HomeMy WebLinkAboutPermit Mechanical 1996-11-05I
SPRINGFIELD
Of f ice:
INSPECTION LINE:
726-3759
126-3769
UOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFOTI' DIVTSION
225 Fiftlr Street
Springfield, Oregon 97477
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Job Location:
Assessor-< Hap ll 4 a
Ovner
e,
Address -Q/ C *
Ci ty:
Phone: #:
Zip Code:
Value o e1Iet Stov 2V6/.oo
Prelirfrinary Inspection is S15.00 (prior to installation of insert)
Vood Stove/Pe}let./Insert Permit is $15.00 + $.75 state surcharge + S.45 administrative
fee * 510.00 issuance = 526.20 total
Type of Inspection Requested:
Contractor:
?*e.fu-./a 4
4 (/.5 frL
S ta te:
Address:
Ci ty:Statez7=7
Construction Contractors Registration #; G,a * lSExpires
By signing thi.s permit/application, f agree to call for inspection(s) as required
(726-3769). I state that aII the information on this permit/application is correct
and,that I vas provided vith the Uood Stove Safety information for vood burning
appliances and preliminary inspection standards. I further state that the appliance
I'am installing meets srnbke .emission standards as set by the Oregon Departmenf crf
Environmental Quality or the Federal Environurcutal Protection Agency and I agree to
provide the. testing approval number to the iuspector at the time of inspection- I
also understand thJt if I am requesting a prc).iminary inspection, the vall covering
may be required to be removed.
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nser t:
REQUIRED INSPECTION(S) :
Date of Applicat;on //" ? -?6
Total Amount Collected: 2e 2a
Receipt n, ?7/3
-Checked for Deliquencies : _-___,_-
FOR OFFICU USE
.? PRELIHINARY
Job S
Issued BY:
LLETTOVE
Chccked for Ilistoric Status:
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q7/77
phone *. 7?- =Z/A
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SPRTNGFIELO
0ffice:
INSPECTION LINE:
U00D STOVEU In-SERT INSPECTI0I{ APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFET}' DIVISION
225 Fiftlr Street
Springf ieId, .,0regon 97 477
7 26-37 59
726-3769
Job Location:
Assessor-s Map il: I l'U 2
0vner:
lz CO^jVnc 7- )*/1/?fu
- 7/1-- 534{c*ry)
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/
Tax Lot #2a
Address:
Ci ty:State I a-y
Value of Vood Stove/PelIet Stove/Insert:rd 4r /'- d
Preliminary Inspection is S15.00 (prior to installation of insert)
Uood StoreTPe}let/Insert Permit is S15.00 + $.75 state surcharge * S.45 administrative
fee + 510.00 issuance = 526.20 total
Type of Inspection Requested:
Phone: #
Zip Code
te
Address:Phone #,-
Ci ty, S ta te:
Construction Contractors Registration #:Exoires:
By signing this permit/application, I agree to call for inspection(s) as required
tlZO-ilOgi. I srate that alt the information on this permit/application is correct
and,that I vas provided vith the Uood Stove Safety information for vood burning
appliances and preliminary inspection standards. I further state that the appliance
I'am installing meets srbke emission standards as set by the Oregon Departmenf crf
Elvironmental Quality or the Federal Environnrcntal Protection Agency- and I agree to
provide the testing approval number to the iuspector at the time of inspection. I
ilso understand that ii f am requesting a prc).lminary inspection, the vaIl covering
may be required to be removed.
Con t rac to r:
gna ture
FOR OFFICU USE
REQUIRED INSPECTI0N(S) : VOODSTOVIi/PELLET/INSDRT
Date of Appli.cation:
PRELIMINARY
Job fl:
TotaI Amount Collected:
Receipt fl 2 rssued By,-
thecked for Deliquencies:
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-q
a
Clrccked for IlistoricaL Status:
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