HomeMy WebLinkAboutPermit Mechanical 1999-4-26
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WOOD STOVElINSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION - BUILDING SAFETY
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Assessors Map #:
Tax Lot#:
00/'10
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Address:
Contraclor:_tJlJ /VJI'/.,
Address:
City:
State:
Zip:
Construction Contractors Registration#:
Expires:
By signing this pennitlapplication, I agree to call for an inspection(s) as required (726-3769). I state that
all infonnation on this application/pennit is correct and that I was provided with the Wood Stove Safety
infonnation 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 Prolection .Agency and I agree to provide the testing
approvall\umber to the inspector at the time of inspection. I also understand that if I am requesting a
pre~~ ins~'on, the wall covering may be. required to be removed.
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Slgn1f1rre . . Date
FOR OFFICE USE
REQUIRED INSPECTION(S): WOODSTOVElPELLETflNSERT
Date of Application: i{/ U, I'i' "I Job #:
PRELIMINARY
Total Amount Collected:
L(I. ~
Receipt #:
990 ft. ('
05 $ /,5 r Issued By:
a.ftJJ
Checked for Delinquencies:
Checked for Historical Status: