HomeMy WebLinkAboutPermit Mechanical 1992-03-06SPRI'{GFIELD
Offlce:
INSPECTION LINE:
qp
ITOOD STOVE/INSERT INSPECTION APPTICATION
CITY OF SPRINGFIELD
BUILDING SATETY DIVISION
225 Flfth Street
Sprlngfleld, 0regon 97477
Prellminary Inspectlon is $15.
Wood Stove/Pe1let/Insert Permi
may be
tes
and
red
also underst t lf I am requestlng a
r to installation of insert)
.00 + $ .75 state sureharge +
lnsp
pre1l
FOR OFFICE USE
mlnary inspectlon, the vall coverlng
b qL-
PRELIMINARY
Job *:
726-3759
726-3769
Job Location:
Assessors f:Tax Lot *:
0wner:
Address:Phone S:
Ci ty:State:Zlpz
Value of Stove/Pellet Stove
(please circle appropriate ce
00 (priois$t Issuance.
10n
that I vas provlded wlth the Uood Stove Safety informatlon for vood burning
appllances and prelimlnary inspection st andards. I further state that the a ppllance
I am installing meets smoke emission stand ards as set by the 0regon Department of
Bnvironmental Quality or the Federal Environmen tal Protection Agency and I agree to
provide the ting approval number to the ector at the time of insPection. I
Type of Inspectlon Req ues t \
Contractor:
Address:Phone #:
Ci ty:State:zi p3
Cons truct i actors Registration *:ires:
By signing thls permit/application, I ag ree to call for an inspection(s) as requlred
(726-3769). I state that aII informat on this appllcatlon/permlt is correct and
REQUIRED INSPECTION(S) :
Date of Application:
Total Amount Co1lected:
Recelpt *:
CITY OF ort,
ert:
Checked for Dellnquencies:
Issued By:
Checked for lllstorical Status:
a
CITY OF ONEGO'U
IJOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Sprlngfleld, Oregon 97477
Job Location:
Assesso Map *:
Ovner:
Address:
Ci ty:State:
Value of ove Insert:
(please circle appliance
Type of lon Requested
Cont rac tor:
Address:
SP'lI,{GFIELO
0ffice:
INSPECTION LINE:
726-3759
726-3769
Preliminary Inspection is $15.00 (prior to instal
llood Stove/Pellet/Insert Permit is $15.00 + $ .75
Tax Lot *:
Phone #:
.ZIpz
Iatlon of insert)
s tgte surcha
Phone #:
zip:
10.Issuanee.
Ci ty:
Cons t ruct
S tate:
FOR OFFICE USE
T
l-6
tractors Registration #:Expires:
lnspectBy signing thls permlt/aPPI ication, I agree to ca}l for an ion(s) as required
(726-3769>. I state that a 1I lnformation on this appllcation/permi t is correct and
I was provlded wtth th e Uood Stove SafetY lnformation for vood burning
iances and prellmlnarY inspectlon standards.I further state that the aPPllance
installing meets smoke emission standards as set by the 0regon DePartment of
ronmental Quality or the Federal Environmental Protection Agency and I agree to
ide the testlng approva I number to the insPe ctor at the time of insPection. I
tand lflam requestlng a PreLlnrl nary inspectlon, the waII covering
required
that
appr
Iam
Bnvi
prov
also
may
ture
REQUTRBD INSPECTTON( S) :
Date of Application:
Total Amount Collected:
Recelpt *:
te
PRELIMINARY
J *:
Ilet St
Checked for Delinquencles:
ssued
Checked for Historical Status: