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HomeMy WebLinkAboutPermit Mechanical 1997-11-2111, uooo (rovElrNsERT rNspEcrrot'J AppLrcATroN CITY OF SPRINGFEILD BUILDINC SAFETT DIVISIOI.I SP6.INGFI€LO Office: 726-3759 INSPECTION LINE;" 726-3769 I €h Assessors l1ap il :t7 0 3v ba q O q ?oP ra>: Lot ii: ovnerr ?st..\ &Sau.dra Cal\a\^"^ Address:4u4 ru. lib s+, Ci ty:S ta te:OR Value of Vood Stove/Pe1Iet Stove/fnsert: 2 4 Prelirfrinary Inspection is S15.00 (pr Uood .Stove/Pellet/fnsert Permi t is Sfee + S10.00 issuance = 526.20 total tion of insert) ate surcharge + S.45 administrative Phone: *: Zip Code: 1 ql Ll1-7 t.t 90 *s47^a Type of fnspection Requested:o Contractor: Address:6lA Phone *:- o?t3 Ci ty:State:<t Zip Qode:1 0z- Construction Contractors Registration S:Expires: I ltlqg By signing .this permi t/ap plication, I agree for inspection(s) as required<726-3769). I srare r hat all the information on s Perm i t./apirlica t ion is correc tand .that I vas provided vith the Uood Stove Safe ty information for vood burningaPpliances and preliminary inspection standards. I {urther state that-the applianceIam installi ng meets smoke .emission standards as set by the Oregon Depa r tmen t qf.Envi ronmen ta1 Quali ty or the Federal Environnrcrr tal Protection Agency and I agree to I provi also may b de the. t esting approval number to the i nspector at the time of ins pection. Iunderstand that if f am requesting a prc).iminary inspection, the va 11 coveringe required to be removed. ter. REQUTRED TNSPECTTON(s) : vooDSTovE/?ELLET/TNSDRT Date of Applicarion: TotaI Amount CoIlecred: E-tf". P Receipt l{: J3o 8')- PRELIUINARY - Job fl: Issued By thecked for Deliquencies: tqq Clrccked for Itistorical Status: 225 Fifth Street Springf ield , 0regon 97 /,77 Job Loca r ion: 41"4 Al I Utt' '.3+. -1t, l/