HomeMy WebLinkAboutPermit Mechanical 1997-03-14SPRTNGFIELO
9
UOOD STOVD/INSERT INSPECTIOI'] APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFET\' DIVISIOI']
225 Ftfth Street
Springfield, 0regon 97477
Job Locati.on:
ses so u^^ llttdy t
€h
0ffice:
INSPECTION LINE:
7 26-31 59
t 26-31 69
ner
Add ress :
Ci ty:S ta te:
Va1ue of Uood Stove lIet Stove/Insert:
Preliminary Inspection is S15.00 (prior to in
Uood Stove/Pellet/fnsert Permit is S15.00 1 S
fee + S10.00 issuance = 526.20 total -
Type of Inspection Request
Contractor
Address
Ci ty:State:
Ta>: Lo t I
Phone: *
Zip Code
tallation of insert)
75 state surcharge + S.45 administrative
Phone #
{-r4
Construction Contractors Registration S Expires i
-
By signing this permit/application, f agree to call for inspection(s) as required
(726=3769). I state that al] the information on this permit/application is correct
and.that I vas provided vith the Uood Stovc Safety information for vood burning
appliances and preliminary inspection standards. I further state that-the appliance
I am installing meets smoke .emission standards as set by the Oregon DepartmenI crf
Environmental Quality or the Federal Environnrcutal Protection Agency and I agree to
provide the. testing approval number to the irrspector at the time of inspection. I
also understand that if I am requesting a prc).iminary inspection, the vall covering
may be required to be removed.
tu Da te
FOR OFF.ICU USE
REQUIRED INSPECTION(S): vOO VElPDLLET/INSDRT
Date of Application:
TotaI Amount Collected:
Il.eceipt ll:
H ARY -
Job fl
ncI
Issued By
r5
Clrccked for Ilistorical Status:
ssA
theclced for Deliquencies:
I
SPRI^lGFIELO
0ffice:
INSPECTION LINE:
Ta>: Lo t #
VOOD ST('VD/INSERT INSPECTIOI'I APPLICATION
CITY OF SPRINGFEILD
BU I LDI I'IG SA FET\. DI V I S I OI'I
225 Fifth Street
Springfield, Oregon 97417
Job Location
Assessor-. llap il
0vne r \t-
Adci ress
Ci ty:S ta te:
ert
7 26 -37 59
1 26-37 69
S,\\.r
rfl\38rGPl:one: f
Zip Code
Value of
e'-
Stove./Pe1let Stove
Preliminary Inspecti.on is S15.00 (prior ro installation of insert)
Uood Stove/Pellet./fnsert Permitris S15.00 + S.75 state surcharge + S-45 administrative
fee + SiO.00 issuance = 526.20 total
Type of rnspection Requesred: \AAU,(
Contractor:FISt=
ser
Add ress :Phone #:
Ci ty:State Zip C.ode:
Constructj,on Contractors Registration f, :Expi res :
By signing this permit,/application, f agree to calI for inspection(s) as required(726-3769). I state that all the information on this permit./application is correct
and .that I vas provided vith the Vood Stove Safety information for vood burning
appliances and preliminary inspection standards. I further state that-the applianceI am installing meets smoke .emission standards as set by the Oregon DepartmenI o{
Environmental- Quality or the Federal Environnrcntal protection Agency and I agree toprovide the testing approval number to the il'rspector at the time of inspection. I
also understand that if I am requesting a prcl.jminary inspection, the vall coveri.ng
may be required to be removed
{gnature
.-
->)t- q1
Da te
SDRT
FOR OFFICD USE
REQUfRED INSPECTT0N(S) : VO0DSTOVE/PDLLET
Date of Application:-z/-
TotaI Amount Collected:
Receipt {l:
Job f;
fssued By:
PRELIMINARY ,
10
{
-Checked for Deliquencies :
a
Clrccked f or Ilis torical S ta tus:
d'I
X
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