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