Loading...
HomeMy WebLinkAboutPermit Mechanical 1994-09-19VOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFEILD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 SPiIXOF!ILD 0ffice: INSPECTION LINE: 726-3759 726-3769 CITY OF SPRING OREGON Job Location:16.{q 'r ti Assessors MaP #:7-z€^B P qrql'1 Tax Lot *: O7/aa Ovner:No{r+t'rU LphA le Address:16,-iq ^J t6r'it Phone: #: Zip Code: Lt -28'i81t/ (.fJCi ty: Contractor: state t O i2 q -lli *l 'l Phone *: Value of Vood Stove/Pelfet Stove/Insert:0.rlcl- Jr"Vf @'"4 Preliminarylnspectionis$15.00(priortoinstallationofinsert) vood Stove/pellei7ir,""tt Permit i;'$i;:OO-.-S'ZS "t"t" surcharge + $'45 administrative i;;-.-SrO.OO issuance = 526.20 total Type of rnspection Reques "o' fr:<Ze7 f,DfE Zip Code: Construction Contractors Registration #: Expires: By signing this Pe rmi t /app lication, I ag ree to call for insP ection(s) as required (7 26-37 69)I stat e that aI 1 the informa tion on this Permit/aPPI ication is cor.rect and that I vas Provide d vith the Vood S tove SafetY information for vood burning app Iiances and Pre liminary insPe ction standards.f further state that the aPP1iance Iam installing mee ts smoke emi ssion standards as set bY the oregon Department of Environmental Qual-it y or the Fed eral Environmen tal Protecti.on AgencY and I agree to p rovide the testing approval nun ber to the insPe ctor at the time of inspection. I a Iso understand tha tiflamreq uesting a Prelimi nary inspection, the vall covering may be required to be removed. iqs.pq tegnature === == = === ===========================================--==================FOR OTFICE USE REOUTRED INSPECTIgN(S): vOOoSrovefrffi)'INSERT -)' PRELIMINARY Date of APP1ication: TotaL Amount Collect Job *: ed: 2C.2a Receipt +, /?78 . Checked for Deliquencies Issued BY ============ ==== Checked for llistoricaf tatus: