HomeMy WebLinkAboutPermit Mechanical 1991-11-19I.IOOD STOVE/INSERT INSPECTION ATTLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Ftfth Street
Springfield, 0regon 97477
SP'IIHGFIELD
0fflce:
INSPECTION LINB:
726-3759
726-3769
CITY OF SPR,,VGF'ET,D, OREGO'U
Job Locatlon: *pZ'f 4 74 J,-
Assessors Map *:Tax Lot #:
owner: 541 F ./y
Address, ,RdZf ./" 7 4s-Phone #:6-2_e<Ci ty:State:ZIpt v"77
Va1ue of Wood Stove/Pellet Stove/Insert:
(please circle appropriate appliance)
Preliminary Inspection is $15.00 (prior to installation of lnsert)
Wood Stove/Pel}et/Insert Permit is $15.00 + $ .75 state surcharge + $10.00 Issuance.
rype of rnspectlon Requesteaz PRE- lN94FeT7Ol,1
Address:Phone S:
Ci ty r State:Zipz
Construction Contractors Registration #:Expires:
By signing thls permit/application, I agree to call for an inspection(s) as requlred
(726-3769). I state that aII information on thls appllcation/permlt ls correct and
that I was provlded wlth the llood Stove Safety information for wood burning
appliances and prellminary lnspection standards. I further state that the appllanceI am installing meets smoke emission standards as set by the 0regon Department of
Environmental Quality or the Federal Environmental Protection Agency and I agree to
provide the testing approval number to the inspector at the time of inspection. I
also understand that if I am requestlng a prellninary inspection, the vaIl covering
may be required to be removed.
Signature Date
FOR OFFICE USE
c
REQUIRED INSPECTION(s) : IIO0DST0VE/PELLET/INSERT
Date of Applicati on, /,/= /7 *7 /
Total Amount collected t /$,av
Receipt #:
PRELII.IINARY
Job *:Qtt17r>y'r'
Checked for Delinquencies:
Prca w
Cheeked for Historical Status:
(
o/2/(?
Contractor:
OREGO'I'CITY OF
SP'rI},lGFIELD
qp
I.IOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Ftfth Street
Springfield, Oregon 97477
0ffice:
INSPECTION LINE:
726-3759
726-3769
JobLocation: 2Db,T ,Uo '7 rl sf
Assessors Map #z /?-o1-26-/=Tax Lot *:o/2,/6
-l
owner t/ ob ru #, = krr) s
Addressr 2o6;,/o '- f(Phone #: 7 26 -/Zz-7
Ci ty:
Value of l{ood Stove/Pellet S
(please circle appropri
u State: 6 a zt
P ?s'f -
ate a ance )
Preliminary Inspection is S15.00 (prior to lnstallatlon of insert)
I,lood Stove/Pe]Iit/Insert Permit is $15.00 + $.75 state surcharge + $10.00 Issuance.
Type of Inspectlon Requested:
/
/z/z2er I
Contractor: Go o J Q*'/ l,tu/o.
nser
Address z 5-,?hj 4 .f/Phone *:
Ci ty:S tate:zi p:
Construction Contractors Reglstration #, ?A '- / 3 . Explres:f ,/ze /g-.-T1
By signlng this permit/appllcatlon, I agree to caII for an inspection(s) as required
<iZO-|lOgt. I slate ttai-all infornation on thls appllcation/permit is correct and
ifrat f vas provlded vith the lIood Stove Safety informatlon for vood burnlng
appliances ind prellminary lnspectlon standards. I further state that the appliance
I'im installing meets smoice emission standards as set by the 0regon Department of
Environmental Quality or the Federal Environmental Protection Agency and I agree to
provide the testing approval number to the inspector at the time of inspeetion. I
also understand ttrit it I am requesting a prellminary lnspection, the vaII coverlng
ber ired to
.z/-a.o *,?/
gnature Date
r'OR OFFICE USE
REQUIRED INSPECTION( S) :VOOD STOVE / PELLET / TN SERT
Date of Application:
Total Amount Collected:
Receip t *: OO '3 t ; / rssued By:
PRELIMINARY
Job *:7// s 7c)q
Checked for Delinquencies:_for Historical Status!
o, qFr77