HomeMy WebLinkAboutPermit Mechanical 1993-9-15
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Job Location: ,~~ 3 c'S'" 'n,aI..~ J
Assessors Map #: \ ~ ('>r;z ~ ~ ("[)
owner:c;Pe-..,a-t>> L-+ ~ 2),,9-vvv<-.e
Address: .5~,~~ 5-- ~~~
City:--S'~ ~J:) State:.m..---ll7 h
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Value of Vood Stove/Pellet Stove/Insert:
(please circle appropriate appliance)
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
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Tax Lot #:\ ~C'y"
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Phone #: J t!/ ) - J? / ~ -2-
Zip: 9'> ~ > :sf
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state surcharge.
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Preliminary ion is $15.00 (pr~o installation of insert)
Vood Stov /Pellet;Jnsert Permi t is $,1f\OO + $10~ Issuance + $.75
Type of Inspection Requested: \ JV 0 ~Q<L)\
contractor:"71L~~Yhz<!-C1~~;I- .@~_
Address: ~ () ~ d4 91 U ,Phone #:
City:~ State:@v ZiP:C\'\~l.\()?
Construction Contractors Registration #: l\ (0 ~):::\ Expires: \() ! '22" \ q3-
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 was provided with the Vood 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 ~f
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 wall covering
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Signature ~ Date
FOR OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVE ~ NSERT ~ PRELIMINARY
Date of APPlication:C\ - \ S l' " JOb~: q~ \ L\ \ /
~ '15 -- ,
Total Amount Collected: \ ,,) . _ ~
Receipt #: \ LfI.6 9> Issued By: ~ \.----.)
Checked for Delinquencies:
Checked for Historical Status: ______