HomeMy WebLinkAboutPermit Mechanical 1996-10-16
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SPRINGFIELD
VOOD STC>VEIINSERT INSPECTION
CITY OF SPRINGFEILD
BUILDING SAFET. DIVISION
225 Fiflh Slreel
Springfield, Oregon 97677
Office:
INSPECTION LINE:
726-3759
726-3769 .
...
Job Location:
.'
Assess
.O\lner:
Address:
Phone:
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City. State: Zip Code:
Value Stove/~ Lf)~
preliminat'y Inspection is $15.00 (pdor to installation of insert)
Uood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge +
fee + $10.00 issuance = $26.20 total
Type of Ins ection Req ested\; ~O~~~'<t"~
Contractol.': * ~ .
Address: ~() ~~~\1)_
City: h.)f\Q1\L - 'St~te:~OO-
Constl'uction Antl.'actors Registl.'ation~ ~~U Expires:
$.45 administrative
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Phone c:J.0K6.32-\0
Zip Gode: -Q:14.~
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By signing this pet'mi tlapplication, 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 \las provided \lith theUood Stove Safety information for \lood burning
appliances and preliminary inspection standards. I fUl.'ther state ~hat the appliance
I am installing meets smoke emission standanb as set by the Oregon Department of
Environmental Quali ty or the Federal Environmental Protection Agency and I agree to
pr.ovide the testing approval number to the inspector at the time of inspection. I
also 'understand that if I am requesting a pl.'eliminary inspection, the \lall covering
may be l.'equil.'ed to be l.'emoved.
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Dale
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REQUIRED INSPECTION(S):
VOODSTOVE
FOR OFFICE USE
ELLET/INSE~ ~
,
Date of Application:
10 -({()-
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Jot> II:
PRELIMINARY
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Total Amount Collected:
Receipt
II: :2'31ifs
Issued Dy: -I~
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Checked tor Jlislorical Slalll~:
'~heckcd [or Dcliqucncic~: