Loading...
HomeMy WebLinkAboutPermit Mechanical 1992-12-17CITY OF OREGO'V ljOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, 0regon 97477 !SP,lI]{GFIELD al 0ffice: INSPECTION LINE: 726-37s9 726-3769 Job Location:2ffi /tu,-n- /?)O Assessors Hap #: 0vner:,il, Tax Lot *: A/dAa r/\m- Address:t-D*/Phone *: 7 r'6 - b 7?A State:zipt 7 2 77? =a6,.eaan .00 (prior to installation of insert)it is $15.00 + $10.00 Issuance +state surcharge. )iq Ci ty: Value of Uood Stove (please circle appropr ate Preliminary Inspection is 915 IJood Stove/Pellet/Insert perm Type of Inspection Requested: Contractor: Address:Phone *: 4732,/A Ci ty:S tate:c*- zip, 2Za4 Construction Contractors Registration *:Expires | ,/2-ZA 97 By signing this permit/apprication, r agree to calr for an ins pection(s) as required(72 6-3769>. I state that all information on this application/permit is correct andthat I vas provided vith the Uood Stove Safet y information for vood burningappliances and preliminary inspection stand ards. f further state that the appliancef am installing meets smoke emission s tandards as set by the Oregon Department ofEnvironmental Quality or the pederal Environmental Protection Agency and I agree toprovide the testing approval number t o the inspector at the time of inspection. Ialso unders d that if I am re questing a preliminary inspection, the vall covering may be d removed. te FOR OFFICE USE REQUIRED INSPECTI0N(S): IJ00 Date of Application:Z Total Amount Collected:r'az{ Receipt $: Job *:I 2_ fssued By: q- /INS Checked for Delinquencies:Checked for Historical Status: r:w /.r=-7-( €pxELrMrNARY t2n n