HomeMy WebLinkAboutPermit Mechanical 1993-8-26
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Job Location: to \ 7.n ~Lu~ S+--
Assessors Map #: 170Z-~U ::., )
Ovner: ~Ou.)Af1\.. L~rrT IJ.1LrTOU!.;;.
Tax Lot #: c:s '--I 0 ('J
Address: ~ I ZO MAIO "
City: Sp,cU) State: r:'lR
Value of Vood Stove6ellet Sto~/Insert: '"2....39,
(please circle approprlale appliance)
Phone It: 7t/eo - 11 17
Zip: q7lf7)
*
Preliminary,lnspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $.15 state surcharge.
-
Type of Inspection Requested: 1-, t\JAL
Contractor: r~,:: IJn'L,\ lO<\.H7-I20Cl"li\I\ J
Address: <"-7"'- UJtl(&)
~ n - (") 'lil
Zip: Q,467
III q~
I
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 remov~
.r;~~~ ~~<'MT'~~L.&Y~Q lfi"'J'- tip' -.!J,lC. 1-lj~9J
SIgnature I ' Date '
FOR OFFICE USE
Phone #:
City:
(.::, IC EA.J c,:::
State:
rJll.
Construction Contractors Registration #:
'5:' '7 'ZL ("\
Expires:
REQUIRED INSPECTION(S): ~SERT ~
7' C;
Date of Application: <x ~ _AD -- 1?:; Job #:
Total Amount Collected: '1.h.1?
PRELIMINARY
q 3/ 2--, '1
Receipt ft:
\ e-ol,?
Issued By:
~
Checked for Delinquencies:
~
Checked for Historical Status: ~"