HomeMy WebLinkAboutPermit Mechanical 1998-9-3
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11000 ~TOVE/INSERT INSPECTIO, ' ATION
CITY OF SPRINGFEILD . THIS PERMIT SHALL EXPIRE IF THE W
BUILDING SAFETY DIVISION AUTHORIZED'UNDER THIS PERMIT IS NOT
225 Fifth SU"eet COMMENCED OR.IS ABANDONED FOR Office: '726-3759
Springfield, Or-egon 97477 ANY 180 nAY PERIQO. INSPECTION LINE:- 726-3769
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Job Loca t ion: .::;; II ~r titr.s (;..1,0(,1
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Assessor-s Hap ~: /7 /l ,~,). 7', ~
Ovner-: Selh .~()u LP
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Address:6.J \ <rO~ Glev.. 1y
City: .~ ~~('Nl-'(~. State: (),(
Value of 1I00d Stove/Pellet'Stove/Insert:
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. Ta;: La t ~:
IO~dO
Pho~e: ~';1t"~~02J.,. ,,<LjC7~/yfJ I
Zip code: '
______,Preliniinal"y.lnspection -is 515.00 ,(pdlir .to instilllation
lIood .Stove/Pellet/Iosen Perinit is 515.00 + $.75 state
fee + 510.00 lssuance ~ 526.20 total
TYP~ of Inspection R'eQue~~ed: (Vt?O (\. '- Itlv.p
Contr-actOl:: 6()Il;C(\tJftl. N]p71J!."
Address:':;:?2cMiGh -
Ci ty: ilp ~ tWfWIJ.
0-'. insert) _. _... "'
surcharge + ~.45 adminiitrative
Phone
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o C:LI
Construction Contractors
state:[)y{
'Regi'stration ft: 'z.t 7q 3
ZipC;ode: '
Expires:
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. By signing ,this pel"mi t'tapplica'tion, I agree' to. call fOI: inspection(s) as required
(726-3769). I state tha t all the informa tion ,on this permi t/applica tion is correct
and ,that I vas' provided vi th the \lood Stove Safety' information for vood burning
appliances arid prel~minary inspe<;:fffl!Nft~andards. I ~l\rther,s ta te" tha t- the appliance
I am installing' meets smoke .em:itelf~n !H!lIiQfflgtml~r~r ~the Otegon Department- of,
. Envi ronmen tal Quali ty or the Ff%~Ii&l~~~t;alhe'tfflJ~e I;Jft Agency and I agree to
provide the. testing approval ~'1\~%dea ~rii'i!lOS$F6llis n WtYtime of inspection. I
also unders ~and tha t if I am r_'!~f{i~lPoa-Qfl:l~th~e\A 1l~~l9tf:l1on, the vall covering
ma~, e requl red' to, be removed. " ou may obtain copies f, 9 2-001. ..
. , , Calling the tenter (N ' 0 the rules by ,
m numberfortheo . . ote:.~hete/ephone ,/ !
- . ~ . or . . Center is ;~~~~3~~~~ ~otif;cation1/ ? 19 .
S"lgna tUl"e ' ' , 31>IHe "
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CCCCC=7=======================~============================~=========~=================
REOUIRED INSPECTION(S):
FOR OffICI; USE
\/OODSTOVEI PELLET IINSERT WnJ Sf.UJl
<<II J /f'~
I 2.-c. w
Job II:
PRELIMINARY.,
0/25/ID9
.afJ !JJ
Date of Application:
To tal Amount Collec ted:
Re~'eipt II: 3t '505
Issued Dy:
'-Cliecked, for Deliquencies:
Checked for Histori,ciil Status: