HomeMy WebLinkAboutPermit Mechanical 1995-03-06UOOD ST()VE/INSERT TNSPECTION APPLICATION
CITY OF SPRINGFEILD
SUTLNTNC SAFETY DIVISION
225 Fifth Street
Springfiefa, Oregon 97477
SPRIlvGFIELE)
0ffice:
INSPECTION LINE:
726-3759
126-3769
a
CITY OF SPR OR
?2a
Assessor-s Map li :-e2
Ovner:
Address:
Tax Lot #:
Phone: *:
Zip Code:
21/6-Z'>
State:
0 total
Ci tY:
Value of l{ood Stove/Pe1let Stove/Insert:
PreliminarY InsPection is $15
uooa Sto"eTPellet/Insert Perm
i""-.-SfO.00 issuaDC€ = 526'2
Type of InsPection Requested:
.00 (prior to installation of insert)
it is S15.00 .r S:;;-;tut" "ut"t'"ie" * $'45 admlnistrative
Contractor:
Address:
Phone S:
Zip Qode: '
5-e-gf,
Date
Construction Contractors Registration *: Expiresi
Bysigningthispermit/application,Iagre'etocallforinspection(s)asrequired
Q26_3769). i "t"ui"" tr,ri'+r. ir,"-'iniorrn-ation on
-ir,i" permit/aoolication is correct
and that r vas provided vith ihe vood stove
";ri;it informatibn for vood burning
aooliances and p'eliminary 'n"p""ii";-;;t"dtrcls'--I
further state that the appliance
r. am installing meers smoke "ri;;l;;
-stanaat,tt .; ;;i - uy tt'u 0regon Departmeni cf
Environmentar Quarity or tr," E"alrir trnvirorro,o,.,t.i protection Agency and r agree to
provide the ,""ijie''"pptoval nuiiti- to the i"ti'"tto' at the tiie of inspection' I
also understand thit if I am t"q'"tti"e ;-prul;l;"t""ty insfection' the vall covering
;"r-u" r-equired to be removed'
ture
State:
FOR OFFICI'USE
REOUIRED INSPECTION(S) :VOoDSTOVE /PELLET /TNSERT- PRELTMTNARY
Date of APPIication:7-6^Job #:
Total Amount Collected:
Receipt *z /6'52{
ao
Issued BY:
Checked for Deliquencies:tilrccked for Historical tatus:
Job Location:
€>*
a40297