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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 % .)/ *q L Tax Lot { 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. ,) -/f-.4 4v gnature teq/rL 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: r .. -i' q7/77 phone *. 7?- =Z/A __l_- DN zdrxe '4)c'-)c zt I 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) &. / 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: a -q a Clrccked for IlistoricaL Status: f2tfi)z l-/- Tze2:u /pr0<r % €+/, (.<-OA ZA 2a