HomeMy WebLinkAboutPermit Mechanical 1998-09-15I
UOOD STOVE/INSERT TNSPECTIOI{
CITY OF SPRINGFEILD
BUILDII.IG SAFETI' DIVfSIOI.I
225 Fiftlr Streer
Springf ie1d, 0regon 97t,77
THIS PERMIT SHALL EXPIRE IF THE %ON
AUTHORIZED UNDER THIS PERMIT IS NOT
ooMMENoED oR rs ABANDoNEDfp$r.rr.fftfifi;; , ;-tr|_llZ|
ANY 180 Cav PERI0D v-r'-;
'liiTrF;?$'
Job Location:qru 3rd-nea
Assessor-< Hap il :l7a3ts'z Tai: Lot f :0S7o/
Ovner:
Add res
O\v\C
s:
ciVz =Of,rr-,€*i)
I qct2-.Phone: #:
Zip Code:?zqt t-T--J-
Value of Vood Stove/
.PreJ iniir:ary lnspection is S15.00 .(pr-i. Uood .Scove/Peller/Insert permit is S1fee + 510.00 issuance = 526.20 total
Ci ty:
Cons t
Pellet stove/rnserr:,4 t Ol:f:, (i.9-
9r co installation oE. insert)
5.00 + S.75 state surcharge + S.45 adrninistrative
S ta te:in OAR 952-001 952-001 -
@ain of tne rules Dy
telephone
Utility Notificationtion(s) as req ui red
s permit/Iication is correct
Type of Inspection Requested: ..
Con t rac Ior:
Address:follow rules regon Utiliry
ruction Contractors'Rbgirstration S: oalli the cente
8y signing 'this irerrnit/applicatior., f agree Gsttodll(726-3769) . I s tate that aII rha information .on thi
and .that I vas provided vi th the llood Stove Saf et y' information for vood burning
appliances and preliminary inspection standards. I (urther state..that-the appliance
I am installing.meets smoke.emission standards as set by the Oregon Departmeni.sf-
Environmental Quality or the Federal Environnrcrrtal Protection Agency and I agree to
provide the. testing approval number to the iuspector 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
FOR OFI.ICU USE
Date of Application:
To taI Amourr t ColIec ted
Rec-bipr {l: OhaLh Issued By:
PRELIMINARY..
Job {l:6k s .g':
^( il,l
thecked for Deliquencies:
7 Lo
Clrccked for Ilistorical Status:
SPGlINGFIELO
State A4-
-r**, fyfu-*-aa =-^DY ) t, l??ySignature / v'
/ -Date: l-
EEEE==_== -.- == = === = ====== ===== = ======
REQUIRED INSPECTION(S) : UOODSTOVE/PELLET/INSDRT