HomeMy WebLinkAboutPermit Mechanical 1990-2-5
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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
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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 __
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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-~'
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PRELIMINARY ~
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Job #:
~
Total Amount Collected:
Receipt #: j5Cj(p I
Issued By:
~iJA1;J_
Checked for Delinquencies: V'
Checked for Historical Status:
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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:
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