HomeMy WebLinkAboutPermit Mechanical 1993-12-20CITY OF OREGOA'
SPFIi.GFIELO
0ffice:
INSPECTION LINE:
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, 0regon 97477
7 26-37 s9
726-37 69
nJob Location:
Assessors Uap *, \Tax Lot #:
0vner:
Address:Phone *:
Ci ty:State:zip:
Value of
(p1
e1let Stove/Insert:Rt
appropriate appliance)
Preliminary rnspection is S15.00 (prior to instarlation of insert)vood stove/Perlet/rnsert Permit is S15.00 + S1o.oo rssuance + 5.15
Type of Inspection Req uested z lZr/Ab,+
)
state surcharge.
tove
Contractor:
Address:Phone #:
Ci ty: State:zip:
Construction Contractors Registration #:Expires:
By signing this permit/application, I agree to call for an inspection(s) as required(726-3769). I state that all information on this application/permit is correct andthat I vas provided vith the Vood Stove Safety information for vood burning
appliances and preliminary inspection standards. I further state that the applianceI am installing meets smoke emission standards as set by the Oregon Department of
Environmental Quality or the Federal Environmental Protection Agency and I agree toprovide the testing approval number to the inspector at the time of inspection. I
also understand that if I am requesting a preliminary inspection, the va1l covering
may be req uired to be removed.
U-Ao^9s
Date
FOR OFFICE USE
REQUIRED INSPECTION(S) :LLET/INSERT PRELIMINAl.Y
Date of Appi-ication:IL -{\Job *, q7/92=&al \Total Amount CoIlected:
Recei p t *: ///?/Issued By:
(/'---Checked for Delinquencies:for Historical Status: