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HomeMy WebLinkAboutPermit Mechanical 1999-02-18, SP'IINGFIELD 0fflce: INSPECTION IINE: mI.IOOD STOVE/INSERT INSPECTION APPTICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth S.treet Springfield, 0regon 97477 726-3759 726-3769 CITY OF OFEGOTU Job Location: Assessors Hap *; i7a3 >\ S*( Tax Lot *:lo/oo 0wner: Address z /f-A / )f ,;il -O],*U aw req*tres llC'.; ' .: Ci ty:State: n tJtiiiit N n Center. Those rules are set ft;i 952-0il 0090. You may obtain copies of the rules i; calting the center. (Note: the telephone number for the Oregon Utitity Notiticati*r, center is 1 -B0et-33?-2344). zip:?r4s r Value o d PeIIet Stove/Insert:00 (pI ease c ircle appropriate appllanee Preliminary Inspection is $15.00 (prior to installation of lnsert) llood StoveTpettlt/Insert Permlt is $15.00 + $.75 state fil*t+#H,: + $10.00 Issuance. Type of Inspectlon Requested: - 'i.r';lli l)i.iirlillr SF|ALL EXPIFIE lFTl-lE WORP' },iJTIIOBI;IilN UNDER THIS PERMIT IS NOT Cont rac tor: Address , P.n. tox g *: Ci ty:0",ffi-State: Ot, Construction Contractors Registration #:73 rue _Expires: S ture Date FOR OFFICE USE By signlng this pernit/application, I agree to call for an lnspection(s) as requlred <iZO-|tOgj, I state tt.i'aII information on this applleation/permit ls correct and inat f vas provided wtth the llood Stove Safety lnformation for vood burnlng appliances ind prellminary inspection standards. I further state that the appllance I'am installing meets smoke emission standards as set by the Oregon Department of Environmental Quality or the Federal Environmental Protection Agency and I agree to provide the testing ipproval number to the inspector at the tlme of inspection. I also understand ttrat it I am requesting a prellminary inspectionr the vaLl coverlng may be required to be removed. I -B-rq RBQUIRED INSPECTION(S) : II0ODST0VE/PELLET/h/ooJcfrrt PRELIMINARY tZgzildETtV Date of Application:l, Total Amount Collected:{r. >a Receipt *:t))>1 ot Job #, ff 6L?zf / Pr,,"t Checked for Delinquencies: Issued By: Checkbd for Historical Status: r'