HomeMy WebLinkAboutPermit Mechanical 1990-10-1
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VOOD 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: cQ\Lt?J \C\~ )eo ,3 I
Assessors Map II: \1\ n ~~ f\ \(")
Owner: <-~l lU ) ~(J \ ~\\\\
Address: A)~r \ () i ')m ,
CitY:~~\!X\I ~ State: r0f_)
Value of Vood Stove/Pellet Stove/Insert:~ I,!:J qq CO
(please ci rcle appropria te appliance) ) ^ ,
Tax Lot
II: ()\P{X)
Phone II: f\4\ -A4na
Zip: .Qri--r1
Preliminary Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + ~ state surcharge + $10.00 Issuance
$/.]6
Type of Inspection Requested:
Contractor:
Address:
Phone #:
City:
State:
Zip:
Construction Contractors Registration II:
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 Vood Stove Safety information for wood burning
appliance nd preliminary inspection standards. I also understand that if I am
requestin a preliminary inspection, the wall covering may be required to be removed.
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Date
FOR OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVE/PELLET/INSERT
Date of Application: \f). \ ,q()
\~90
Job #:
PRELIHINARY
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Total Amount Collected:
Receipt
II: l~4D\
Issued By:
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Checked for Delinquencies:
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Checked for Historical Status:
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