HomeMy WebLinkAboutPermit Mechanical 1991-10-17IIOOD STOVE/INSERT INSPECTI. . APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
SPRI'''GFIELO
0ffice:
INSPECTION LINE:
726-3759
726-37 69
CITY OF OREGO'V
Job Location:
Assessors ilap *:-o ^ ?5 s !.1.Tax Lot *z 2f,1e:,
0vner:
Address:Phone *:7cr7^?4v
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Value of Uood Stove/
(please circle ance)
s $15.
IJ,Stov
Type of Inspection Requested:LE
2
00 (prior to installation of insert)t is $15.00 + $10.00 Issuance + $1.25 state surcharge.
Phone *:(/#-1*>/
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Address:
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construction contractors Registration * r ?V sEadl txpires . </?z
By signing this permit/application, I agree to caII for an inspection(s) as required(726-3769). I state that aII information on this application/permit is correci andtha_t I vas provided vith the llood Stove Safety information for vood burningapplianees-1d prelirninary inspection standards. I further state that the appliancer am installing meets smoke emission standards as set by the oregon Departme;t ofEnvironmental Quality or the Federal Environmental Protlction Ag-ncy .na r agree toprovide the testing approval number to the inspector at the time of inspecti6n. Ialso understand that if I an_requesting a preliminary inspection, the vaII coveringmay be required to be removed.
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REQUTRED TNSPECTT0N(S) :
Date of Application: /D-D -?/
Total Amount Collected: 4/. Z;
Receipt *:>t Lan lsynl-
Job t:
NARY
Checked for Delinquencies:
Issued By:
Checked for Historical Status:
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