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
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Assessors MaP #:7-z€^B
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Tax Lot *: O7/aa
Ovner:No{r+t'rU LphA le
Address:16,-iq
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t6r'it Phone: #:
Zip Code:
Lt -28'i81t/
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Contractor:
state t O i2
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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.
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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
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Checked for llistoricaf tatus: