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
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