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HomeMy WebLinkAboutPermit Mechanical 1996-11-25 .W .-.. .._~-..:. .1" '-. SPRINGFIELD 11000 STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFEILD BUILDING SAFETY DIVISION 225 Fifth' Street Springfield, Ot'egon 97477 Office: INSPECTION LINE: 726-3759 726-3769 - Job Location:-L9.:2./ #~~ L,:z> Assessors Map ~: l~o"3.~:k, YO Tax Lo t ~: Ovnet': ~~r6f/ 1'r:-~/?/?76 Address: /~2/ ,A.?'E"""p'L::P {,;z:>. Phone: ~: City: 5~Tc..z::,. State: .&?/1, Zip Code: Value of <$fod S tovJ>'Pelle t S tove<(ii'sert~ ,/ Y.:p~ Preliniinat'Y Inspection is $15.00 (prior to installation of insert) 1I00d Stove/Pellet/Insert Permit is $15.00 + $,75 state surcharge + $.45 administrative fee + $10,00 issuance ~ $26,20 total ,. ~2~* 70//'8 53~ 970/'77 Type of Inspection Requested: ~&?P?~YG 4;':J~'J--/'" . . . Contractor: 1/7 /;',7> ~/~~ ~'~;ob _~ ~~. Address: ~2/ "'5.e"'3 ~ Phone~: 7V/'/.Je6z:> Ci ty: ~ State:,OA;. Zip code: ~'y <'0' Conslt'uction ContractorsR~gistration #: /LJ35?'? Expires: /=<.y""~ ~? By signing .this pet'mi t/application, I agree to call for inspection(s) as required (726-3769), I state that all the information on this permit/application is correct and ,that I \Ias provided \lith the 1I00d Stove Safety. information for \Iood burning appliances and preliminary inspection standards. I further state that the appliance I am installing'meets smoke ,emission standat'ds as set by the Oregon Department of Environmental Quali ty or the Federal Environnlcntal Protection Agency and,I, agree to provide the testing approval number to the inspector at the time of inspection, I also understand that if I am requesting a preliminary inspection, the \Iall covering. may be required t6 be removed. ~ 1f~/ Signa ture ' .... IIIOIS/f'~ .Date ' ======================================================================================= FOR OFFICE USE REQUIRED INSPECTION(S): CIlQODSTOvE)PELLET/<1'rrS~ Y PRELIMINARY, Date of Application: //- '2 ?-~ Job #: 9b/7({!;:2... Total Amount Collected: 26. ~<::> .'Checked for Deliquencies: Checked Issued By: ~~ t'~ ' for Historic~l Status: ,. Receipt 11: '2?~7 . . SPRINGFIELD 11000 STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFEILD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon - 726-3759 726-3769 b. 7'1"177 .~ ~: C>~~~ ~. .- 97477 Office: INSPECTION LINE: Job Location: /RJ./ 1Yluzf",' of,., "I , Assessors Map ~: //!"tf:)7-::? li'- ~ Ovner: J11~ ~ Address: / r?;J/ 71~ ~ , ~ ..kl'iJ /);{I . V ]?if Tax Lo t Phone: ~: 74/- ?S~~ 0/7'177 Ci ty: ~/i~p~J o~od StoV$YPellet State: OJ! S Stov~ /L/tn, ~ / Zip Code: Value Preliminat'y Inspection is $15.00 (prior to installation of insert) 1I00d Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge + ~.45 administrative fee + $10.00 issuance ~ $26.20 total Type of Inspection Requested: &eC/ A'7 "oh"'~ y /9!y. /7~ ~- ,,~ ~..:-<;:-.><- Con nac tor: Address: Phone ~: Ci ty: State: Zip code: Construction Contractors ~~gistration #: Expires: By signing .this .permi t/application, I agree to call for inspection(s) as required (726-3769). I state that all the information on' this permi t/application is correct and .tha t I vas provided \Ii th the 1I00d Stove Safety. informa tion for \Iood burning appliances and preliminary inspection standards. I further state that the appliance .1 am installing meets smoke .emission standards as set by the Oregon Department of Environmental Quali ty or the Federal Environnrental Protection Agency and I agree to provide the. tes t ing approval number to the inspec tor a t the, time of ins pee tion. I also understand that if I am requesting a preliminary inspection, the \Iall covering. may be required to. be removed. 1}~/ YIJ~J.~t- Signature 1/ /;,s he, .Date ======================================================================================= FOR OFFICI.> USE REQUIRED INSPECTION(S): ~OODSTOVE2PELLET~SER1:> Date of I\pplication: Ir/'-~ Total Amount Collected: /c:;;-- PRELIMINARY - y Job #: q~/ $""Gz .~hecked for Deliquencies: Checked Issued By: .d~ for "istori~~l S~tus: . Receipt II: ;<"3J~