HomeMy WebLinkAboutPermit Mechanical 1993-11-23WOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPFTilGFTELE,
0ffice:
INSPECTION LINE:
7 26-37 59
7 26-37 69
CITY OF OREGO'V
4Job Location:
Assessors Hap *:
3r
O rax Lot *: L3 eO
Address:?r-t--5. 3 n
0vner:
Ci ty:
Value o@tove/peIlet Sto
(please circle appropriat
6
zipz/ >2>f
state sureharge.
Phone #:
State:
4
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Preliminary rnspection is $15.00 (prior to installation of insert)llood stove/Pellet/rnsert Permit is 915.00 + S10.00 rssuance + $.1b
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Type of Inspeetion Requested:
Contractor:l<
Address:Phone *: 4"6 - \fnf
Ci ty:State I fX.Zip: ? 7 /ZO
construction contractors Registration *: 7 2o z Z Expires . ,*- '-
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By signing this permit/application, r agree to carr for an ins pection(s) as required(726-3769). I state that all information on this application/permit is correct andthat I vas provided vith the Uood Stove Safety in formation for vood burningappliances and preliminary inspection standards.f further state that the applianceI am installing meets smoke emission standards as set by the 0regon Department ofEnvironmental Quality or the Federal Environmental Protection Agency and I agree toprovide the testing approval- number to the ins pector at the time of inspection. Ialso understand that if I am requesting a prel iminary inspection, the vall covering
may uired to be removed.
//- z B- ?>ignature Date
FOR OFFICE USE
ser
REQUIRED INSPECTI,N(S) : @@
-t
TotaI Amount Collected:
Receipt *:67
PRELIHINARY i--
Job #:
Issued By:
U/'-
SERT
Checked for Delinquencies:Checked for Historical Status:
225 Fifth Street
Springfield, 0regon 97477
Date of Application: