HomeMy WebLinkAboutPermit Mechanical 1992-10-15UOOD STOVE/INSERT INSPECTION APt..CATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
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Office:
INSPECTION LINE:
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726-37s9
726-3769
cfiY OF OFEGO'U
Job Location:
Assessors Hap *:/7*'7a -/z Tax Lot S: 49 7OO
2 27
Ovner:
Address:Phone *: 7*-2/2,/
Ci ty:State:26 zi p:q"/22
Value of Uood Stove/Pellet Stove/Insert:a?-z>
(please circle appropriate appliance
Preriminary rnspection is $15.00 (prior to installation of insert)
Uood Stove/Pellet/Insert Permit is S15.00 + S10.00 Issuance + g state surcharge.
Type of Inspection Requested:
Con t rac tor:
Address:
1,12.5
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zip:#c-z+GCity:_S tate:' '-/
Construction Contractors Registration *:
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Phone *:
7A2"= Expires ?2a4=
By signing this permit/application, I agree to caII for an inspection(s) as required(726-3769\. I state that all information on this applieation/permit is correct andthat I vas provided vith the l,Iood Stove Safety information for vood burning
appliances and preliminary inspection standards. f further state that the appliance
I am installing meets smoke emission standards as set by the Oregon Department of
Environmental Quality or the Federal Environmental protection Agency and I agree to
provide the testing approval number to the inspector at the time of inspection. I
also understand that if I am requesting a preliminary inspection, the vaII covering
may be uI d to be removed.
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FOR OFPICE USE
Checked for Delinquencies:
Issued By:
Checked for Historical Status:
1--REQUIRED INSPECTION(
Date of Application:
TotaI Amount CoIlected:
Recetpt fi:
-a2
PRELIMINARY
Job *:
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