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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: --__