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HomeMy WebLinkAboutPermit Mechanical 2001-10-5 . -. SPAINOFIELD WOOD STOVE/INSERT INSPECTION APPLICATION , CI1Y OF SPRINGFIELD , "COMMUNITY SERVICES DMSION - BUILDING SAFETY ',. 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759, INSPECTION LINE: 726-3769 Job Location: 2 "'Z, /...I, QodN.0 I Assessors Map #: 170::> Z7 z- Z. D~n Mi\\ev Address: '2 "3 4 ~ K'oJ..'N~ c +, City: .:sp'f\~ +1eJd.., State: 0((, Value o~ StovelPellet ~ 2 So 0 r:t I . Tax 1ot#: 03300 Owner: Phone#: 74/-200t..( Zip: .t j, (please circle G......v...:ate appliance) Preliminary Inspection is $45.00 (prior to installation of insert) , \.. Wood Stove/PelletlInsert Permit is $61.75 (includes Permit, Issuance Fee, State Surcharge & Admin Fee). Type of Inspection Reqnested: New -+I'~\ac.e. ~+ (..+_~ -cl-elyer.ce /...1v<.cw 9.t$kvv-, Contractor: Cli\'(\"'::> \N\y\<S.\OW D.IS.A. V-e otd. IOv-l^- S~p AddreSs: 8\q()$ ~'\J\?SOVl ~~, Phone#: -T2.c...-,3&2- City: C>t-es v,->e.l \ State: oR Zip: 9,L( 2.. Co Construction Contractors Registration#: ' 5 2 38 (Expires: / / 10 / z DO 'Z. . ' By signing this permit/application, I agree to call for an inspection(s) as required (726-3769). I state that all information on this applicationlpermit is w..~. and that I was provided with the Wood Stove Safety information for wood burning appliances and prelimin.'Y inspection standards, I further state that the appliance I am installing meets smoke emission standards as set by the Oregon Department of :....:.v ment.l Quality or the Federal EIIvironmenta1 :'.v~_";on Agency and I agree to provide the testing approval number to the in.,...._:.... at the time of inspection. I also understand that if I am requesting a ' preliminary inspection, the wall covering may be required to be removed. ~ :::>- ;.' ~~ Signature /~/.5 /01 Date r FOR OFFICE USE REQUIRED INSPECTION(S): WOODSTOVElPELLET/INSERT v;;;.IM1NARY Date of Application: / r ~I Job #: 0 (-0 (() '7 5 - (:) I Checked for Delinquencies: - Checked for Historical Status: / :J> :3: -I -I '=' ::0 :J> :J> ;0 -I :z: n1 rr1 co C"J.. # .0 00.. :::D ..,no (i) r-..J-I........ ::c I I--ICJ~oo I'Tl ::c U'1 0 :::IJ:DO" 0 .. Z"""""'-JCi' om- 0....0 0" rrl -..J C) ......... ......... .. t.n..........s-' VALIDATION: