HomeMy WebLinkAboutPermit Mechanical 1995-5-8
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UOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Job Location: 1L/7o AAJPc;tL~ LN.
'11 (J1-;'1/t t.{()
Owner: ~ AMES. COOK
Address:J:1jO ~\, L,/t...)
Ci ty :<:::;'f'tlJA.JC" I~)t:-l.() Sta te: C) .
Value of Wood Sto~tove~se~ Ls~7Q.O
~liminary Inspection is $15.00 (prior to installation of insert)
Uood Stove/Pellet/lnsert Permit is $15.00 + $.75 state surcharge +
fee + $10.00 issuance = $26.20 lftal
Type of Inspection Requested: f/1Z..6 rL GAL
contractor,J(qAi) .cr"5t(~AL' C~"'n...\
Add ress' 30;1. s;- I11Gw o.ej ~ . Phone
City: E.u~E" ' State: OR- Zip Code:
#: q~"i,21
Assessors Map #:
Tax Lot #:
(JZ8J()
Phone: #:
-7t/i>... (p 7Cf 7
4)t../7'7
Zip Code:
$.45 administrative
#: CO~- 37.2.~
cnl/o if
Expires: '2/9f.o
,
By signing this permi t/application, I agree to call for inspection(s) as required
(726-3769). I state that all the information on this permit/application is correct
and that I was provided wi th the Uood 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
may be required to be removed.
Construction Contractors Registration
~~ ~'Al1:!"'1 ..'J;:,C 11/1 l' W'l S-
~:::::_~~~:::ooo::oooo:::::::::::o:ooo:::::oo:o::ooo0:::0::
FOR OFFICE USE
'REQUIRED INSPECTION(S): WOODSTOV~L~NSERT ~ PRELIMINARY., ~
Date of Application: C?,. g...q0- , Job #: q(O(oO?
{}I. d1J
I'
Total Amount Collected:
Receipt
#: or1Uv
K
Issued By: ~J1;yI
Checked for Historical ~ta~ ~
Checked for Deliquencies: