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HomeMy WebLinkAboutPermit Mechanical 1993-05-26CITY OF OBEGO'V TIOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97417 SPF!]tlGFtELD 0ffice: INSPECTION LINE: 726-3759 726-3769 Job Location: /,c 1? A/, /fr Assessors Map *r 17 fi< 3to Z / rax Lot *, '2 {OD 0vner: Address:*,ruC citvz ly4 State: Value of llood Stove/pellet Stove/Insert: 2 Phone *: zip: ,/1-4A ?o(please circle appropriate appli ance) Preliminary rnspection is 915.00 (prior to instalration of insert)I'Iood Stove/Perret/rnsert permit is $15.00 + $10.00 rssuance + $.]g state surcharge. Type of Inspection Requested: Contrac tor: Address:250/Phone *: Ci ty:Statet (r:a Zipt ?71O L Construction Contractors Registration * | 4A .,r Expires:2 !1_qiqing this permit/application, I agree to call for an inspection(s) as required(726-3769>. I state that aII information on this application/permit is'correcf andthat I vas provided vith the Uood Stove Safety infoimation for vood burningappliances and preliminary inspection standards. I further state that the applianceI am installing meets smoke emission standards as set by the oregon Departme;i ofEnvironmental Quality or the Federal Environmental Protection Agency "na r agree toprovide the testing approval number to the inspector at the time of inspectiln. Ialso understand that if I am requesting a preliminary inspection, the vill coveringmay be required to be removed. f-2e-t3gnaeDate FOR OFFICE USE REQUIRED INSPECTION(S): U0ODSTOVE/ Date of Applicati on, € /Z a1= s TotaI Amount Collected: T 26;,7J Receipt *:4 L/. PRELIMINARY 22"Job *, 7 3C ,/ O .a,(A OIJ /INSERT Checked for Delinquencies: Issued By: checked for Historical Status, H* D<1:r -;