HomeMy WebLinkAboutPermit Mechanical 1996-12-02SPRINGFIE.LO
9
UOOD ST(IVEIINSERT INSPECTION APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFETT DIVISION
225 Fif tli Streer
Springfield, 0regon 97477
ert
0ffice:
INSPECTION LINE:
726-3759
7 26-37 69
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Job Loca t ion 0 I .-
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Value of Uood Stove/pellet Stove./Insert: N,/1,
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Phone: #
Zip Code
Prel-iriinary Inspection is S15Uood Stove/Pe1let/fnsert perm
fee + Si0.00 issuance = 526-2
X typu of fnspection Requested;
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.00 (prior to insrallation of insert)it is S15.00 + S.75 state surcharge + S.45 adminisrrative0 total
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Contractor:Vo J -M
Phone #:
Zip C.ode
Expi res :
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Construction Contractors Registration *, ,/A7 f '23
By signing this permit./application, f agree to call for inspection(s) as required(726-3769). I state that al-l the information on this permit/application is correctand.that I vas provided vith the Vood Stove Safety information for vood burningappliances and preliminary inspection standarcls. I further state that the applianciI am installing meets smoke .emission standartjs as set by the Oregon oeparimenf ofEnvironmental Quality or the Federal Environnrcutal Protection Ageniy and I agree toprovide the testing approval number to the iuspector at the time it inspection. Ialso understand that if f am requesting a prc).iminary inspection, the vail coveringmay be required to be removed
/2-2-7L
Dateu
REQUIRED INSPECTION(S )
Date of Application:
TotaI Amount Collected:
Recei p t 1l >37y'o
UOODSTOVE / PELLET / INSDRT
FOR OFTICU USE
Job fi
fssued By:
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thecked for Deliquencies:
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Ulrccked for Ilistorical Status:
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