HomeMy WebLinkAboutPermit Mechanical 2000-01-14WOOD STO VEIINSERT INSPECTTON APPLICATION
CITY OF SPRINGFIELD
COMMUNTTY SERVICES DIVISION - BUILDING SAFETY
225 Fifth Street
Springfield, Oregon 97 477
SPRINGFIELO
Office: 726-3759
INSPECTION LINE : 7 26-37 69
CITY OF ONEGON
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Preliminary Inspection is $ 15.00 (prior to installation of insert)
wood Stove/Pellevlnsert Permit is $ 15.00 + t .o5 state surcharge + $.45 Administrative Fee + $ 10.00
Issuance.
Type oflnspection Req,uested: Ngql i rr.rsanr*t^l el<srt,r.nq- b.r.l-Lt
Contractor;
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Construction Contactors Registration#: 5Z 3A(/o 240
By signing this permit/application, I agree to call for an inspection(s)as required (726-3769). I state thatall information on this application/permit is correct and that I was provided with the Wood Stove Safetyinformation for wood burning appliances and preliminary standards. I further state that theinspectionappliance'I am installing meets smoke emission standards as set by the Oregon Deparrnent ofEnvironmentalQualityor the Federal Environmental Protection Agency and I agree to provide the testingapproval number to the inspector at the time of inspection. I understand that ifI am requesting apreliminary inspection,the wall also
covering may be required to be removed.
Siguature q do
Date
FOR OFFICE USE
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REQUIREDINSPECTI.N(S); WooDST.VE/PELLET/INSERT
-PRELIMINARY
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Date of Application
Total Amount Collected
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ipt #:Issued By:
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