HomeMy WebLinkAboutPermit Mechanical 1995-6-25
.
..
YOOD STOVE/INSERT INSPECTION
CITY OF SPRING FEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Assessors Map #: J7.-A~ -:7?-~'Z
O...neL': TJ/pMAU=; ;:3/'-3 y"'S~.A;/
;
Address: /6,ffr? m6J0'/'7
?7rz:'9-
Value 0~60d Stov~Pellet Stove/Insert:
./,t:;i!50 ;P/!?e"5c~7T ?..~E
Tax Lot #:~?5'~
Job Location:
City:
State:
LA' -
~~ . Zip Code:
/~......:=:.
Phone: #:
7 "2&-/9Ji?/
"7' ;??E? '7
Preliminary Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge + $.45 administrative
fee + $10.00 issuance = $26,20 total
Type of Inspection Requested: ./:%IrE "~~/~ I~".~'? ~E .
conu-actor:~~hI P ~.P~~' ,7{P/~q/~/I/?~ .~~
Address: -::? 2 / "1'0 ~C/ ~ 67; Phone It: ?t.//-~~
- i . .
City: ~??~7j State: ~;;q. . Zip Cpde: q74/?~
Construction Contractors Registration #:)t'::3~.-=? Expires: /2....~-95"'
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 ...as provided ...i th the Vood Stove Safety information for ...ood burping
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
Environmen tal Quali ty or the Federal Environmen tal Protec t ion 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 ...all covering
may be required to be removed.
I
CO'2':f- .Q5
Date'
===============================================================================
,
"
FOR OFFICE USE
REQUIRED INSPECTION(S): ~DSTO~/PELLET/INSERT ~ PRELIMINARY
Date of Application: 6'-?7'~ Job #: 1':::~:2"3
Total Amount collected:
'26. -;;>-
Checked for Deliquencies:.
Checked
Issued By: /2~.;~;--
for Historical ;~tus: '
Receipt #: /~