HomeMy WebLinkAboutPermit Mechanical 1993-07-23I.IOOD STOVE/INSBRT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, 0regon 97477
Job Location:
Assessors Hap *:
0vner
Address:
Ci ty:State:
!SPFINGF!ELD
0ffice:
INSPECTTON LINE:
726-3759
726-3769
Tax Lot *:
Phone #:
Value of llood eIIet Stove/Insert:
(please circle appropria te appliance)
Preliminary Inspection is 915.00 (prior to installat
llood Stove/Pellet/Insert Permit is $15.00 + $10.00 I
Type of Inspection Reques
Contractor:
1300
Zip:
insert )+ $.15
ion of
ssuance state sur charge.
Addr
Ci ty
Cons
Bys
Phone *:
Zi p:
Expires:
inspect
ion/perm
tructi on
igning this
State:
rtractors Registration *:
permit/application, I ag
1 >.J
ion(s) as required(726-3769). r state that all information on this applicat it is correct andthat I vas prov ided vith the lJood stove Safety inforrnatlon for vood burni ngappliances and preliminary inspection st.rndards. I further state that t he applianceI am installing meets smoke emission staldards as set by the Oregon Department ofEnvironmentar Quality or the Federar Environmental pro tection Agency and I agree toprovide the testing approval number to the i nspector at the time of inspection. Ialso understand that if requesting a preliminary inspection, the vaII covering
may be r uired to ed
L
RED INSPECTION(S):
Date of Application:.3
Total Amount CoIlected:D
Receipt fl:
ree to call for an
FOR OIIFICE USE
PELLET/INSERT
--)
te
/, PRELIMINARY
Job *:
e
CITY OF OREGO'V
Checked for Delinquencies:
Issued By:
d for Historical Status:
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