HomeMy WebLinkAboutPermit Mechanical 1990-9-10
YOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Ofhce:
INSPECTION LINE:
726-3759
726-3769
Job Locatlon: ~r;7 I UwzOklL !JuJL
Assessors Map 11' /8 -0 z.. '0 & . J J-
Owner: t-tJA0/r] Ii fJlrtr}-L
Address: .:jY7/ (I j; l/)o/uL.- J.J2itiG
Slid State: /)12
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Value of Yood Stov ~?7 ~u
(please circle
Tax Lot 11: () /q () ()
Phone
11: 1LJ;./Z /~
Zip: q7l177
Ci ty:'
Preliminary Inspectjl~is $15.00 (prior to installation of insert)
Wood Stove/pellet~~rmit is $15.00 + $10.00 Issuance + $1.25 state
Type of Inspectlon Requested: /Ju~~~ i 1121i!Jj- ShrvL
Contractor: 1-t.f1/,)) -rfLh J_+d, (V
Address: di/J~\ ;;;;!1.U!A I!A
.~/
surcharge.
Phone
11: 5L/J-'~\-7r;-7
Zip: tf1t.!o/
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CIty:
State:
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ConstructIon Contractors Registration 11: F. LI;J. c:; 5
v.
Expires:
By signing this permit/application, 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 Yood Stove Safety information for wood burning
applIances and preliminary inspection standards. I also understand that If I am
requesting a preliminary inspection, the wall covering may be required to be removed.
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SIgmitur'e.' . "
FOR,OFFICE USE
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Date
, '
Y~. STOVE/PELLET/INSERT (/----- P~:~~_____
LJ'Ii) .qu Job (11:, /())/Jrj ~~ ___
$i!;';;JS ~,--,- /'
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Issued By: II.IlJ~
V
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REQUIRED INSPECTION(S):
Date of ApplIcation:
Total Amount Collected:
ReceIpt 11. ) 1:J 3 Y
Checked for DelInquencIes:
Checked for HistorIcal Status