HomeMy WebLinkAboutPermit Mechanical 1996-10-9
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SPRINGFIELD
VOOD STOVE/INSERT INSPECTION
CITY OF ,SPRINGFEILD
BUILDING SAFETY DIVISION
22~ Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
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Job Location: \tJ\..A "=r (\j\.U. N\ D\r)
Assessors Mapg:' - \~~"Q.f)3~ _ t\. . \ ~
Ol/ner: ~~~ *- 'fI\n 1I'f'i \l:;u,\ j.J'vc
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o\Jto~ellet ~tf-{) ~
Preliminary Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge + $.45 administrative
fee + $10.00 issuance = $26.20 total~. (\ ~ ~
Type of InS]iOn ReqUested:~ Ul 10\00 ~\s,e21::!
Contractor: l)~ \
Address: Phone &:
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Tax Lo t g:
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Value
Ci ty:
State:
Zip <;ode:
Construction Contractors Registration ft:
Expires:
By signing this permi tlapplication, I agree to call for inspection(s) as required
(726-3769)~, I state,t.ha.t a.ll the. i~~~~ma}i.o.n o~}his p~~mit/a~~:ic&a~tion is ~~rr~ctlJt.\
and th1t.. Ll. ~.~ 'f'\C'O.... .......(;.... ........~ ..I...:. _!_ _ _ .,.If;'.....1!t)' l.....v......~. __ r unn,.l rR1Ag1
.-;I!)!) 1 ;.nr~~ "'..~ ... ~:'~"'~"~.J ~"'.)"~~'<~""" ":~..~Qrd~. I further s ta te tha t the appliance
I am installing meets smoke emission standard::; as, set by the Oregon Department of
Environmental Quali ty or the Federal Environmental Protection Agency and I agree to
pr~vide the testing approval numbeL' 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 removed.
o .-l-. 'l,. I 'lib
Date
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. FOR OFFICE USE
REQUIRED INSPECTION(S): V~STIVE ELLET/~SERi )~ELIMINARY
Date of APplication:llJ. . q I ~ Job II: 0\ \.0 f 0 s I
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'~hecked for Deliqueneies:
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Checked for Historical Status:
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