Loading...
HomeMy WebLinkAboutPermit Mechanical 1999-3-24 . 21/,) 0 . IS ,0 0 IV' fO--' . lil.j)il WOOD STOVElINSERT INSPECTION APPLICATION CITY OF SPRINGFIELD COMMUNITY SERVICES DIVISION - BUILDING SAFETY 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LINE: 726-3769 Job Location: /~o //PIft!-l~A /7039--'J.-1; LAI, Assessors Map #: Tax Lot#:_J5 S () 0- Owner: /n/W&..=-f; IWAUAoJ.J rlAl4A . ki,.,/..."C' . Address: &0 I /:J7' A~ J 0). oJ, Phone#:-Z-i 7 - 5' 74' n ""1" SHA'-L EXPIRr l.ETHr- 'J'("""iv City: S AJ.tz.l State: rV .' ""c" -Zip:. "~., ii."z;z -;'-{ ,. - - In.., -"HIII 1..JlllVI Value of Wood StovelPellet Stove/.lnsert:....-.~ . --~)(Please circ.lef1~~'il:1iiPP1ianCe) '----_~,__.... _ iINY'-Hm Oil Y PER/Ot.\. Preliminary Inspection is $15.00 (prior to installation of insert) Wood StovelPellet/Insert Permit is $15.00 + $ .75 state surcharge + $.45 Administrative Fee + $10.00 Issuance. Type of Inspection Requested: f"Zle-eJ72!!!.iJJ};; IAIM~~~~~ (I.o// k4i8'eTl] --, laW reQuI. - n U\ili\)' Contractor: /J1/~.\ ,."nN..ore9~~'ll\"le ore9~.r "A\ 10,-\\"1 .-f' ~u}esLadOIl"" se rUle" ~p; 952'OU \- Address: / & 7 e A~:N ~7.en\6l' '~~tOU9\"1 O~~e ,!/1\61ij#'! ~ </3 -//.1/ _ NO\ll\Go'9\2_00~ _uu '':' ~ cOllies u. . iell\'lone . J-.. J/ . O~f\ nb\a\ '/./4- \\"Ie\e '. \" ,n 97 -/rJ City: L---I/lq, ,n. '." nStak . <"""'.'" ll"O.,hcal31p: ",I'F I 009U. .' to. \\'Ie cen\";~90J' U\\\\\~ 44).~' /~ Construction Contractors Registrati6i\tz 6Il~ ~~-3::Ex~i}es:Y <!p (0 /2D.~7 nu{"(\ center \..:::-~. _- 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 rorrect 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 Department of Environmental Quality or the Federal Environmental Protection Agency and I agree to provide the testing approvall\umber to the inspector at the time of inspection. I also understand that if I am requesting a preliminary inspection, the \vall rovering may be required to be ~moved_ / ~ nO'. \ . Date~iJ<!kt; FOR OFFICE USE REQUIRED INSPECTION{S): ~DST~ELLETIINSERT V'" PRELIMINARY Date of APPlication:')/ .:2.~'9 ,7' lob #: 9 7' /,/) "5 '7 ? Total Amount Collected: 20,2'.0 Receipt #: Issued By: Checked for Delinquencies: -' / Checked for Historical Status: