HomeMy WebLinkAboutPermit Mechanical 1994-10-26
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YOOD 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: J 2.oCo C"0Li.I\.lALI <;',
Assessors Map #: I 7 0 ~ d. Co L.J II
Owner: AJ~ Al 'f- ';K.U (AWl"'" l4c..t
Address:_/7_t'\C_ GLl4./r ~'T"
City: S~J2./A1(IF'FL(\ State: {;n
Value of Yood Stove~let Stove/Insert~
-
Tax Lot #: 5q 00
Zip
00
7 <: 'R7-
Phone: #: 77(",,- }?(Jol/
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Code: Q7'-h"/
Preliminary Inspection is $15.00 (prior to installation of insert)
Yood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge + $.45 administrative
fee + $10.00 issuance = $26.20 total
Type of Inspection ReqUested:~E ct b'YA,. - MI4S<,>^-)au F/f
Contractor: &/ PH u..lt=c OJ'PjG( _ ( OA1'7'I2.d('"T'f'It)t I
Address: ~/<:" u]'U:if'A_l \. Phone #:lc..'i1' ( -r-,9..b.-R""
City: r---'l(.t'::AJ(.::. State: rJ.o Zip Code: Q7c.{())
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Construction Contractors Registration #:__C7~\-~--L--- Expires: 1~(qLi
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By signing this permit/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 \Jas provided \Ji th 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 \JaIl covering
~be required to be removed.
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~~ . I Date I
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FOR OFFICE USE ~
REQUIRED INSPECTION(S): YOODSTOV~L~0~ / PRELIMINARY. V
Date of APplication:~4 a:J- q L( Job #: q4 j &5 7
Total Amount col1ected~ 41- 20
Receipt #()/ 5;:)3~ /-
Checked for Deliquencies:
Checked
ISS~ /1UL~
for Historical Status: ~