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
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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+.
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