HomeMy WebLinkAboutPermit Mechanical 1999-09-15WOOD STOVE/INSERT INSPECTTON
CITY OF SPRINGFIELD
COMMUNITY SERVICES DTVTSTON -
225 Fifftr Street
Springfield, Oregon 97 47 7
SP,lINGF'ELI'
APPLICATION
ATT'E'i\-I*
BUILDING SAFETY
Office: 726-3759
INSPECTION Lll{E: 7 26 -37 69
CITY OF OREGON
nu torth€ (]t'e ori ("Itiiity Notificatior
Job \O
Assessors Map #/Llfia3 3)Tax Lot#: 0 C-t o
owner: Tco O\r..--(-
Address:
Value of Wood
Type oflnspection
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Preliminary lnspection is $15.00 (prior to installation "tilnI-CI:.-wood Stove/peuet/rnserr pernit is $15.00 .1. 0H;;:.tiii6fru,ufrH'frhhPXE{BFETI-*EilmRT
Issuance' AUTHoRIZED UNDERTHIS PERMIT ls Nor
state: f)C-
Phone#:
(please circle appropriate appliance)
ISABANDONEDFOR
toD.
COMMENCEDOR
Contractor:L\"*^.-{ r
Address: Z\I ai€-+-
Phone#:
Ctty:
Construction Contactors 6T L%
By sigring this permit/application, I agree to call for an inspection(s) as required(726-3769). I state that
all infonnation on this application/permit is correct and that I was provided with the Wood Stove Safety
information for wood burning pretiminary inspection standards. I furttrer state that the
appliance'I am installing standards as set by the Oregon Departnent of
Environmental Protection Agency and I agree to provide the testing
approval at of inspection. I also understand that if I am requesting a
preliminary the wall to be removed.
q
Date
FOR OFFICE USE
REQUTRED INSPECTION(S): WOODSTOVE/PELLET/TNSERT PRELIMINARY
Date of /S 11 lob #:?rzs
Totat Amountcottectea: 26- 5"7) Receipt #, C35tt/Issued
Checked for
Checked for Historical Stafus: