HomeMy WebLinkAboutPermit Mechanical 1996-07-12BUILDING SAFETY DIVISION
225 Fifth SrreerSpringfield, 0regon 97477
Job Location:
Assessors Map {l:"a? -
Ovner:
Address:
Ci ty:
UOOD STOVE/INSERT INSCITY OF SPRINGFEILD
PECTION APPLICATION
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S ta te:
SPRINGFTELO
0ffice:
INSPECTTON LTNE:
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7 26-37 s9
726-3769
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Phone: #:
Zip Code:
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S ta te:
Va1ue of l{ood Stove/pel1et Stove/fnsert | -TP .49. O -
Contractor:
Prerimi'ary rnsoegtion is s15.oo.(prior to insralration of insert)I::0.'ii;:63"1",;Jjl::;:lr;;ili;,;;"iiilod".'ili;-;;;;;"";;"h;i*i . $.45 administrarive
Type of fnspection Requested:
Address:
Ci ty:
Phone #:-4y'3
Construction Contractors Registration #: %g;>f
Zip Code:
Expi res :/a '28'By signing this permi t/application f agree to caII f.or inspection (s) as re qui red(726-3769). r s tate that al1 the information on this permi t,/a pplication is correc tand that f vas provided vi th the Uood Stove Safety informat ion for vood burni ngappliances and preliminary inspecti on standards. f further sta te that the a ppliancef am installi ng meets smoke emissi on standards as set by the Oregon Depar tment ofEnvi ronmen tal Quali ty or the Fede ra1 Envi ronnrcu tal Protecti on Agency and I agree toprovide the t esting approval num ber to the ius pector at th e time of inspec
vaI1
tion. Ialso underst and that if f am re questing a prcJ.iminary insp ection, the coveringmaf be requi red to be removed.
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PRELTMINARY
Date of Applicati onz :> 2 '?6 Job *, o26C=35?
Total Amount Collected:.72
Receipt *, ?2 ?6o-=
-Checked for Deliquencies 1
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Issued BY:
Clrccked for l]istoricaf tatus:
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Tax Lot S: D
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REQUIRED INSPECTION(S) : u0oDSTov