HomeMy WebLinkAboutPermit Mechanical 1994-04-15OFEGO'VCITY OF
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IJOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth StreetSpringfield, 0regon 97477
Job Location:
Assessors *:
Ovner:
Address:
0ffice:
INSPECTION LINE:
726-3759
726-3769
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Lot *:
Phone *:
Ci ty:
Va1ue of ll
(please circle ap
Preliminary Inspection is 915.IJood Stove/Pellet/Insert permi
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00 (prior to installation of insertis $15.Q0 + $10.00 +
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SartType of Inspection Req ues C\
Con t rac tor:
Address:
Ci ty:
Phone *:
state: L-zi p:
Construction Con
By signing this(726-3769). I sthat I vas provi
ctors Registration *:Expires:
permit/application, I agree to call for an i nspection(s) as requiredtate that all informat ion on this applicati onlpermit is correct andded vith the ltood St ove Safety informatlon for vood burningappliances and preliminary inspec tion standards. f further state that the applianceI am installing meets smoke emission standards as set by the Oregon Department ofEnvironmental Qual Federal Environmental pro tection Agency and I agree toprovide the t number to t spector at the time of ins pection. Ialso under r a preliminary inspection, the vall coveringmay be
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FOR OFFICE USE
REQUIRED INSPECTION(S) :ELLET/PRELIHINARY
Date of Application:Job #:
TotaI Amount CoIlected:
Receipt S:
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Ilet Stove/Insert
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Checked for Delinquencies:
Issued By:
Checked for Historical Status:
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