HomeMy WebLinkAboutPermit Mechanical 1990-4-2
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SPAa'ELD
WOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: :Z3? '7 c.e~
Assessors Map #:\l()~?"l \'2.,(} Tax Lot
Owner: F.4.J.;C , I HJ4R L(') &oJ
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Address: ?".., 11"""rd' ~tJ.,3~ ~",\",~one #:
City: Sv~\r\ State: C)::7
Value of Wood Stove/Insert: ,
(please circle appropriate appllance)
~;n"ry I~EP~'~ is $15.00 (prior to installation of
Wood Stove/Insert Permit is $15.00 + $0.75 state surcharge
Type of Inspection Requested: ?L~~l...t~
Contractor:~ \ ~
Address: Phone #:
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City:
State:
Zip:
Construction Contractors Registration #:
Expires:
By signing this permit/application, I agree to call for an inspection(s) as
required (726-3769). I also ,state that all information on this appl ication/
permi is correct and that I was provided with the Wood Stove Safety information
'for 09 burning appliances and preliminary inspection standards.
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FOR OFFICE USE
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Date
REQUIRED INSPECTION(S}: WOOD STOVE/INSERT
Date of APPlication:l\ -(_ -~()
Total Amount Collected: \S OD
Receipt #V //01 G Issued By:'-\ ~ ~(' A -::::--
PRELIMINARY ~'
Job #: qCl')~W_
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Checked for Delinquencies: \ \[~.
Checked for Historical Status: