HomeMy WebLinkAboutPermit Mechanical 1990-10-23
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VOOD STOVE/INSERT' INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
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Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: I ~I.-IO J{.e..,ki/1 Bftll.
Assessors Map #: 11 o~ 2.144
Owner: \2.nl,uw+ !f,).uev
Address: \~y() ILJ,IIJ
City: crV1~1p I,} State: Oe...
Value of Vood Stove/cf\!lleC~ve/tiiFert) fl.{ 1770. c5D
(please circle appropriate appliance)
Tax Lot #: ()]OZ>/
Phone #: 7zfn -7q (pC-,
Zip: 07'-177
Preliminary Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 +.. state surcharge + $10.00 Issuance
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Type of Inspection Requested: 9V.p./'I'M;I/lf.l"t.~ ~.-finpJ
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Contractor: r. Cli+^\/I .
Address: '2,.11; r::_ :2,~ .t\1Je.....
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City: 8ut1.P.iA0 State: 0 tz-
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Construction Contractors Registration #: c-:, 777.9:
Phone #: Lf K r..) -90 't3
Zip: Cc7'-1.05
Expires: 5? - q I
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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Signature - - - Da,te /
FOR OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVE/PELLET/INSERT ~ PRELIMINARY
Date of Application: 16-2:S-CZu Job #: Clfl/7..95
Total Amount Collected: 4 I .2-6
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Receipt #: I q qX-d
Issued By:
Checked for Delinquencies:
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Checked for Historical Status: ~