOODSToVE /PELLETIINSERT PRELIT{IN/II(Y.
Date oI Application:t- 2-a a Jolr ll ;oa'
Total Amount Collec,ua,-d LA.+?
Refe fssued By 4a
'tliecked for Deliquencfes:ulrcckeb for' tti=torisal Status:
x
ipt {1, l$?11 '
DEC-31-199? A9t3t 5A3 ?25 3689 96'.P.At
I
I
I