HomeMy WebLinkAboutPermit Mechanical 1998-01-02UOOD STOVE/INSERT TNSPECTIOI{ APPLICATTON
CITY OF SPRINGFEILD
BUILDII'lG SAFET)' DIVISIOI'l
225 Fifth Street
Springfield , Oregon 97 t 77
Job Loca t ion:(;t-
Assesso[-< Hap ii :L o
Ovner:
Add ress
SPRINGFI€LO
Office:
INSPECTION LINE;-
eft,
7 26-37 59
7 26-37 69
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Phone: #:
Zip Code:
7 u- le6
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Value of Uood Stove
S ta te:
./Pe1Iet Stove/fnsert:
Prelirfiinary Inspection is S15.00 (priof to installation of, insert)
Uood.Stove/Pellet/fnsert Permit is S15.OO + $.75 state surcharge + S.45 administrative
fee * Si0.0O issuance = 526.2O total
Type of Inspection Requesrca: Pollerl- T:nSeet- ..
Contractor:
Add ress :Phone *:
Ci ty:S ta te:
Expi res :
By signing this permit./application, I agree to caII for inspection(s) as required
(726-3769). I state that aII the information on this permit/application is correct
and.that I vas provided vith the Uood Stove Safety information for vood burning
appliances and preliminary inspection standards. I further state that-the appliance
f am installing meets smoke.emission standards as set by the Oregon Department-of
Environmental euality or the Federal Environnrcrrtal protection Agency and I agree to
provide the. testing approval number to the irrspector at the time of inspection. I
also understand that if f am requesting a prc).iminary inspection, the vall covering
may be required to be removed.
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REQUIRED INSPECTION(S) :
Date of Application: I
To tal Amoun t CoI lec Ied :
Recei p t lt 2e33 6O
19
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F.ICU USE
SDRT PRELIHINARY -
Job ll
Issued By:{a
tlrecked for Oetiqrun.ius Chccked for Ilistorical Status:
Construction Contractors Registration f, :
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