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HomeMy WebLinkAboutPermit Mechanical 1994-01-31VOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, 0regon 97477 !s' 'I}IGFIELE, 0ffice: INSPECTION LINE: W 726-3769 CITY OF SPR OREGO'V Job Location: Assessors Map *: e Tax Lot *: &2z) Ovner: Address:f,o-UU Phone *t ??cr*7aey Ci ty:State:zi p:277>? Value of llood St +a ( pleas e circle appro ate app ance Prellminary rnspection is $15.00 (prior to instarlation of insert) IJood Stove/Pellet/Insert Permit is $15.00 + S10.00 Issuance + g.lg state surcharge. Type of Inspection Requested: t Stove/Ins er Con t rac tor: Address:Phone *:5s7:r< Cityt .F/ ZA,Arzd- Statet zfr ^ Zipz 4>va\ Construction Contractors Registration # z 44SAS Expires s /A88€7 By signing this permit/application (726-3769). I state that all infothat I vas provided vith the lJood appliances and preliminary inspectf am installing meets smoke emissi Environmental Quality or the Feder provide the testing approval numbe also understand that if I am re que required to be removed. Si gnat , I agree to call for an inspection(s) as required rmation on this application/permit is correct and Stove Safety information for wood burning ion standards. I further state that the appliance on standards as set by the 0regon Department ofaI Environmental Protection Agency and I agree tor to the inspeetor at the time of inspection. Irsting a preliminary inspection, the vaII coveringetfu?ts Date FOR OFFICE USE REQUTRED TNSPECTT0N(S) : Date of Applicati onz / ^5t<2 r/Job #: PRELII-IINARY Z-.."-- Total Amount CoLlected: Receipt *: checked for Delinquencies: fssued By: Checked for Historical Status: ?qa?z -