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
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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?
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.00 (prior to installation of insert)it is $15.00 + $10.00 Issuance +state surcharge.
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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.
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FOR OFFICE USE
REQUIRED INSPECTI0N(S): IJ00
Date of Application:Z
Total Amount Collected:r'az{
Receipt $:
Job *:I 2_
fssued By:
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/INS
Checked for Delinquencies:Checked for Historical Status:
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