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HomeMy WebLinkAboutPermit Mechanical 1994-09-09CITY OF SPRINGFIELD, OREGO'V SPFIi'GFIELD IIOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFEILD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Job Location , 3t5 fv &b t= Assessors MaP f:7 ^71 . /7 Office z 726-3759 INSPECTION LINE t 726-3769 Tax Lot *t Zo/aa iOvner: F c Address '3t5 N. abe io\State: Phone: *:I ato - r35 i Zip Code:q 1 Lt-t Ci ty:S \r\ Cont o&( Value of Vood Stove/Pe1let Stove/Insert:#'it0tiL Preliminarylnspectionissl5.o0(priortoinstallationofinsert) vood stove/Pe11ei7i"""rt Permit i:"ii;:00".-'$:i5-ti"t" surcharge * $'45 administrative i""-.-SrO.00 issuaDC€ = 526'20 totaL Type of InsPection Requested: ractor , 6ror\,^o n( Address , 5'33>. M\oi-ra \+"Phone #: 1qb 'la>>-l O ( zip code z otlq--1 t Ci ty:ot State: Construction Contractors Registration #z )k'7(-t3 Expiresr E ,2 By sign ing this P ermi t/app1 ication, I agre e to caLl for insPe ction(s)AS requi red (726-376e).I StA te that al I the informati on on this Permit/aPP Iication is correct - and that I vas provide d vith the Vood Sto ve SafetY information for vood burning ap pJ-iances and P reliminarY insP ection standards.I further state that the aPPliance I am installing meets smoke emi ssion standards as set by the oregon Department of Environmental QualitY or the Fede raL Environmen tal Protection AgencY and I agree to provi de the testing aPP roval- number to the insPe ctor at the time of inspection. I e vaLl covering also understand that if I am requesting a PreliminarY inspection, th may be required to be re moved. € tet ========================-_======-_=================================================__=====FOR OFFICE USE REQUIRED INSPECTION(S) :LLET/INSERT PRELIMlNARY Date of APPlication:Job #: Total Amount coll-ected ' ?6 '7 o Receipt x,a/43 Checked for De1iqu"n"i"" ' - Issued BY: Checked for Historical tatus: