HomeMy WebLinkAboutPermit Mechanical 1990-1-8 ::./ 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: cD 0f) B ~Ct~j)_Y, -\t J f} J J / Assessors Map #: )f)O?;~4l\.\() Tax Lc0#: ():y)~_ owne~ \_C'~ SL ~\~c1()m' . Address: cOr) ~R ~ 1: j)'(f)\t )\ \ I,~ Phone t:~!2l G ~~3f) IL]- City:~~. .~. state:~()r$YI Zip: q~ll Value of. .od Stov;)Insert: ~ \ ~.c:cJ \J (pleas cin:.1i appropriate~pplianCe) , Preliminary Inspection is $15.00 (prior to installation of insert) Wood Stove/Insert Permit is $15.00 + $0.75 state surcharge Type of Inspection Requested: \~. S~~-' Contractor: t':... n_~ :::sIIJt.R _ Address: Phone #: ,....- City: --.. State: Zip: .-- Construction Contractors Registration #: I""" Expires: By signing this permit/application, I agree to call for an inspection(s) as. required (726-3769). I also state that all information on this application/ permit is correct and that I was provided with the Wood Stove Safety information for wob~ burning appliances and preliminary inspection standards. " _ )\gnatu~\))\s&~ l- <6 - ~ Uate FOR OFFICE USE REQUIRED INSPECTION(S): ~D ST~NSEBT L-- PRELIMINARY, Date of Application: . (-- ~g() . Job #: ~l)<\\D\ ::::;p~:~nt\~~t~:~\ ~s~;: t~fu / . "---/' - .. -.- - .> V-' Checked for Delinqu~ncies: Checked for Historical Status: f..-./'-