HomeMy WebLinkAboutPermit Mechanical 1993-9-8
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VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION "
Offi,., ~
INSPECTION LINE: 726-3769
;
225 Fifth Street
Springfield, Oregon 97477
Y Assessors Map #:
Job Location: /gw M{V\lo [JJDvJ Cv r[YViherd
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Ovner: ~tA.'(C f cA$e~ GVO~0LA{r
Address: I~ ~eVllo (j)Or
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Value of Vood Stove/Pellet Stove/Insert: >< *
(please circle appropriate appliance)
Preliminary.Inspection is $15.00 (prior to installation of insert) ,
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $.75 state surcfiarge.
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Tax Lot #:
Phone #:
14-1..()l/Jo8
014-/7
City:
State:
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Zip:
Type of Inspection Requested:
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Contractor:
Address:
Phone #:
City:
State:
Zip:
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/permit is correct and
that I vas provided vith the Vood Stove Safety information for vood burning
appliances and preliminary inspection standards. I further state that the appliance
I am installing meets smoke emission standards as set by the Oregon Department 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 preliminary inspection, the vall covering
may be required to be removed.
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Signature I Date
FOR OFFICE USE
REQUIRED INSPECTION(S):
Date of Application:
9-~ -93
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" Job #:
PRELiMINARY 93/ Jet;
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VOODSTOVE/PELLET/INSERT
Total Amount Collected:
Receipt #: 1t0!"~.J,
Issued By:
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Checked for Delinquencies:
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Checked for Historical Status: