HomeMy WebLinkAboutPermit Miscellaneous 1992-9-9
SPRINGFIELD
VOOD STOVE/INSERT INSPECTI
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Job Location:
7247
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Tax Lot #:
0200'0
Assessors Hap #:
Owner:
Address:
Phone #:
City:
State:
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Zip:
c:;J 74"78
Value of Vood Stovel~ Stov~IInse~
(please circle appropnate an:~,...~.;)
Preliminary ,Inspection is $15.00 (prior to installation, of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $1.25 state surcharge.
Type of Inspection Requested: /.?Ai'?/.//n -/ tul);!)lJ~101/5
Contractor: /:AVf7:;-r <mJ/(~ ffP 15./~~ (<;i'cE-~ (.:A"~\ Cir dee)
1~7) t:A.J.r ~ 0 Phone #: -?I~s- -OS.3J
Zip: '5'?46 2-
Expires: ~~B/,~
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By signing this permit/application, I agree to call for an inspection(s) as required
(726-3769). I state that all information on this application/permit is correct and
that I was provided with the Vood Stove Safety information for wood burning
appliances and preliminary inspection standards. I further state that the appliance
I am installing meets smoke emission standards as set by the Oregon Department of
Environmental Ouality or the Federal Environmental Protection Agency and I agree to
provide the testing approval number to the inspector at the time of inspection. I
also understand that if I am requesting a preliminary inspection, the wall covering
;a2~ilo ;/2' Date 57~~2-
Sl~ature ' i' ~
Address:
City:
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State:
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Construction Contractors Registration #:
FOR OFFICE USE
REOUIRED INSPECTION(S):
Date of Application:
VOODSTOVE~LL~T/INSER1)
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PRELIHINARY
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Job #:
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Receipt #:
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Issued By:
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Total Amount Collected:
Checked for Delinquencies:
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Checked for Historical Status: