HomeMy WebLinkAboutPermit Mechanical 1993-12-14CITY OF OREGO'U
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VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OP SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, 0regon 97477
0ffice:
INSPECTION LINE:
726-3759
726-37 69
Job Location:
Assessors M.p *,
/Z <:
/3 Tax Lot *:S o-e>
4Ovner:
Address:
Ci ty:
Value of Uood Sto
(please circ
Preliminary Inspection is $15.00
Uood Stove/Pellet/Insert Permit i
c--,Phone #:
State:4<,Zipz 72277
Insert , 72 ?,oeppliance)
(prior to installation of insert)
s S15.00 + S10.00 Issuance + S.1g state surcharge.
z 7/7- zr '7
apPropr tea
Type of Inspection Requested: FE/Ll_r7 A,Zt ,.C
1et s tov
Con t rac tor:
Address:Phone *:
Ci ty t State:Zipz
Construction Contractors Registration *:Expires:
By signing this permit/application, I agree to call for an inspection(s) as required(726-3769). f state that a1I information on this application/permit is correct andthat I vas provided vith the llood Stove Safety information for vood burning
appliances and preliminary inspection standards. I further state that the applianceI am installing meets smoke emission standards as set by the Oregon Department of
Environmental Quality or the Federal Environmental Protection Agency and I agree toprovide the testing approval number to the inspector at the time of inspection. Ialso understand that if I am requesting a preliminary inspection, the valt covering
may be required to be removed.
tz-/?-7 )
gnature Date
FOR OFFICE USE
PELLETREQUTRED TNSPECTTON(S) :INSERT L----' PRELIHINARY
Date of Application: /2 -/4 - 7 3 Job *:
Total Amount Collected: Z-:;-75-
Receipt *, l/ t.{/T
Checked for Delinquencies:
7
Issued By:
C---'--
/lr't 2.L
Checked for Historical Status