HomeMy WebLinkAboutPermit Mechanical 1999-02-10SP6tINGFT€LO
I
uooD (Tov E/INSERT TNSPECTIOI,I .APPLTCATTON
CITY OF SPRINGFEILD
BUILDII.IG SAFET)' DIVISIOt,t
225 Fif tlr Streer
Springf ield , 0regon 97 /,77
Otf.ice: 726'-3759
INSPECTION LrNE;- 726-3769.
ert
Job Locat ion
Assessor-< Hap i.l :i1o3z53)low rules adoizted by gppng-ftitiry IZ j ct ofol
ru aresetffi
Ouner:
Address:l3
- -..--_ --PreIirfiinary Inspection. Uood .S tovs/Ps]Ie t/Inse
fee * Sig.00 issuance
Type of fnspecrion Req
contraclor:
in OAR 952-001:0010 throu g h oAH 952.001-
calling the center. (NotOilbedet
7tt
Utility.Notifi
is 1-$$"1-6Prff@d*e {
is 515.00 .(pr-.ier co in s calla t ion
.75 stare surcharge + S.45
of. insert)rt Permit is 515.00 + S
526 .20 to tal ALL EXPIRE IF THE
ues ted :{^o/ m ecLa.rr t( d/
LUt
- lzn
Ci ty:S ta te:
Value of Uood Stove/Pellet Stove/Insert: &/tz; -
adminiit ra t ive
5 OFl IS ABANDONED FOR
Address:Phone #:-//
Ci ry:S ca te:/L zip c.ode, fu.y'o 7 -
Cons ( ruc t on contractors rRbgi:strarion fi , Ol7 3Lq Expires:
9I:rgning'this lermit./application, f agre€ to call for inspection(s) as required(726-3769). I state that aII the information on this permit/apirlication is correc(
and .that I vas provided vith the Vood Stovc Safety'information for vood burning
appliances and preliminary inspection standards. I (urther..state...that-the appliance
I "I installing'meets smoke .emission standards as set by the Oregon Departmen(. of
Environmental Quality 6r the Federal EnvironnrcntaL Protection agency and I agree toprovide the.testing approval number to the iuspector at the time of inspection- Ialso understand that if I am requesting a prc).iminary inspection, the vail covering
may be required tcj be removed.
/o ?ture te
REQUIRED I
Date of Ap
TotaI Amou
Rec'bipt ll:i
'tliecked fo
FOR OFT.TCU USE
ELLETlINS DRT PRELTHINARY.NSPECTION(S):
plication:
nt CoIlccted:
r0 Job fl , Qau +u. t
7u.-i-Qq o
Issued By:O\zt3
r Deliquencies:
1-c
/\ntrtJ
Clrccked for Iiistorical Sta(us:
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