HomeMy WebLinkAboutPermit Mechanical 1994-03-10CITY OF OREGO'V
IJOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, 0regon 97477
37- EFIELD
0ffiee:
INSPECTION LINE:
726-3759
726-3769
Job Location:
Assessors Map *:--) o 2.1 r {Tax Lot *:
0vner:
Address:Phone *:
Ci ty:State:a Zipz ct -l et-l ')
Value of ttood Stove/pellet Stove/Insert:-%l,t-+ Lns-'+(please circle appropriate appli ance
Preliminary rnspection is $15.00 (prior to instarration of insert)IJood Stove/Pelret/rnsert permit is'$15.00 * sio.00 rssuance +-s.-ts state surcharge.
Type of Inspection Requested:
Contractor:
Address:Phone #:
Ci ty:State:Zipz
Construction Contractors Registration *:Expires:
By signing this permit/a pplication, I agree to caII for an ins pection(s) as required(726-3769r. I state tha t all information on this appr ication/permit is correct andthat I vas provided vith the lIood Stove Safety informatlon for vood burningappliances and prelimina ry inspection standards I further state that the applianceI am installing meets s moke emission standards as set by the Oregon Department ofEnvironmental Quality or the Federal Bnvironmental Protection Agency and I agree topthe testing ap proval number to the inspecto r at the time of inspection. Ialsors tand ti flanr equesting a prelim inary inspection, the vall coveringberequi red be remo
3
ure Date
FOR OFFICE USE
REQUIRED INSPECTION(S): UOODSTOVE
Date of Application: 3/,r, \q-l
Total Amount CoIIected:
Receipt #, \ \Q4n rssued By:
Checked for Delinquencies z ,/
PRELTMINARI
Job *:
Checked for Historical Status /
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