HomeMy WebLinkAboutPermit Mechanical 1998-01-29SPRINGFI€LO
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UOOD STOVE/INSERT INSPECTIOI{ APPLICATION
CITY OF SPRINGFEILD
BUILDII.IG 5/TFETI DIVISIOI.I
225 Fiftlr Street
Springfield, Oregon 97477
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0ffice:
INSPECTION LINE;.
7 26-37 59
7 26-37 69
Job Loca t ion:
Assessor-< Hap ll
Ovner:
Add ress i,lrone: *: 74-7 337/
S ta te:Zip Code:
Value of Uood Stove/Pe1Iet Stove/Insert: Zaoooo
Prelirfii.rrary rnspection is S15.00 (priop to insrallation of insert)Uood'Stove/Pellet/fnsert Permit is S15.00 + S.75 srare surcharge + S.45 administrative
fee * S10-00 issuance = 526.2O total
Type of fnspection Requested:
9I- :'-gling this perrni t/app'l i q3tlon, r agree to call for inspection(s) as required(726-3769)' r state thai'aII the informltion on this permit/application is correctand.that r vas provided vith the uood srove saf;;t irioir.tiir" for vood ;;;;i;;appliances and preliminary. inspection standarcls. r further state that-the applianceI tI installing meets =rtk".emission standards as set by the oregon Departmeni.o{Environmental Quality or the Federal Environnrcntal protection Agency and I agree toprovide the testing approval number to the insl>ector at the time of inspection. rarso understand thit ii r am requesting a p..ct.iminary inspection, the varr coveringmay be required to be removed
Contraclor:
Address. 33t I 74 Phone #:
Ci ry:state &,Zip C,ode:7244b
construction contractors Registration fi: z2a?z_ Expires:z-Z<- 79
Job ll:
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REQUIRED INSPECTION(S) :PELLET/INSDRT )/PRELTl'TNARY -
Date of Applicarion,
TotaI Amount CoIlccted
Receipt {l:QeZ fssued By:
STOV
thecked for Deliquencies:
2O
Clrccked for Ilistorical S ta tus:
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Ta>: Lo t ii : /2,/e,/
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