HomeMy WebLinkAboutPermit Miscellaneous 1996-10-24
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VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
,726-3759
726-3769
...
:Job Location: ~ '1 {)[) ~ $(10 t-
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Address:'~_of)() I.. \.~ _ . Phone:
CityJ::OO.-N', State: l\JAoQJYl Zip Code:
Value of' v1J~tove011~Stove/€se~ ~ I PiY).oO
Preliminary Inspec tion is $15.00 (prior to' ins talla tion of insert)
Vood Stove/Pellet/Insert Permit. is $15.00 + $.75 state surcharge + $.45 administrative
:::e + o:l:~::e:::::n::q:e:::~t. 'xO~Q ot ,~sed
Contractor: 0~f).CX~~ M.1I- \ tlf!1nQ,t\
Address: ,II') \~ \ll\\SO-U Phone~: ~q..q~
City: ?YjQc5 JI() State: ()1L rJip COde:Jll4t1 L..
'Construction cont~actors Registrati~n, #:- loll-z.,~xpires: Q ~~fl
Tax Lo t
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By signing this permi t/application, I agree' to call for inspection(s) as required
(726-3769) . I s ta te tha t all the information on this permi t/applica t ion is correc t
and ,that ~ ..=-:- ;=-:..:--!~ ..~"'h 1:1~~::.::!:' :..::fdrm::ltion fnr uQQrt. burning
app.l:.:.:.:::. :'::'~._~l'~,~pec"M '~I:'lm'<tards. I further state that the appliance
1 am Instaiiing meets smoke ,emission standards as set by the Oregon Department of
Envi ronmen tal Quali ty or the Federal Environmcntal Pro tee tion Agency and I agree to
provide ,the testing approval number t~ the inspector at th~ time of inspection. I
also understand that if I am requesting a preliminary inspection, the wall covering
may be required to be removed.
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Date- -.
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FOR OFFICE USE
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Da te of Applica tion: lD ./) L\-. to ' Job #:
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PRELIMINARY
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Total Amount Collected:
Rcceipt #: 6.05\0
Issued
BY~)
'-Checked for Deliquencies:
Checked ror' Historical Status: