HomeMy WebLinkAboutPermit Mechanical 1991-1-2
SPRINGFIELD
VOOD 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 Locatlon: 2/7,' -r,{,& .:2ioC:; 'X
Assessors Map ft: ( ~ 0 z. 0 C{; f Z--
Owner: M v: -1'" Mv<;, Q LA '; ck-
Address: 6D~ ~ r-flA ur)
CitY:~I~ State:
Value okllo.od Sto~Pellet Stove/Insert: :$13.150 - c5D
(please circle appropriate appliance)
Tax Lot ft: 6ll aD
Phone ft:
Zip:
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Preliminary Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $1.25 state surcharge.
Type of Inspection Requested:
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Glove
Contractor:
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Address:
Phone ft:
City:
Zip:
State:
ConstructIon Contractors Registration I:
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 Vood 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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FOR OFFICE USE
REQUIRED INSPECTION(S):~ODST~/PELLET/INSERT ~
Date of Application' [- Z- - CZ I Job ft:
PRELIMINARY
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Total Amount Collected: 20 zh
Receipt ft: /Cf,{)!{) Issued By: f1~
Chcckcd for Dellnquenclcs ~ Checked for HistorIcal Status ...---
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