HomeMy WebLinkAboutPermit Mechanical 1997-04-23UOOD ST(IVD/INSERT INSPECTIOI'I APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFETT DIVISIOI'J
225 Fifth Street
Springfield, 0regon 97477
SPFlINGFIELO
0ffice:
INSPECTION LINE:
1 26 -31 59
7 26-31 69
%
Job Location:-toa Ltsl A
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Zip Code:
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7?0 -77
7S ta te:NL2Value of Vo ovelPelIet Stove/Insert:
Preliniinary Inspection is S15.00 (prior to installation of insert)
Vood Stove/Pe1let/fnsert Permit is S15.00 + S.75 state surcharge + S.45 administrative
fee + Si0-00 issuance = 526-20 total
Type of Inspection Requested:
contractor
Address:Phone #,
Ci ty:S ta te:Zip C,ode: '
Construction Contractors Registration S:Exoi res :
By signing this permit/application, I agree to call for inspection(s) as required
(726-3769). I state that all the informatj.on 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 further state that-the appliance
I'am installing meets smoke .emission standarcls as set by the Oregon Departmenf af
Environmental Quality or the Federal Environnrcntal Protection Agency and I agree to
provide the testing approval number to the irrsl>ector at the time of inspection- I
also understand that if I am requesting a prc).iminary inspection, the vall covering
may be required to be removed
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======. FOR OFFICT' USE
REQUIRED INSPECTION(S): voO INSDRT P
Date of Appl-ication
To taI Amoun t Col-1ec ted
4-/
Receipt ll fiw
Job fl
Issued By
VE/P
thecked for Deliquencies:
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Clrccked for Ilistorical Status:
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