HomeMy WebLinkAboutPermit Mechanical 1989-11-22
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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: ?;'1 () 0()\()~\G. Q \:In\ \~
Assessors Map D: \ '10 O~~ I ~
Owner: ~ \ ~C\j:c\ I\. ~ \\(\ IL'C<)
Address: 'f),,~ ('CJ\(}{\\(t ~ C\e__
City:~Y'\\~ f~ \ ~ State: (Y? ,
Va 1 ue of Wood Stove/ nsert., l { Om. C)Q
(please circle a oprlate appllance)
Tax Lot H:
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Phone H:
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Zip: ql4l1
Preliminary Inspection is $15.00 (prior to installation of insert)
Wood Stove/Insert Permit is $15.00 + $0.75 state surcharge
Type of Inspection Requested: ~~Jl~
Contractor: ~ \ k~Q If\Q~)
Address: ~~h~ \ \ f\\\)-~~( ~hone D:
City: EuOJl f\J2 -' State:' Zip:
Construction C~tractors Registration D: -vso.. 5\ ~ Expires: 3/{)O/(1/\
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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 application/
permit is correct and that I was provided with the Wood Stove Safety information
. for wood burning appliances and preliminary inspection standards.
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REQUIRED INSPECTION(S): WOOD STOVE~
Date of Application: ,\- ~~.Rq
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FOR OFFICE USE
PRELIM I NARY
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Job H:
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Total Amount Collected:
Receipt D: \~ 4\ 4
Issued By:
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Checked for Delinquencies:
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Checked for Historical Status:
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