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HomeMy WebLinkAboutPermit Mechanical 1993-08-23CITY OF OREGO'U LIOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, 0regon 97477 0ffice: INSPECTION LINE: 726-37 726-37 59 69 Job Location: Assessors Map *: 0r.rner:,k/ fan,/l/u* e 2- rax Lot *: l4a A t*/ OA 7y ?) Address:r city, 9y'nnt(*/cu4 state:O/L I phone *: 7/7- 6 /Ztr .?7r77zip Value of lJood S (please ci oa0 Ao // y'oo rcle appropr ate ance Preliminary rnspection is $15.00 (prlor to installatlon of insert) llood Stove/Pe11et/Insert Permit is $15.00 + $10.00 Issuance + $.15 state surcharge. Type of Inspectlon Requested:se<,r let Stove/Insert: Contractor:, Address: Ci ty: Phone *: 23f- //37 zi p , ,7y's ?- oto 7State 2 fk te/tb s// By signing this permit/application, I agree to caII for an inspection(s) as requlred'(726-3769), I state that all information on this application/permit is correct and that I vas provided vith the lJood Stove Safety infornration for vood burning appliances and preliminary inspection standards. I further state that the appliance I am installing meets smoke emission standards as set by the 0regon Department of Environmental Quality or the Federal Environmental Protection Agency and I agree to provide the testing approval number to the inspector at the time of inspection. I also understand that if I am requesting a preliminary inspection, the waII covering may be required to be removed. t- 2t*7s gnature Date rOR OFFICE USE REQUIRED INSPECTI0N(S): v00D Date of Application:g Tota} Amount Collected:.7'f l/ PRELTMTNARY <--./ Job *: Receipt o, Za z? r6@ssued By:--( Checked for Historical Status:Checked for Delinquencies: -rnaruraEss Construction Contractors Registration *t 2aZ7b nxpires: