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HomeMy WebLinkAboutPermit Mechanical 1993-05-18,CITY OF OREGOA' I{OOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, 0rcgon 97477 SPFI]{GFIELD 0ffi ce: INSPECTION LINE: 726-37s9 726-3769 Job Location:gt-,,' 3r Assessors Hap *:'DV -2/, *2"//? Ovner: Address: Value of lJood St (please cir Type of Inspection Requested: Phone *, 2r/6 -*2.f i ztv, =42- Tax Lot *: Ci ty:State: 4A cIe appropr a appr Preriminary rnspection is 915.00 (prior to installation of insert)tlood stove/Perret/rnsert permit is 915.00 + $1o.oo rssuance + 5.15 state surcharge. q/a€- Contractor: Address:Phone *: Ci ty:State:Zip: Construction Contractors Registration *, %,* < Expires:124€7 By signing this permit/application, I agree to caII for an inspection(s) as required(726-3769). I state that aII information on this application/permit is correc[ andthat I vas provided vith the lIood 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 0regon Departmeni ofEnvironmental Quality or the Federal Environmental Protlction lgency ana r agree toprovide the testing approval number to the inspector at the time of- inspection. Ialso understand that if r am requesting a preliminary inspection, the vaII covering may be required to be removed. gnat FOR OFFICE USE REQUIRED INSPECTION(S): lIO0DsT0vE Date of Application: Total Amount Collected: Receipt #: PRELI}.'INARI Job *: a4 Issued By: Checked for Delinquencies:ch d for Historical status: 7* ,/?Sa V-i,/-2 z Date