HomeMy WebLinkAboutPermit Mechanical 1996-10-29I
SPRINGFIELO
0ffice:
INSPECTION LINE:
7 26-37 59
I 26-37 69
UOOD STCIVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISIOI{
225 Fifth Street
Springfield, Oregon 97477
Job Location:
Assessors Map ll Tax Lot f;:
0 vner:
Address:
city: j.gf],tA
/?-v/-
,rw J State OJTE
Phone: #:
Zip Code:
&*tWof Uood Stove/?eL &f s€",Efi ,7"{-.daELcEnEz affu
S15.00 (prior to installation of insert)
Uood t Permi t is S15.00 + S.75 state surcharge + S.45 administrative
fee + 510.00 issuance = 526.20 total
Type of Inspection Requested:
Contractor:
Address:Phone #:
Ci ty:Sta te:Zip C.ode
Expires:Construction ctors Registration .ll .tt.
By sig ng this permit/application, I ag ree to call for inspection(s) as required
726-3769). I state that aII the informa tion on this permit/applicati.on is correct
and that I vas provided vith the Vood Stove Safety in formation for vood burning
appliances and p reliminary inspection standards- I furthe r state that the aPPliance
I am installing meets smoke .emission standards as set by the 0regon Department of
Environmental Quality or the
provide the testing aPProval
also understand that if I am
may be required to be removed.
Federal Environnrctttal Protection Agency and I agree to
number to the itlsP ector at the time of insPection.I
requesting a prc) imi nary inspection, the vall covering
Signature Date
(
11mlllary Inspection
FOR OFTICU USE
REQUIRED INSPECTION(S) :VOO DSTOVE / PELLET / INS DRT
Date of Application:r0
Total Amount CoIlected:
PRELIMINARY
Job #:
Issued BY:Receipr 0.23b'lz
Thecked for Deliquencies:Uhccked for Historical Status:
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