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HomeMy WebLinkAboutPermit Mechanical 1993-03-10CITY OF OREGO'U SPBIl\lGFTELD Office: INSPECTION LINE: l. UOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Job Location: Assessor Map *: 0vner: Address: Tax Lot *: Phone *: (prior to installation. of insis $15.00 + S10.00 Issuance + ert) 726-3759 726-3769 \(.1?DO Ci ty Valu Preliminary Inspection is $15.llood Stove/Pel1et/Insert Permi Type of Inspection Requested Contractor: State: eof ood St llet Stove/Insert: (please circle ppropriate appliance zip: 00 W state surcharge. Address:Phone *: Ci ty, State:Zipz Construction Contractors Registration *:Expires: By signing this permit/application, I agree to caII for an inspection(s) as required(726-3769). I state that all information on this application/permit is correci andthat I vas provided vith the Uood Stove Safety information for vood burningappliances and preliminary inspection standards. I further state that the applianceI am installing meets smoke emission standards as set by the 0regon Department ofEnvironmental Quality or the Federal Environmental protection Agency and I agree toprovide the testing approval number to the ins pector at the time of inspection. Ialso understand that if I am requesting a prel iminary inspection, the vaII covering be uired to be removed. a ture te FOR OFFICE USE REQUTRED TNSPECTT0N(S) :VOODSTOVE//INSERT PRELIMINARY Date of Application:Job *: Total Amount Collected: Receipt *:Issued .dJChecked for Delinquencies:Ch for Historical Status: @ \t