HomeMy WebLinkAboutPermit Mechanical 1990-6-20
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STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
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225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Job Location: '\[1 \ ~ ~J ~,\; \ )~)., ~ ~\\ ~ ..
Assessors Map #: \ 'I D?1Q4J\~ Tax Lot #: ()4'ltD
Owner: Thf:i"\c:L \"{\ L~
Address: '\~ \ ~ ~tl~ \ ~ lliJ
City: ~ r\ _ ,\ State:
Pellet Stove/Insert:
appropriate appliance)
Phone #:
(W C'1f)\\
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Zip:
C\'\L\-flrJ
Preliminary Inspection is $15.00 (prior to installation of insert)
"'ood Stove/Pellet/Insert Permit is $15.00 + $0.75.s~ate sUrCharg~~~ C"'~.o
Type of Inspection ReqUested~~ 9J!_::)-\O.J\C1./mDI \ ~ O\U-J~
contractor:\ ~ f\ Y \\(1 "- n ~
Address:
Phone #:
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City:
State:
Zip:
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Construction Contractors Registration #:
Expires:
By signing this permit/application. I agree to call fo~ 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 "'ood Stove Safety information for wood
burning appliances and preliminary inspection standards. I also understand that
. inary inspection, the wall covering may be required
(p~ajq7J
Date
to be
L
FOR OFFICE USE
~
Signature
REQUIRED ~NSPECTION(S):~OODSTOit/PELLET/INSERT
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Total Amount Collected: \ ~.I\ S
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PRELIMINARY
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Date of Application:
Job #:
Receipt #:
Issued By:
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Checked for Delinquencies:
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Checked for Historical Status: vi'