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HomeMy WebLinkAboutPermit Mechanical 1998-10-22 . .. .~;J;llll(cJ~I=lHFJ;I3ii!) . UOOD ~TOVE/INSERT INSPECTION .APPLICATION . CITY OF SPRINGFEILD BUILDING SAFETY DIVISION 225 Fifth' Street Springfield, Oregon 97477 Office: 726'-3759 INSPECTIONLINE;- n6-3769' .' - . I - . e:f;C\ \'d-\1\n1(\P.. ~ 'h ...... . ~ Assessors Hap ~: l'7n?t1oIQ -~- Ta;; Lot {: -0/&11- Ouner: L,/-JIlJ!lV&. Job Loca t ion: .- C4~Nl~Jf . Address: ~()1 N1J~Tt;lillDG~ Ave . PhGi\~.s~: 74/-1./006 f~/low lV'l'to . Ci ty: SPa /) State: D if 'J'1.t(/ic.f:/{;'MsO-~4/. 7 ? . 1/ O.q~ 70f/ C. "uo/)t "'07 'il Value of \lood Stove/Pellet Stove/Insert: /.~lJ'DOP 0090. ....9$<-ooeflISI', ~ObYfT}Wre9I1ir. '. . . '-'<lllif/ -</ 'nil)! T '00 T 0 f10Sfl r. fI Oreg fIS YOII l -- preliliiinal'y Inspection is 515.00. (,pd9f to installatf6'lb~~f-%t~el?tl~il/'?rO/JgJ1~s~r. Of/Utili,O . Uood .Stove/Pellet/Insen Permit is $15.00 + $.75 state S~<9l~et!'(1\1.<;'~fIl~~S'e';~l.lfve fee + 510.00 issuance = 526~2 ot~ ~ ttflf/fer' Ore,., Offl'ffo Olfl)~ 9$<-0,,1'/1) ~ IS T "of/'," 'fI . ~ r,., uF_ . <:. (II . 'Sa VlJZ't <file "'fIS b Type of Inspectio~n ReQ.~ste' 0 0 \,,~ q'3&,~'YlVo...'?ho,,~ ~ ~\ .' . n \I \'c::::.... - ......""t4) "~<NiOI] Con tl'ac tor: \! ":\..l "r . Addrese-. \l. .' \.L). ~ 1J()fL, Pho~e ~: . ~~. '. \ \~! City: u....-:L{2r\~... State: (Q.JLj Zip <;ode:4 )cq{JJ.-; Const~uction ~~tractors 'Regi'su'ation fi: I~& Expires: lrJ.'7 t) .~ ,By signing .this ~el'mit/ap~)i'ion. I agree 'to' call for inspect'ion(s): as required (726-3769). I state thatr~~l ~Qe information .on this permit/application is correct and .that I vas providec;ltUv'i'{lf'~AShe \lood Stove Safety' information for vood burning applia?ces ari.d prel~mintR.'''I:iLrw,g~<!.t~~n, standards.r ~u~thers tate.. that- the appli?-nce I am lnstalhng' meets .smql$e. .emt.sslolll ~landard:;as set by the Oregon Department. of. 'Environmental Quality /o'rr}fi~1tF,ed~i:'al':',J>'hV'3:~",ental Protection Agency and I agree to provide the. testing appro,fa~".d;}Mn()'~r,"'to"'li,t.h~ !,fl1;W..ector at the time of inspection. I also understand that if I am 'f~9Ue'~t!t~~ ~QiJi~l.'finI~['y inspection, the vall covering may. be L-equi L"ed tei. be removed. ,'tll')t? . VDO~ '1r/s ~ . ~. \ _ /l .. .' ~D"'O-'Y4'or . ,.j )),~If ~ UJ..~ . /1) ~ d;? ,-- tf 4 .srg ature\j- .Date . ,. . . mc=c==~=c====~========e=====c=e=~==============~===========~=========~============~==== FOR.OFnC!; USE REQUIRED INSPECTION(S): \lOODSTO~,ET/INSER~ Date of Application: .10 .M..~, . . . Total Amount Collected: c{) (O.-4f ) Job ff: PRELIMINARY- qr)Jn~_ 0'. ,;;{;,{V) ~) Recei p t jl:~\~~ -co Issued '-Checked. fOL" Deliquencies: Chccked for' Ilistori.cal Status: