HomeMy WebLinkAboutPermit Mechanical 1993-6-7
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE:<:726-3769 ~
Preliminary.Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $.15 state surcharge.
Type of Inspection Requested: ~I\~ ~:~
Contractor: '~JA/C-",r~-f Qr..J"'o~
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Job Location: \ 14 ~ (~I J " V'\cJ1-/..,
Assessors Map D: I J 0;"::;) (,,4-'
Owner: '~nc:.....n,. ~ 0 VY'\("A/\ ~ f,)
Address: I \ (u,.., (J\ A', VV'A 0 I.>
City: ~pv: .V\e ,Q.eJJ".e State: ("1<..
Value of Vood Stov~pellet Stove/Insert: P\.Q. _ E. .,,~,
(please circle appropriate appliancey- .
Address:
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State:
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Construction Contractors
City:
Registration D: I 00 ~7)
Tax Lot D: ('J J () {")n
Phone D: {'-/I ~:J.'~31
Zip: q~)l-i-J)
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Phone
D: 2,4<\ -??Oc:;-~
Zip: Q7l.f/) I
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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 Vood 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
mar~equired to be removed.
'{/;;:;.....A~~ 7Y1 /:~~/ 0h Iq':;;.
,Signature' Date
FOR OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVE/PELLET/INSERT
Date of Application: CoI'lI'??. Job D:
Total Amount Collected:
) c., nO
Receipt D: S?5? II
Issued By:
DR
Checked for Delinquencies:
................
Checked for Historical Status:
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PRELIMINARY K
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