HomeMy WebLinkAboutPermit Mechanical 1991-11-1
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth S.treet
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: 3~ f~l\fH~J. t ~mv. . .
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Owner: ~ 't \ ~ ~ 9- 1\ ~ ~. \',().r\ ~ (H ~ .
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Value of 10d- Stov:;p\bet Stove/Insert: f\ ClJ \j .
(please circle appropriate appliance)
Preliminary Inspection is $15.00 (prior to installation
Vood Stove/Pellet/Insert Permit. ~15.00 ~ $ .75 state
Type of Inspection Requested: ( J(\ Q \ ~ ffi f
of insert)
surcharge + $10.00 Issuance.
Contractor:
Address:
Phone ti:
City:
State:
Zip:
Construction Contractors Registration #:
Expires:
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 Quality 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
V\Jll'ffll. ?/Z'7" ,.((-/ - 7/
\ ~ FOR OFFICE USE
'"
REQUIRED INSPECTION(S): VR~S:OVE/PELfET~RT PRELIMINARY ~
Date of APPlication:j{ ,\\QtJ j \'-+'\1JOb #: C\ \ \ a L\n
Total Amount Collected: \~. '---/1 '
Receipt ti: ~~~ Issued By: ~ m .)
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Checked for Historical Status: ~
Checked for Delinquencies:
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