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HomeMy WebLinkAboutPermit Mechanical 1996-09-25,aC'TY OF UOOD ST(IVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFEILD BUILDING S/tFET)' DIVISI0N 225 Fifth Street Springfield, Oregotr 97477 SPATNGFIEL() 0ffice: INSPECTION LINE: 7 26-3759 726-3769 tuJob Location: .. Assessors Map ll :/ 7n3 z-./z 0vner: Addressl. 2?1ut 11^*'- Ci ty:S ta te:\a Zip Code:8l+zz Value of Uood Stove/Pellet stove/rns ertr( iLSSw Preliminary Inspection is 515.00 (prior to installation of insert) ' Uood StovuTpettitUlnsert permit is-S15.00 + $.75 state surcharge + $.45 administrative fee * 510.00 issuance = 526.20 total Type of Inspection Requested:),t---I t*t -t bl Zv*azT -fc-boTt^- ll NE" AA2 Phone li:Address: Ci tv: Sta te:Zio Code Construction Contractors Registration $:Exoires: By signing this permit/application, f agree to call for inspection(s) as required <iZO-ilOgl. I state thaf-aII the information on this permit/applic,ation is correct and that I vas provided vith the Uood Stove Safety information for vood burning appliances and preliminary inspection standards. I further state that the appliance f'am installing meets srtk. emission standartJs as set by the Oregon Departmenf af Environmental Quality or the Federal Environnrctttal Protection Agency_ and I agree to proviie tlre testing approval number to the itrsltector a.t the time of inspection' I also understand ttrit ii I am requesting a prcJ.iminary inspection, the vaII covering required to be removed. -e5 -1 gna ture te ==== == = === == = = ======== = === =================== = = = ===== ============================ ===== =r FOR OFFICD USE REQUIRED INSPECTION(S) : vo0DST0V PRDLIMINARY Date of Application:JoLr ll: Total Amount Collected: Receipt ll: 2 975 Issued BY: q PDLLET/ -Checked for Deliquencies:Chccked for Itistorical Status: I rax Lo t tlz G2 / 3O.:f Phone X:'7Zb-8i7L Er i\ contrac tor z 7z> zs& rza.azzz)t) tt-