HomeMy WebLinkAboutPermit Mechanical 1993-7-15
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
771?
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Tax Lot 'It:.LS 2& c)
Job Location:
Assessors Hap 'It:
Owner:
Address:
Phone 'It:
City:
State:
~
Zip:
974/5'5
i:"
Value of Vood Stov~ellet Sto~nsert: ';),0 C9 0
(please circle apprOprlBnre appliance)
Preliminary ,Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $.75 state surcharge.
Type of Inspection Requested: ,.,c;~-- ,~,-'~
Contractor: '~~./ ~47
Address:
City:
&&""/V6
State:
t':X ,
2,7
Phone II: ~S~- '74{~L
Zip: 5' ?..erJ~i
Expires: /~.3~
Construction Contractors Registration 'It:
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 understan at if I am requesting a preliminary inspection, the wall covering
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~igii'aV're / . -c Date'
/ FOR OFFICE USE
I,
Date of Application:
VOODSTOV((PELLE~NSERT
1//5/93
I I.,', 1r
~s,
~ PRELIMINARY
REQUIRED INSPECTION(S):
Job 'It:
Q<nJo3
, -- - -
Total Amount Collected:
Receipt 'It:
Cj5/7.
Issued By:
C---.
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Checked for Historical Status:
Checked for Delinquencies: