HomeMy WebLinkAboutPermit Mechanical 1996-01-05CITY OF SPruNGFIETD,ONEGON
SPTII]tIGFIELD
225 Nort.h Fifth Street
Springfield, OR 97477
WOOD STOVE/INSERT INSPECTION APPLICAT]ON
CTTY OF SPRTNGFIELD
COMMUNITY SERVICES DIVISION
BUILDING SAFETY
office:
Inspection Line:
726 -37 59
726 -37 69
Job Location: 2307 N 15TH ST
Assessors Map #: L7032522
Owner: PAULA LEEPER
Address: 2307 NORTH 15TH STREET
City/State/Zl-p: SPRINGFIELD, OREGON 97477
Tax Lot #: 02000
Phone #:
Value of Wood Stove/Pe11et Stove/rnsert: $2,L65
Preliminary Inspection is $15.00 (prior to installation of insert)
Wood Stove/Pe11et/Insert Permit is $15.00 + $1.20 State Surcharge & Admin +
$10.00 Issuance.
Type of inspection requested: PRE-INSPECTION / PELLET INSERT
Cont.ractor:Address/city/state / zip :DPhone # : \p63.\D
ConsLruction Contractors Regis tration #: AExpires: \D
By signing this permit/application, I agree to call for an inspection(s) asrequired (726-3769) . I state that all information on this application/permitis correct and that I was provided with the Wood Stove Safety informat.ion for
wood buring appliances and preliminary inspection standards. I further statethat the appliance I am install-ing meets smoke emission standards as set bythe Oregon Department of Environmental Quality or the Federal- Environmental
Protection Agency and I agree t.o provide the testing approval number to the
inspector at the time of inspect.ion. I also understand that if I am requesting
a preliminary inspection, the wal1 covering may be required to be removed.
Lb
sb \-b-qu
srs-naE€e Dat.e
FOR OFFICE USE
REQUIRED INSPECTION(S) : Woodstove/pe1let/Insert X Preliminary XDate of Application z 01-/05/96 Job #: 950009Total Amount Collected: ?)@.LOReceipt #: 19981 fssued By: LISA HOppER
Checked for Deliquencies: NONE Checked for Historieal Status: NONE
OFCITY
SPFINGFIELD
t
wooD SToVE/TNSERT TNSPECTToN APPLTCATTON
CITY OF SPRINGFIELD
COUT'/IUNTTY SERVICES DIVISION
BUIT,DING SAFETY
office:
Inspection Line:
726-37s9
725 -37 69225 North Fifth Street
Springtield, OR 974'77
Job Location z 2307 N L5TH ST
Assessors MaP #: L7032522
Owner: PAULA LEEPER
AAA'e== z 2307 NORTH 15TH STREET
ti;;7;;; tZ] zip',- spnrucr'lEl,D' oREGoN e7 477
Value of Wood' Stove/Pellet Stove/Insert:
Tax Lot #: 02000
Phone #:
$o
Preliminarylnspectionis_$15.00(priortoinstallationofinsert)
Wood Stove/peffet/Insert peimit is- $1-5 ' OO + $1'20 State Surcharge & Admin +
$10. O0 Issuance
Type of inspection requested' OpLG1\J\rlNJ'1/\
ContracLor: OWNER
Addre s s / CitY/ Sta Le / Zl-P :
Phone #:
ConstructionContractorsRegistration#:ExPires:
By s:-gn ing this Permit/aPp lication, I agree to caII for an insPection(s) as irrequiredTtze -37 6e)ISI ate that aLI info rmation on this aPPlication/Perm
is correc t and that I was provided with the Wood Stove SafetY information for
wood buring aPPlianc es and preliminarY insP ection standards I furt.her state
that the aPPliance I am installing meets smo ke emission standards as set' bY
t.he Oregon DePartmen t of Environmen ta1 QuaIitY or the Federal Environmental
Protection AgencY and I agree to Provide the t esting approval number to the
inspector at the time of inspection.f also unde rstand that if f am requesting
a eliminary insPect ion, the waII cove ring may be required to be removed.
t-6.q1.,
FOR OFFICE USE
Date
REQUIRED INSPECTION (S) : Woodstove/pe11et/rnsert Prelimina
Date of Application, 1.3'1U ,.Iob #: 950009Total amount Cqllectedf \59DReceipt #: \qq\d/ I v' rssued By: LrsA Ho
Checked for Deliluencies: NONE Checked for Histori
PPER
cal- Status: NONE