HomeMy WebLinkAboutPermit Mechanical 2003-7-29 (2)
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CITY OF SPRINGFIELD, OREGON
225 filTH STREET. SPRINGFIELD, OR !J7477 . rH:(54 I)726-g75g . FAX: (54 I)726-g68!J
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Value of Wood Stove/Pellet Stove/Insert: "Z '[ 0 0
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City Job Number Lavvr eoe:. J - 0 0 b 7 '7
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17032532.
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(please circle appropriate appliance)
Preliminary Inspection is $45.00 (prior to insert)
Wood Stove/PelletJlnsert Permit is $62.65 (inclndes Per~, Issnance Fee, State Surcharge & Admin Fee.)
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Contractor Information ~ \<l> O\'!J <f><i:I Cil~'I; ~o'l> " I
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By signing this permit/application, I a~ee to call for an inspection(s) as required (726-3769), I state that all
information on this application /pennit is correct and that I was provided with the Wood Stove Safety
information for wood burning appliances and preliminary inspection standards as 'set by the Oregon Department
of Environmental Quality or the Federal Environmental Protection Agency a d I agree to provide the testing
approval number to the inspector at the time of inspection, I also unde at if I am requesting a
preliminary inspection, the wall covering may be required to be re S ~~
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Slwed Drive(f:)lBuilding FonmlWood Stove Penmtl.(l).doc