HomeMy WebLinkAboutPermit Mechanical 1994-7-21
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SPRINGFIELD
YOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: :77~ .A/~~/de;~
Assessors Map #: /'7273 2r::. J 2- Tax Lot #:
Owner: L A4?~ J/ /M,,~.'#A)
Address: 7 -7-f //~?f1e/'l"v:;'?, Phone: #:
City: -s: V~ State: /1X'" Zip Code:
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Value of Yood- Stove/Pellet Stove/Insert: -'?~?, )'9
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7../7 <?~ 7.5
77~77
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
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Contractor: ///A-7~t!).?Z:??/("A"'~,.~J c;r- /Jk'~~.
Address: ~"tJ, ....-c;,)-><' "74 )'/1"')
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J:2,te:r-2Vc- State: Q.(
Construction Contractors Registration #: &5"tJ5 Expires:
Type of Inspection Requested:
,
Phone #:
City:
Zip Code:
9'7.4/)-2...
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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 was provided with the Yood 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 approval number to the inspector at the time of inspection. I
also understand that if I am requesting a preliminary inspection, the wall covering
may be required to be removed.
VQr:-w.L l )~;11\ n - '7 -;;f - 97
/" Sl~narvl'e' <...~V..... Date
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FOR OFFICE USE
REQUIRED INSPECTION(S): YOODSTOVE~T/INSER~ ~
7/2//Qc:L - Job#:
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Checked for Deliquencies:
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Checked
PRELIMINARY L----'
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for Historical Status:
Issued By:
Date of Application:
Total Amount Collected:
Receipt
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