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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