HomeMy WebLinkAboutPermit Mechanical 1997-09-11@
v00D
CITY
BUILD
225 Fi f tli S rree rSpringfield, Oregon 91477
Job Loca t ion
Assessor*c Hap ll
Ovne r :
SPGtTNGFTELO
Offi ce :
INSPECTION LTNE:
Ta>: Lo t i
1 26 -37 59
7 26-3t 69 4ee
Address:. 2?\- Nrl Phone: # :
Zip Code:
'1L6--71 bL
Ci ty:
Value of Vood St
Prelimirrary Inspec
\lood S tove/Pe11e t/
fee + SiO.00 issua
igna ture
S ta te:R q 1q-1 -1
fnsert:\?oo
(prior to installation of insert)
Si5.00 " S.75 state surch ge * S.45 administrative
4
In
nce
Type of Inspecti.on Reques
Contractor:
Address:Phone #: Sq I ^ ? St <1)'?-
Ci ty:State o Zip Co ae, Q1A3O
Construction Contractors Registrarion g: (o1 LLZ Expires:s, /qr
.By signing this permit./application, f agree to call for inspection(s) as required
(726-3769). I state that all the information on thj.s permit/application is correct
and.that I vas provided vith the Vood Stove Safety information 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 Oregon Departmenf sf
Environmental QuaIi.ty or the Federal Environnrcutal Protection Agency and I agree to
provide the testing approval number to the irrspector at the time of inspection. I
also understand that if I am requesting a prc).iminary i.nspection, the vaII covering
may be required to be removed
\
1 q/,, I
te
FOR OFF USE
REQUIRED INSPECTION(S): v0ODSTOVE LLET/INSDRT
Date of Application:
TotaI Amount Collected
INARY -
Job ff
Issued By:
PRELIM
Q\
Receipt
-Checked
J?11ltti
for Deliquencies:Chccked for Ilistorical Status:
o*,971J2117
O36tot \
a