HomeMy WebLinkAboutPermit Mechanical 1992-9-2
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VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
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Assessors Map #: /?o~ 26:. / '3
Owner:, JJ2~ L/2 ~ r-r z-:,. /
Address: (/ X Y h/{'. . -<:;i.
City:. ~4/..;,~/du'/{J
Value ~06d St~~pellet Stove/Insert:
(please circle appropriate appliance)
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Job Location:
Tax Lot #:
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State:
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Phone #: :7..<.:/ .?: ---- ( -:r~,( -> ~
Zip: P7 ij '7 "7-
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state surcharge.
City:
State:
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Zip:
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Construction Contractors Registration #:
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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 vas provided vith the Yood Stove Safety information for vood 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 vall covering
may be required to be removed.
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~ 'Signature , ,~ ~OR OFFICE USE
Expires:
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Date
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REQUIRED INSPECTION(S): YOObSTOVE(ftLLET/INSERT) "V-- PRELIMINARY' 'L./"
Date of Application: , Job#: 92/'7 ~ 7
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Total Amount Collected: 40,/S'
Receipt # : (~/mJ Issued By: #~
Checked for Delinquencies: V' Checked for Historical Status: ~