HomeMy WebLinkAboutPermit Mechanical 1994-08-30IIOOD STOVE/INSERT TNSPECTION APPLICAT]ON
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
SPFII'GFIELD
0ffice:
INSPECTION LINE:
126-3759
7 26-37 69
CITY OF OREGON
Job Location
Assessors MaP f:
Ovner:
Tax Lot #: A 3
Phone: #:
ip Code:
Addr
Ci ty
Valu
PreL
Vood
fee
Type of Ins
Contractor:
Address:
Ci ty:
ess :
eof ood St el-Iet Stov
iminary Inspecti on -ts-
State:
nsert:
ti
( pri or
s $15.0
ta
a)
Stove/Pe1let/Insert Permi
+ S10.00 issuance = $26.20
ction Req ues ted :
to installation of insert)
0 + $.75 state surcharge + $.45 administrative
Phone #: CA7-
e
Construction Contractors Registration 4z b v- Expires ' ,/A-Z?-o,n
By signing this permit/appl,ication, I agree to cal-I for inspection(s) as required
<iZO-ilOgl. t state thai'all the information on this permit/applic-ation is correct
and that r vas - pi*iaua vi th the vood stove saf ety inf ormation f or vood burning
.ppfi.r*"s and prllirirr.ry inspection standards. I further state that the appliance
I am installing meets sm-oke emission standards as set by the oregon Department of
Environmental Ouality or the Federal Environmental Protection Agency_ and r agree to
piovide the testin!-"approval number to the inspector a.t the time of inspeetion' I
also understand that if I am requesting a preliminary inspection, the vall- covering
may be required to be removed.
t
OFFICE USE
REQUIRED INSPECTION(S) :I/OODSTOVE INSERT PRELIMINARY
Date of Application:Job #:
Total Amount Collected:
Reeeipt +t /Y *2.
Checked f or Deliquencies: 7-
Issued BY:
<-
Checked for Historica] Status:
State: 2T . Zip Code, ?-qa>Z-
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