Loading...
HomeMy WebLinkAboutPermit Mechanical 1993-1-22 SPRINGFIELD VOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LINE: 726-3769 I y {" L.j Q \,{ lIA tJ I+- Sf- Assessors Map #: 17D 320":::>2.... M e rr-~ I \ B u. v j..e.....- Address: \ t.\ \0 L\ G.lv() \II. o.J + 25f- City: SOft oi State: 012- I ' Value of \/ood Stove/~llet Sto;~sert~ Jf~1 on ,00 (please circle appropriate appllance) Job Location: Tax Lot II: 01 2-d:) Ovner: Phone II: I Lj7-DR-7~ Zip: '1 7L/ 77 PreliminarY.Inspection is $15.00 (prior to installation, of insert) \/ood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + ~state surcharge. ,1~ Type of Inspection Requested:'/V1S-r-o. (( cchllVi Contractor: !i-8(' ~ f.h., ..'^ \i\.LJ SP('\I:( P Address: rp 0 ~OJC 2-35c)Co Phone #: H-u f+) ~ q ~7-/~==>'q'J Zip: q7L/n7 ;:;-1'5 - q:~ (-r."rl Ci ty: ~ 11~ P.1r..J) _ Construction Contractors State: D12-. Registration II: 77-; &0 to 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 vas provided vith the \/ood Stove Safety information for vood 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 ap al number to the inspector at the time of inspection. I also understand that : f am requesting a preliminary inspection, the vall covering may e requir moved. /112/73 Date FOR OFFICE USE REQUIRED INSPECTION(S): \/OODSTOV~iT/INS;o V PRELIMINARY -'2--2--CJ?;; ---JOb II: Q30D\..p7 ZC:). 7~ Date of Application: Total Amount Collected: Receipt II: I~I sr Issued By: (Gvv. '" Checked for Delinquencies: --- Checked for Historical Status: ---