HomeMy WebLinkAboutPermit Mechanical 1992-11-16
SPRINGFIELD
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YOOD STOVE/INSERT INSPECTION APP
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Job Location: "'nq~ 5)~ rL-edurOlJd ---or-N"€...
Assessors Hap II: ] C)( 0 -z...O G II
Owner: ~ A--J -;-SVV\ UJ k d-e-
Address: 3,0'3 s- e-€,j wa:=d))y- Phone II:
Ci ty: Srf-I Jl State: ~
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Tax Lot II:
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124 z--c;r::;O
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Zip:
Value of Yood Stove/Pellet Stove/Insert:
(please circle appropriate appliance)
Type of Inspection Requested:
Preliminary.Inspection is $15.00 (prior to installation of insert)
Yood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + ~state
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surcharge.
Contractor:
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Address:
Phone II:
City:
State:
Zip:
Construction Contractors Registration II:
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 Yood 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
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FOR OFFICE USE
Date of Application:
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Job II:
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REQUIRED INSPECTION(S):
YOODSTOVE/PELLET/INSERT
Total Amount Collected:
Receipt II:
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Issued
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By:
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Checked for Delinquencies:
Checked for Historical Status:
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