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HomeMy WebLinkAboutPermit Mechanical 1991-12-24OBEGOfUCITY OF SPR D SPIIT'{GF'ELO Offlce: INSPECTION LINE: IIOOD STOVE/INSERT INSPECTION APPLICATTON CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Ftfth S.treet Springfield, 0regon 97477 726-3759 726-3769 Job Location: iO;':u0u$u^ S-}', Assessors Hap #:t1 -0 > -3a-77 Owner:to Tax Lot fi:h*tc0 ({q V rr1 rlA!vY1 a w +Phone #:1H,-Ll'7 /8Address:t0 73 u)a Plr' Ci ty:State 3 zip: Value of let Stove/Insert: (p appropriate appliance Preliminary Inspection is $15.00 (prior to installation of insert) lJood StoveTp"ttltZlnsert permit ls-$15.00 + $.75 state surcharge + $10.00 Issuance. Type of Inspection Requested: Contrac tor: Address:Dox Y3>Phone *:s Ci ty:boc State: m(zi p:Qt4t4 Construction Contractors Registrat ion #: S}jctI ires: I By signing thls permit/application, I agree to caII for an lnspection(s) as requlred (726-3769). I siate thai-aII informati6n on this appllcatlon/permlt is correct and inat f was provlded vlth the llood Stove Safety lnformatlon for vood burnlng appliances and preliminary inspection standards. I further state that the appllance I am installing meets sroice emission standards as set by the oregon Department of Bnvironmental Quality or the Federal Environmental Protection Agency and I agree to provide the testing "pproual number to the inspector at the time of inspection' I also understand that if I am requesting a preliminary inspection, the wall coverlng may be required to be removed. flo Ir a lqt /L teSture FOR OFFICB USE REQUIRED INSPECTION( S) : 1IO0DSTOVE /PELLET/INSERT PRELII.IINARY Job #:9 t \8.0Date of Application: Tota1 Amount Collected: Receipt *: 1s \.- Checked for Dellnquencies: Issued By: Checked for Hlstorical Statusr- .-- r t*l>qlf / 7 *'/7 1 a-Lt g s-l