HomeMy WebLinkAboutPermit Mechanical 1994-02-23SPF', gIELO
LIOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth StreetSpringfield, Oregon gl4l7 0
INSPECTION
ice: 7 759
6-3769
CITY OF OFEGO'V
Job Location:3sl S \la0 0 0+Qt ttlz
0vner:
Address:
Ci ty:
Value of
(pr
Assessors Hap *t
State:
t Stove/Insert z 15 OO OL
ease appropriate appli ance)
Preliminary Inspection is $15.Ilood Stove/Pellet/Insert permi
Type of Inspection Requested:
Con t rac tor:
Tax Lot *: DJ/Ca
Phone *: 1U l-'7 nl
OR Zipz q)q 17
00 (prior to installation of insert )t is $15.00 + $10.00 fssuance + g .15 state surcharge.
L
Address:Phone *:
Ci ty:State s Zipz
Construction Contractors Registration #:Expires:
By signing this permit/plication, I agree to caII for an ins pection(s) as requiredap(726-3769). I state that all information on this applieation/permit is eorrect andthat I vas provided vith the lJood Stove Safety inf ormation for vood burningapplianees and prelimi nary inspection standards.f further state that the applianceI am installing meets smoke emission standards as set by the 0regon Department ofEnvironmental Quali ty or the Federal Environmental Protection Agency and I agree toprovide the testing approval number to the inspect or at the time of inspection. Ialso understand that if I am questing a prelimi nary inspection, the vall coveringmay be requi to be remove
ture Date
FOR OFFICE USE
REQUIRED INSPECTION( S) : rroODST0VE /PELLET/INSERT
Date of Application: ?--/
Total Amount Collected:Gbe
Receipt *t (-? 1? Issued By:
Checked for Delinquencies:
PRELIIIINARY .-/-
Job *:
A
for Hlstorical Status:
U &