HomeMy WebLinkAboutPermit Mechanical 1996-10-3
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VOOD STOVE/INSERT INSPECTION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Ol.'egon 97677
Office:
INSPECTION LINE:
726-3759
726-3769
...
Job Location:
.'
Assess
O\lnel.':
City.
State:
Phone: U:t44- .3~f)'L
Zip Code: U~Arl!
Address:
,.
Value
Stove/Insert:
\\
Q.;
Preliminal.'Y Inspection is $15.00 (pl.'ior to installation of insert)
Uood Stove/Pellet/Insel.'t Permit is $15.00 + $.75 state surcharge + $.45 administrative
fee + $10.00 issuance = $26.20 r\tal
Type of Inspection Requested:~
Contractol.':
Address:
Phone C:
City:
State:
Zip Gode:
Construction Contl.'actors Registration U:
Expires:
By signing this pet'mi t/application, I agree to call for inspection(s) as required
(726-3769). I state that all the information on this permit/ap~lication is correct
and that I \las' provided \Ii th the '\Iood Stove Safety information for \lood burning
appliances and preliminary inspection standards. I further state that the appliance
I am installing meets smoke emission standanJs as set by the Oregon Department of
Environmental Quali ty or the Federal Environmcntal Protection Agency and I agree to
pr.ovide the testing approval numbel.' to the inspector at the time of inspection. I
also 'understand that if I am requesting a pl.'eliminal.'Y inspection, the \lall covering
may be l.'equil.'ed to be l.'emoved.
.~~ b~O
W/3/Q (p
Date
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. FOR OFFICE USE
REQUIRED INSPECTION(S): \I00DS~VE/PELLET/INSERT
Date of APPlication:jD.O'\.i\l.P
\~po
Job U:
PRELIMINARY ~
~\P\~~
By:~\Ii0
Total Amount Collected:
Receipt U~~
Issued
,.
"Checked fol.' Deliquencies:
j
Checked for Historical Status: