HomeMy WebLinkAboutPermit Mechanical 1998-11-24tcsPRtNGFreLo
ert
Of f ice: 726'-3759
ECTI0N LrNE;' 126-3769
Asses
Ovner
Addre
Ci ty:
VaIue
Con t rac I
Address:
Ci ty:
Job Location:
sor-< Ha p i::t1 z-
ss:
State:
of Uood S /PeIIet Stove/Insert:
fee * slo'oo issuance ; s26'20
Type of InsPeccion Requested:
O L
OdL Zip Qode:c I
Issued BY:
q 'n/l
Phone: S:a'1 1)7 g/./
zip code , q 7c/ 71
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Phone fi:3 (/
Ta>: Lot fi:
b
- . --- - Prelirfiinary Inspection is S15'00. Uood .Stove/Pellet/f nsert Permi t i ipr co installation of,' insert) . . '.' .-'. - '"- -
15.00 * S-75 t."i. suicharge * S'45 administrative(pr",
sS
tal
or:
(,
S ta te:
,Rbsi:srration fi, Olq3L04 ExPires:
Cons truc tion Contractors
By signing this permit/aPP Iication, I agree to call for insPec tion(s) as requl red
Q26-3769). r state that a I1 the information o n this Pe rmi t/aPirl ication is corr ect
and .that I vas provided vi th the Vood Stove SafetY' in formation for vood burn ing
APPI iances and Prelim inary insPec tion standards'I (urthe r s tate.. that-the aPP liance
Iam ins talling meets smoke .emiss ion standards 'as sei bY the Oregon DePartmen i. qt
Environmental QuaI ity or the Federa I Environnrctt taL Pro t ection AgencY and I agree to
P rovide the. testing a pproval number to the irlsPec tor a t the time of insPec tion-I
also understand that if I am reques ting a Prc).iminarY inspec tion, the vall covering
may Lle req uired to be removed'
NOTIOE:
ll"f!S pEftiviiT SHALL EXptRE lF
u[e [D iJNDER THIS P
e
EEEB==E=E=============i=========FOR OFTICU USE
LLET/INSDRT P RELIMINARY.
REOUIRED INSPECTION(S) :
Da(e of APPIication:Job {l:
TotaI Amourrt CoIlected:
t/t
Ree'bipt |l:PJU3
-Cliecked for Deliquencies:
/PE
Clrccked [or' llistorisal Status:
a-
UOOD iT(IVEIINSERT rNS
CITY OF SPRINGFEILD
BUILDII'IG SAFETI DIVISIOI.I
225 Fifth Street
Springfield, 0regon 97477
5