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HomeMy WebLinkAboutPermit Mechanical 1993-08-05VOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, 0regon 97477 SPFT]{GFIELEl 0ffice: INSPECTION LINE: 726-37s9 726-3769 CITY OF OFEGO'V Job Location: L/tJF Yat1 Assessors Map *:)10<3 4 Tax Lot #: OSSOa Ovner: Addressr U(? Ll t) State: Op 7./6- z3G( Zip: q'7111-7Ci ty: Value of Vood Stove (please circle Phone *: er t: appropr a e appli ance) PreI llood 1 t ion is $15.00 (prior to installation of insert)nsert Permit is $15.00 + $10.00 Issuance + $.15 state surcharge. Type of Inspection Requested:DB. r t,,* Contractor: L Address:r Phone *:Gv< -9t3 Ci ty:€dG State:zip: q'lLIOL Construction Contractors Registration #:57 ZCO Expires: By signing this permit/application, I agree to caII for an ins pection(s) as required(72 6-3769). I state that aII information on this a pplication/permit is correct andthat I vas provided vith the llood Stove Safe ty information for vood burningappliances and preliminary inspection standa rds. I further state that the applianceI am installing meets smoke emission stand ards as set by the Oregon Department ofEnvironmental Quality or the Federal Envi ronmental Protection Agency and I agree toprovide the testing approval number to th e inspector at the time of inspection. Ialso understand that if I am ting a prelimi nary inspection, the vall covering may be required to be removed. Rqturete FOR OFFICE USE 4qsoeIIet St tove/Pelle REQUIRED INSPECTION( S) : Date of Application: 8 Total Amount Collected: Receipt S:Ct e INSERT PRELTI.|TNARY )a Job *: 1= Issued By: XChecked for Delinquencies:Checked for Historical Status I y \ ,{