HomeMy WebLinkAboutPermit Mechanical 2001-01-22CITY OF OREGOA'
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DEVELOPMENT SERVICES DEPARTMENT
WOOD STOVE/INSERT INSPECTION APPLICATION
CIry OF SPRINGFIELD
COMMUNITY SERVICES DIVISION. BUILDING SAFETY
225 Fifth Street
Springfield, Or egon 97 47 7
h,225 FIFTH STREET,
SPRINGFIELD, OR 97477
(541) 726-3753
FAX (541) 726-3689
Office: 726-3759
INSPECTION LINE: 726-3769
Job
Assessors Map #: "i 70a3 Tax Lot#c3 o
A /7
State:q7V 7r
Value of Wood StovePellet Stove/Insert:(please circle appropriate appliance)
Preliminary Inspection is $ I 5.00 (prior to installation of insert)
Wood Stove/Pellet/Insert Permit is $15.00 + 1. 05state surcharge + $.45 Administrative Fee + gl0.OO
Issuance.
Type of Inspection Requested:
Contractor:
Address:
City:State:
Construction Contractors Registration#: Expires:
By signing this permit/application, I agree to call for an inspection(s) as required (726-3769). I state that
all information on this application/perrnit is correct and that I was provided with the Wood Stove Safety
information for wood burning appliances and preliminary inspection standards. I further state that the
appliance I am installing meets smoke emission standards as set by the oregon Departnent 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
inspeqtion,the may be to be removed.,wo/
FOR OFFICE USE
REQUIREDINSPECTION(S): WOODSTOVE/PELLET/INSERT
-PRELIMINARYDate of )- 2;-- o/Job #:0/-o005
Total Amount Collected:#:Issued By:
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