HomeMy WebLinkAboutPermit Mechanical 1991-1-29
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VOOD STOV~/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Job Locatlon:
~{L.~tJ r!HE"/alJ/6f[. DR.
Assessors Map 1I: /t::<-02....ob-/<'
Owner: ~u cOU--li!../.{ .
1 .
Address: ,90 g-<;j :J. hWN Lo P
City: J..~J;tS~ State: of
Value o/"Vood ~tov"lA,ellet Stove/Insert: / ,;;S-O
(p~~ppropriate appliance)
Tax Lot 1I: C?//tt:'tP
Phone #: .5.3 t, .;;;J. [{ L/-L
Zip: 9773.7
60
preliminary Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $1.25
Type of Inspection Requested' ;:;~~~
Contractor: MrD.c.LF."~ t:LA"",c.,
Address: 409 )/,~J-.( ~-r. -
Clty: ~t=:~
state surcharge.
Phone
#: ..3';'3-1/3)
Zip: 9'71-0 I
Construction Contractors
State: (:)/!
Registration 1I: J q 3. L tJ.-
Expires:
/0-~-91
By signing this permit/appllcation, I agree to call for an inspection(s) as required
(726-3769). I state that all information on this application/permit is correct and
that I was provided with the Vood Stove Safety information for wood burning
appllances and preliminary inspection standards. I also understand that lf I am
requesting a preliminary inspection, the wall covering may be required to be removed.
~~ fL ()~
Slgna ure -
, () FOR OFFICE USE
1-.J-'1- '1 f
Date
REQUIRED INSPECTION(S):C:VOODSTO~ELLET/INSERT )(' PRELIMINARY
Date of Application: /-.2<3-9/ Job 1I: 7'/~P?t::::'
Total Amount Collected:~,~;;--
Checked for Dehnquencles:
Issued By: ~~~
Checked for n,storical Status'
Receipt #: /~~~;;?