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
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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
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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: