HomeMy WebLinkAboutPermit Mechanical 1997-11-21rj;:ii:;I
SPRINGFI€LO
Office:
INSPECTION LINE:-
Tai: Lo t ,-'i : A
VOOD STOVE/INSERT INSPECTIOI,I APPLICATTON
CITY OF SPRINGFEILD
BUILDING SAFETT DIVISIOI{
225 Fif tlr Streer
Springfield, 0regon 97/,77
Job Loca t ion :ls lrr
Assesso rs Ha p il
Ovner
Add ress :
S ta te:
ert
7 26'-37 59
726-3769
Phone: :. :
Zip Code:aus3 3
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Ci ty:
Value of Uood Stove tove/Insert:&
Prelirfri.rrary Inspecrion is S15.00 (pri9r to installation of insert)uood'Stove/Pellet/fnsert Permit is S15.OO + S.75 stare surcharge + g.45 administrarivefee + Si0-00 issuance = 526.2O total
Type of fnspection Requested:
Contractor:q47-blrAddress:
Ci ty:State:Zip Qode:
Construction Contractors Regi:stration fi :Expires:
By signing this permi t/a pplication, f agree to call for inspection(s) as requi red(726-3769). f stare tha t all the information on this permit/apfllication is correctand .that I vas provided vi th the Uood Stove Saf ety information for vood l-rurning
ap pliances and preliminary inspection standards. I further state that-the a pplianceIam installing meets smoke .emission standards as set by the O regon Depar tmen [ .. crfEnvironmental euali ty or the Federal Environnrcutal protection Agency and I agree (oprovide the. testing a pproval number to the irrsqlector at the C ime of inspection. Ialso understand that if I am requesting a prc).iminary ins pection, the vaII coveringmay be re quired to be removed.
ure Da te
REQUIRED INSPECTTON(S) : UOODSTOVE @TINSDRT I,/PRELTMINARY .
Dare o[ Applicarion. //- ?f-?-Job ll:
TotaI Amount CoIIccted
Rec'iipt ll: ZAe Issued By:
e lIe
'Checked for Deliquencies :
20
Clrccked for Ilistorical Status:
Phone #:
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