HomeMy WebLinkAboutPermit Mechanical 1997-11-7
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SPAINCFIELO
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\1000 ~OVE/IN5ERT INSPECTION.APPLICATION
CITY OF SPRINGFEILO
BUILDING SAFETY DIVISION
225 Fifth' Street
Springfield, Oregon 97677
Office:. . 726'-3759
INSPECTION LINE:- 726-3769
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Job Location: 3.2/5: !?ACEI6/-fwooD AVE
Assessors Hap ~:
. Ta>: Lo t ~:
Jg~o
17YP~ -"72 -J";j
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ovner:5'-rr::v~tJ J, ,<;:/ R4uc..H
RAL~ I G /-1 WOO E)
Stat~: nR
Value o~od StOV)/Peliei:.Stov~/OO
Address'- 3;;(/c;;-
City:,\'PFLD
. '.W' fP'K"fO-: 7.'1.20 .
Phone: ~:.j.( '7ZG.-'i!;(S"7'
Zip Code:' 97<./77.
Preliminary Inspection is $15.00 (pd9c'to installation o~ insert) . . . ....:..___.
Vood .Stove/PelletlInsen Permit is $15.00. + $.75 state surcharge + $.65 adminis.trative
fee + S10.00 'lssuance 'c $26.20 total . .
Type of Inspection R~que~{ed: 4'.......eh /~~~P/" }V~ .-5'/'2>)--;' ~..~~:-
. .'. ,.,. 7- , .
Con t....ac to....: ORJ~A
Address: Phone ~:
Ci ty:
S ta te:
Zip .<;ode: .
Construction Contractors 'Regtstration ft: .
Expires:
By signing .this penni tJapplication, I agree to call for inspection(s) as required
(726-3769). I state that all the information .on this permitJapplication is correct
and .that I. vas. provided vi th the \lood Stove' Safety' information f.or vood burning
appliances and prel~minary inspection standards. I 1;urther ..state... that- the appliance.
I am installing' meets smoke .emission standards as set by the Oregon Department. of.
. Environmental Quali ty. or the' Federal Environa,ental Protection Agency and I agree to
provide the. testing approval number to the inspector at the time of inspection. I
~;t9"~:;~tand tha. .' f.I am requesting a p....eliminary inspection, the vall covering
m~'Z:l eremoved. / ;1/d'T/97
-Signa ture (- / .Date
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ccac==~==c====c================c~c===================================~=================
FOR OFFICE USE
REQUIRED INSPECTION(S): ~STOVE~ELLET~SERT).
Date of Application: //,7-9"')
Total Amount Collected: . t-I/, <,c:>
Y PRELIMINARY -. V
..- -' ~
Job ti: ~ ?/~C:>.c,
Re~eipt ti: <'?'9.;;--~
Issued BY:~A~~_
'..,:-. ,
Checked fo..... llistori.cal Status:
'-Checked. for Deliquencies: