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:
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