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 -;