HomeMy WebLinkAboutPermit Mechanical 1999-02-08OREGO'VCITY OF SPR
WOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION. BUILDING SAFETY
225 Fifth Street
Springfield, Oregon 97 47 7
SPFIi.GFIELD
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location:06 E 1 T-An,u,/-^ 2.*/
Assessors Map #:/7Oz jct t /Tax Lot#: O 1Oo.,
Owner:
City:
o Phone#: ltt 6c 11,.
Value Stove/Insert:
Type of Inspection Requested:rt t 7fr
Contractor:O t^,
(please circle appropriate appliance)
uo,/tn,iurHoRizED UNDER THls PERMIT ls NoT
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Phone#: 7%-d q7 z
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l_leliminarf lnspection is $15.00 (prior to installation of insert)wood stoverpeiret/rnsert permit is $rs.oo + $ .75 state surcharg" . r.-#fttl$$ffii*"r+fXftE9flftr
lF THE W9RKIssuance.
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Address:,lrfo*
City:t 4 /6tL
Construction Contractors Registation#:
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REQUIRED rNspEcrroN(s): wOoDSTOVE/PELLET/TNSER
Date of Application:
Job #:
Total Amount collected: 't( . >,Receipt *,03zEza
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Issued By:
Checked for Delinquencies Checked for Historical Status:
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I agree to call for an inspection(s)as required (726-3769). I state thatis correct and that I was provided with the Wood Stove Safetyand preliminary inspection standards.I further state that thestandardsas set by the Department ofOregon
Environmental Protection Agency and I agree to provide the testingtime of inspection. I also understand that ifI am requesting amay be required to be removed.