HomeMy WebLinkAboutPermit Mechanical 1996-4-17
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YOOD STOVE/INSERT INSPECTION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
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Job Location: .1;08 k.~11J..,+hIAIA/k LA!
Assessors Map #: /7'eJ ~ '::<?-~2 Tax Lot #:
01Jner: J!IJ '5. <; f- / I/-nr{P", son
Address: SOl( ~k L AJ Phone: #:
City: ~r/n;/J;;.11 State: & Zip Code:
Value of Yood Stove/Pellet Stove/Insert: i; 9t?5 ~
"
L5:J 26' e:::> P
74'~- 77~<
Of7CJ77
Preliminary Inspection is $15.00 (prior to installation of insert)
Yood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge + $.45 administrative
fee + $10.00 issuance = $26.20 total
Type of Inspection Requested: ~j~
Contractor: YJ,/tl- ~i/I' S.Defl/;,lj;f
/
Address: ~f'Cj'I(~ jt.~':5A c-S f-
City: 5"'J.--/7W1 State: (()~
Construction Contt"actors Registration #: 9dm 7
Phone #: g-y,4 -3505
Zip ~ode: C?7(/7 Y
Expires: 7/9t:::
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 permit/application is correct
and that I lias provided IIi th the Yood Stove Safety information for IIood 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 Quali ty 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 IIall covering
may b required to be removed.
(f)~k-_
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/J0y../ 7, ?~
bate//.
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FOR OFFICE USE
REQUIRED INSPECTION(S): YOODSTOVEtttLLET/INSERi> ~ PRELIMINARY
Date of Application: 7"'/7-"%" Job #: ~P'7':::>25'
Total Amount Collected: 26.7~
Receipt >>: 2//7'"3
Issued BY:~~
/-
Ulccked foi Historical Status:
~
"Checked for Deliquencies: