HomeMy WebLinkAboutPermit Mechanical 1990-1-8
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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
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Job Location: cD 0f) B ~Ct~j)_Y, -\t J f} J J /
Assessors Map #: )f)O?;~4l\.\() Tax Lc0#: ():y)~_
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Address: cOr) ~R ~ 1: j)'(f)\t )\ \ I,~ Phone t:~!2l G ~~3f) IL]-
City:~~. .~. state:~()r$YI Zip: q~ll
Value of. .od Stov;)Insert: ~ \ ~.c:cJ \J
(pleas cin:.1i appropriate~pplianCe) ,
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: \~. S~~-'
Contractor: t':... n_~ :::sIIJt.R _
Address:
Phone #:
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City:
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State:
Zip:
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Construction Contractors Registration #:
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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 wob~ burning appliances and preliminary inspection standards.
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FOR OFFICE USE
REQUIRED INSPECTION(S): ~D ST~NSEBT L-- PRELIMINARY,
Date of Application: . (-- ~g() . Job #: ~l)<\\D\
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Checked for Delinqu~ncies:
Checked for Historical Status:
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