HomeMy WebLinkAboutPermit Mechanical 1999-02-10UOOD STOVE/INSERT TNSPECTIOI.I APPLICATTON
CITY OF SPRINGFEILD
BUILDII']C SAFET)' DIVISIOI.I
225 Fifrh Street
Springf ield, 0regon 97 /.77
-SPclINCII€LO
' Office: 726'-3759
INSPECTION LINE;' 726-3769
e&
Job Loca t ion b:4q ?*h
Assessor-< Hap il :03jbLt
0vner:(*
Address:./
Ci ty:
VaIue
Prelirfiinary lnspection is
Uood .Stove/Pelle t/f nsert Permi
lr"5 a
*i), ATTENTION:O regon law requires you terone; #: 7qq-
lity
Ta>: Lot f;: t7'(,la
Ont,/-'7-4?i / /q / /
rge + S.45 adminiitrative
rules are set fatttr cod
01-
les
one
t titisttlollicataan of. in
btate surcha
Contr-aclor:
Address: 1
fee * Si0.00 issuance = 526.20 total
Type of fnspection Requested:{t -l n.Jo^(cd/
btX rL/4
Phone x: 3/3 -t
ciiv, Fu4zrtl S ta te:(_Zip Qode:q?{o A
Construction Contractors :Rbgi:str.ation ft : 0n3b/Expires:1a
By signing'this permit/application, f agree to call for inspection(s) as required(726-3769). I scate that aII the information on this permit/application is correct
and .that I vas provided vith the Uood Stove Safety'information for vood burning
appliances and preliminary inspection standards. I (urther.state. that-the appliancef am installing'meets smoke.emission standards as set by the Oregon Department.af
Environmental Quality or the Federal EnvironnrcntaL Protection Agency and I agree toprovide the. testing approval number to the irrspector at the time of inspection. Ialso understand that if I am requesting a prc).iminary inspection, the vaII covering
may be required to be removed.
2 /o
ture te
0 ELLET/INSDRTREQUIRED INSPECTION(S) :
Date of Application:q Job ll:aD'
PRELIHTNARY -
f(, z(rt
Total Amount Collected: Z aj
Rec'bipt ll: 072* 3 f Issued By:ilo,/
tliecked for Deliquencies:Chccked for Ilistoricil Sta(us:
*
(e
EEEE=====================