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HomeMy WebLinkAboutPermit Mechanical 1995-01-25b UOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFEILD BUILDING SAFETY DIVISION 225 Fifth Street ipringfield, oregon 97477 Job Location:oSe s;PRINGFIELE, 0f f ice: INSPECTION LINE: 7 26-37 59 7 26-31 69 ,4 Tax Lot #: Assessor-c l4aP *: ovne. G/o n, Address:o u Zt tt t\ a Phone: *: Zip Code: 726-7 7// ,l State:Or ?7,/72 Ci ty: Prelimiuary Inspection is $15'00 (pr u;;a-s;;.,"7P"ttltzrnsert Permit is $ i""-.-Sro.00 issuanC€ = 526'20 total ior to installation of insert) 15.00 * $.75 tt.i" surcharge * $'45 administrative Va1ue of Uood Stove/PeLlet Stove/Insert: Type of InsPection Requested:tr a a I L Contractor: orovide the testi also understand t Phone #:Address: Ci tY:State; Construction Con ractors Registration *:Expires: By signing this permit/aPP Iication, I ag ree to call for insP ection(s) as required (726-3769).I state that a tI the informa tion on this Permit/aPP lication is correct and that I vas Prov ided vi rh the Vood S tove SafetY information for vood burning app Iiances and Prelimi nary insPe ction stand ards. I further state that the aPPliance Iam installing meets smoke emi ssion standa rds as set bY the 0 regon DePartmenf of Environmental QuaIitY or the Federal EnvironnenI af Protection AgencY and I agree to val,number to the insPe ctor at the time of i ction. I may be r uired to be removed. ure nspe va11requesting a Prelimin ary insPection, the covering - 2{-7t Date ( Issued BY: Checked for Historical Statusi-- ng appro hat if I am == = = == = = = = = = = = = = = = = = = = = === == = = == = = = === = = == === == =-- = == =r POR OFTTCE USB REQUIRED INSPECTION(S) :V0oDSTOVE / PELLEL / INSERT-- PRELIMINARY Date of APP1ication:Job #:lL. Total Amount Coflected: Receipt #: €,I t Checked for Deliquencies: CITY Zip Code: ' I 1b6{