HomeMy WebLinkAboutPermit Mechanical 1998-10-5
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\1000 STOVE/INSERT INSPE<rn~!'lE:4,tW-3RAli!ONp"RE 1FT '
CITY OF SPRINGFEILD E:)( HE WORK
BUILDING SAFETY DIVISIO~UTHOR'ZED UNDER THIS PERMIT IS NOT
225 Fit thS tl'ee t COMMENCED OR IS ABANDONED FOR
Springfield, Ol'egon 974 ~o/y 180 DAY PERifl(). '
SPRaNCF'ELO
Office:. '726'-3759
INSPECTION 'LINE;- 726-3769
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Job Location: J'f ?Ii; , /11t: lAP'" SA (/(7,v/2r- ~PA:"'/.1..:.'?:h<""L.ol
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Assessors Hap ~: I,' B.?J :J. '7 I'=?, Ta>: Lo t' ~: 0 ii?' I iJ1) ,- ,
Ovnel': (74/?~eL. 'Yf/? f/.~ !Jet:: ?l. r)o j, /V f(7/t/ , ' ' '~,'
Addres;ICf~r/Jj;'/;r;'!/,')4 r?du~7 Phone: ~:-::;:'Y"j~ik-s"'O"
City::;: f,1?''/''j h'....~n St"te: OR Zip Code:'? 7?";:7
Value ~f \lood St~ve/Peliei:'~tove/lnsert: JP)m '. -
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__,P.reiiniinal'y Inspection isSI5.00_'pl"ior to installation..oJ; .insert), ,'.......u....... . '...
\lood ,Stove/Pellet/I(lsert Permit is S15.00 + S. 75 s""tr<E/$l.1Io;t>vr~gortlaWf5 administrative
fee + SlO.OO'lssuance '= S26.20 total . fo"owrulesadoPtedby'theeoqUlresyuO~!O ,
N 'f' , regon 'trilty "
. Otl IcatlOn Center. Those rules are set forth '
JnOARQt:;;?~nnof."I"H"".'__:_' . _._
.""f"t ...._....~.I vnn ::10.c:::"UU1-
?090. You may obtain copies of the rules by ,
-"",ng t~Q ::~::.-. ;N";,,, u It, Itl'"pnOne' ,
, numb~tJ8l;!.h~9reg<ln Utiliiy Notification 1B 7-:- Y (,(fj'
, t;enFer IS '-OVV-,j,j~-~:$44). " '
ZipC;ode:, .
Type of Inspection 'Reques ted:
, , t-le>c. 'Gh-t,. ...
Contl'actor: +", b~ ~ I?..feti"..,/ved
Add ress ,- "p,() ,
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Cit'y: ~'
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State:
(') /(:-
ft: ~tfJ!J 73fl>{"
Expires: '
6-Q'7
Const,ruction Contl'actors 'Regi'stration
,By signing ,this pemi t'tapplication, I agree to call for inspection(s) as required
(726-37,69). I state that all the information ,on this permit/application is correc't
and .that I Vas' provided \Ii th the Yood Stove Safety' information for \lood burning
appliances arid preliminary inspection standards. I 1;urther ,s tate., tha t- the appliance
I am installing'meets 'smoke .emission standards 'as set by the Oregon Department. of,
' Environmen tal, Ouali ty or the' ,Federal Environn.en tal Pro tection 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 preliminary inspection, the \lall covering
~-a:;j2;~ cOeT! /~m R
.s:>Signature, ,,;,'7 ',", " . ./"Date '
~ccC==~===============ri=======~=~==========================~=========~=~==========~====
FOR OFFICe USE
REQUIRED INSPECTION(S):
\lOODSTOVE/PELLETIINSERT '
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PRELIMINARY -,
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Date of Application:
Ib -"\- qC/,
:Jp~Ct,,~
Job'lI:
, q q I J.."Lt
Total Amount Collected:
Re<:cipt II: 017t:j{~:
Issued By: ct< LV '
"Checked for Deliquencies:
Checked for Ilistori,cal Status: