HomeMy WebLinkAboutPermit Mechanical 1994-10-10
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WOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
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Assessors Map #: J/~-::r-''"::;sI-<~
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571C'c.P State: P/-=r~
Value O~1, c:;~l1et S~Insert: '2?'C!>C::>
Preliminary Inspection is $15.00 (prior to installation of insert)
Wood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge + $.45 administrative
fee + $10.00 issuance = $26.20 total
Type of Inspection Request~d: P~'~~ ~~ -~~~~
Contractor: #~ ? l:!!5cc..~S JtPr ~ ~
Address: ,"P O. ,~~X- 279/6 Phone #: A%'7j'.....5<'/C>
City: ~~~#'c State: ~.-:(- Zip Code: q? :/DL
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Construction Contractors Registration #:$.?~ Expires: ~-<~...c;:;: V
Job Location:
Tax Lot #:
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Owner:
City:
Zip Code:
7'-/;)-~ 5~a
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Address:
Phone: #:
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 Wood 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 bi1:~':~; b00::d~
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Signa ture Da te
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FOR OFFICE USE
REQUIRED INSPECTION(S): WOODSTOVE~LLBlIINSERT
Date of Application: IO~/"'~ . 9'/
Total Amount CoHee ted: 2C~ 2er:>
PRELIMINARY
Job #:
9~ /5"5/
Checked for Deliquencies:
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Issued By: .~~-
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Checked for Historical ~tus:
Receipt #: /~~<;