HomeMy WebLinkAboutPermit Mechanical 1992-8-10
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SPRINGFIELD
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VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Offi<;e:
INSPECTION LINE:
726-3759
726-3769
Assessors Map
Owner: ,f)~/VI/W/A
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1I: \~ffio5a4-
Tax Lot 1I:
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Job Location:
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Address: /0,2'7 1l0~ ~
City: +),/;'#..11"/./ State: (jj(
Value' of(\lood Sto~Pellet Stove/Insert:~&; m./)O
(please cire1e appropriate appliance)
Phone 1I: 7t/t. -3 -<).:zg
Zip: 97Y7ff
Preliminary Inspection is $15.00 (prior to installation of ,insert)
\lood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $1.25
Type of Inspection Requested: ~ -I~~~jI~~;f~~
Contractor: 415(1~ (I/;/;'~/11//./ v&A'LL~b
Address: /0, ;!j~ 2::? <7Jt,f/
state surcharge.
Phone
1I: 9::f7- 3 936-
Zip: 97</1);t.
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Construction Contractors
State:
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Registration 1I: ~q)PO~
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 \lood'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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Signature ' 0
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Date'
FOR. OFFICE USE
REQUIRED INSPECTION(S):~O~S~)PELLET/INSERT ~
Date of Application: K . \C)q~, ' Job lI:
Total Amount Collected: ,~. '1S '-- ,1 -
Receipt 1I:5~2. Issued By:r-J\U\f\
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PRELIMINARY
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Checked for Delinquencies:_
Checked for Historical Status: