HomeMy WebLinkAboutPermit Mechanical 1995-05-01')
SPEINGFIELO
0ffice:
INSPECT]ON LINE:
\JOOD STC}VE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Job Location:
V A""""sors MaP #:
Ovner:
4f,Address:
Tax Lor *: f:B-3&?3
7 26-3t 59
7 26-37 69
I
S ta te:L4-
Phone: *:
Zip Code:
Ci ty:
VaIue fV Stove/PeIIet Stove/Insert :
4
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/r<)36 "-
Preliminary Inspection is $15'00 (prior 1o i1s1911ation of insert)
uood Stove/PelreiTi;;;ti-Permit ii'Sts'00 + $'75 state surcharge +
i""-.-sio.00 issuance = s26'20 totar
Type of InsPection Requested:
$.45 administrative
CITY OF SPF"UGFIELD,
Address:
Contractor:
Tota1 Amount Collected:
Receipt *, i 7/ 7 /
Phone #:
Zip Code: '
Issued By:
Construction Contractors Registration *t.-._- Expires:
By signing this permit/app'lj-cation, I agree to call for inspection(s) as required
(726-3769). r state that'a11 the inform-ation on this permit/appll'oation is correct
and that r vas' prt"iJua vith the vood stove Safety information for vood burning
"ppflan""s and pr^ulirnin.ry inspection standarcls. I further state that the appliance
I am instalting meets "rbke ehiision standariis as set by the 0regon Departmenf af
Environmental Or"tity or the Federal Environrrental Protection Agency_ and I agree to
provide the testing'approval number to the inspector a-t the time of inspection' I
also understand that if f am requesting a prcl.iminary inspection, the vaII covering
may be required to be removed.
ture te
==== ==== = = = = = ================================ ==========================================, FOR OFFICE USE
REQUIRED INSPECTION(S)ELLET/INSIRT T PRELIMINARY
Date of Application:s Job # , 9,SO szn
ODST
Checked for Deliquencies:
21^?a
tlirecked for Historical Status:
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