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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