HomeMy WebLinkAboutPermit Mechanical 1998-08-05SPGlINGFI€LO
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UOOD STOVE/INSERT TNSPECTIOI,I .APP Ltrff€NgtbN :oreson I aw req u i %CITY OF SPRINGFEILD
follow rules adoPted bY theBUILDII.IG SAFET)' DIVTSIOI.I
Notilicaiion Center. Those ru les are set lorth
tlr Street in OAR 952-001-0010 through oAR 9s2-00
1e Id, Oreso
SHALL EXPI
n 97 tr77
RE lF THE WORK calling the
OO9O. You maY obtain coPies
SP IT center (Note:
fice: 726'-3?59
LrNE;- 726-3169
AUTHQBIZED.JOO Locat 1
COMMENCED
UNDon:
OR
4flFu6P9l1v pFnKrb
Ovner:
MIT
Address , 2>2 N33 M.
Ta>: Lor f : fiJzoa
Pltone:*, 7? 7- 6 111 {
U2jts1
Ci ty:S ta ae:on_ -Zip Code:
Value of Uood Stove/Pellet gtove/fnsert:{6D
. . . -.. -.Preliriinary lnspection is S15.OO (pr:i9r -ro. installation of. insert)' Uood'Scove/Pellec/fnsert Permit is S15.OO * S.75 srare suicharge *fee * Si0.00 issuance = 526.20 total S.45 administrarive
Type of fnspection Requested:
ContracIor:
Address:o Phone #:?37 ,8c/ 8
Ci ty:S ta te:Cn zip code: 2zq3/.
Consrrucrion Contracrors 'Rbgistration S, fJ 7 8O 0 Expires:2
By signing .this lermi t./application, f agree to caII for inspection(s) as required(726-3769). I srate that atl the info rmation .on this permi t./ap[rlication is correct
and .that I vas provided vith the V ood Stove Safety' information for vood burni:tg
appliances and preliminary inspection standards. I (urther state..that-the applianceI am installing' meets smoke .emission standards as set by the Oregon Department.ofEnvironmental Quality or the Federal EnvironnrcutaL Protection Agency and I agree toprovide the. testing approval number. to the irrspector at the time of inspection. Ialso understand that if I am requesting a prc).iminary inspection, the vall covering
may be required (o be remov
E-5
tu[e te
FOR OFIICU USE
REOUIRED INSPECTTON(S) :
Date of Applicarion:
To taI Amoun t ColIec ted :
Rec'bipt ll:0)0gq 7 Issued By:
Clrccked for llistorical Status:
uooD6Tot(r V PELLET/INSDRT PRELIHINARY.
Job ll:$077u:pbil
tliecked for Deliquencies:
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