HomeMy WebLinkAboutPermit Mechanical 1991-6-5
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
Job Loca tion .:::<fpZ-3 ChvM-rlt-e. <:::...
Assessors Map It: (1 () ZO~ /? ~
Owner: :\P,m e..- Ye-rk-lJ/t~
Address: "2,/0 Z- '3 ~ /Y'uke- 'Dr
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Tax Lot It: () 2AfJ1'Y~
City:
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Value of Vood Stove/Pellet Stove/Insert: t.j(j) - QZ)
(please circle appropriate appliance)
State:
Phone It: 7Lf7 -0133
Zip: -97L(7'?
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: Pf.tLi)z;1.)'Y1..d/ro
Contractor: p,/-(;;--h'liltJ @7/e-,,.' ,
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Address:
Phone It:
City:
State:
Zip:
Construction Contractors Registration It:
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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Date
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FOR OFFICE USE
Total Amount Collected:
Receipt It: W~
VOODSTOVE/PELLE~N~~KTl
1,,- c;-1/ Job 1I:
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PRELIMINARY
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REOUIRED INSPECTION(S):
Date of Application:
CllC,cked (or Dehnquencies'
Issued By:
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Checked for Historical Status'
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