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HomeMy WebLinkAboutPermit Mechanical 1990-2-5 ( i "~fj4'W\- WOOD STOVE/INSERT ~NSP~CTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETr :QIVISION 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LINE: 726-3769 Owner: Litl:J:?- &india Map #: 17- ();)- ~~~ --3cj , .' I j{fi}hVJ f16vd ftrn i~ ../ ( Tax Lot #: Dt.jcj(J r Job Locati on: Assessors Address: City: forrlevvv:L State: fJt, Value of vlood Stove~s;;;) g6c.gJ;- (please circle~~iate appliance) Preliminary Inspection is $19.00 (prior to installation of insert) Wood Stove/Insert Permit is $15.00 + $0.75 state surcharge Type of Inspection Requested: ~~~~ Phone #: Zip: Contractor: 1571mJh __ - - Address: Phone #: City: State: Zip: Construction Contractors Registration #: Expi res: By signing this permit/application, I agree to call for an inspection(s) as required (726-3769). I also state that all information on this application/ permit is correct and that I was provided with the Wood Stove Safety information :8~~:i~ and preliminary inspection sta:~:~~~__?o 1 gn-'u;~TU<'~ FOR OFF ICE USE REQUIRED INSPECTION (S):. W~D STOV~ . Date of Application: J, 6-~' 3/)/76 L/ PRELIMINARY ~ q (JDlt;!/J Job #: ~ Total Amount Collected: Receipt #: j5Cj(p I Issued By: ~iJA1;J_ Checked for Delinquencies: V' Checked for Historical Status: v' ( WOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: .726-3759 INSPECTION LINE: 726-3769 Job Location: . 4L/;}:;2. f/tfilt.J.. iCL- Assessors Map #: i7--0;;"- 0if -3L( j{aJ1u.J ~ fi lJ yd fIm jd~ C Hy: PurI-/evncL Value O~d St /Insert: / DDtJ . ~ (p circle appropriate appliance) Tax Lot #: 0 L/ L/ () ,\ Owner: State: Phone #: c3JCf-5-37;;2. (':1:!YJ) Zip: Address: {)JL Preliminary Inspection is $15.00 (prior to installation of insert) Wood Stove/Insert Permit is $15.00 + $0.75 state surcharge Type of Inspection Requested: l j) oDdr hru-e- Contractor: roJ~ Address: Phone #: City: State: Zip: Construction Contractors Registration #: Expires: By signing this permit/application, I agree to call for an inspection(s) as required (726-3769). I also state that all information on this application/ permit is correct and that I was provided with the Wood Stove Safety information for wood burning appliances and preliminary inspection standards. UA1tM g~ ) S, gnapre c?-5" -7 CJ Date FOR OFFICE USE REQUIRED INSPECTIDN(S):~ ~/INSERT Date of Application:' ;:;}-s--qo Total Amount Collected: ~ DD Receipt #:~S~ Issued By: V' Checked for Delinquencies: v PRELIMINARY q DO / &/tJ ., Job #: IS 7S- Checked for Historical Status: v/