HomeMy WebLinkAboutPermit Mechanical 1991-11-14TIOOD STOVE/TNSERT- TNSPECTION APPLTCATIONCITY OF SPRINGFIELD
BUITDING SAFETY DIVISION
225 flfth Street
Springfield, Oregon 97417
SPl.lfrracFrELD
Offlce I
TNSPECTTON LrNE:
726-37s9
726-3769
Job Location: I I +11
Assessors Map #:De) O I o*:Tax Lot #: Dt4 )
Qt4t I
Ovner:L.IJ
Address I l3O s Zl-t+^'SE Phone ltr l 2L - m g/
Ci ty:State:n zip:QI -11
Value of l.Iood St rts g, eO
(please circl e appr applianee
Preliminary rnspection is $15.00 (prior to installatlon of lnsert)
llood Stove/Pellet/Insert Permlt'is $15.00 + $ .75 state surcharge + 910.00 Issuance.
Type of Inspection Req uestedt FtUAu kug eYovg
et St
I
Contracto u Ctl+Kfolo S Uot+L--SvC--
Address , 215 E ed'sy',Phone #:t*4-?5s 3
Ernoe^e- state: C v^zfiz Q14D5
Construction Contractors Registration *: b'l129 Expires:Z
By signlng this permlt/applicatlon, I agree to caII for an inspection(s) as required
(726-3769). I state that all lnformation on thls appllcation/permlt is correct and
that I vas provlded vith the ltrood Stove Safety information for wood burnlng
appliances and preliminary inspectlon standards. I further state that the appliance
I am installing meets smoke emission standards as set by the Oregon Department of
Environmental Quality or the Federal Environmental Protection Agency and I agree to
Ci ty:
provide
also und
ture
the
er
testing approval number to the inspector at the time of lnspection. I
and that li f am requesting a prelimlnary inspectlon, the val} coverlng
ired be
?
Date
FOR OFFICE USE
REQUIRED INSPECTION( S) :PRELIMINARY
Date of Application:Job *:
Total Amount Collected:
Receipt *:Issued By:
I,{
E
Checked for Delinquencies:-Checked for Historical Status:-
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