HomeMy WebLinkAboutPermit Fence 1990-2-20
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SPR'NIELD
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: 5~?!5 1:A-\~ ~ dl \~
Assessors Map #:
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Address:3&~ ~\0j l~~
City:, ~\n:)::\e.-~ State: Dr-
Va 1 ue of 60d St~/Insert: fd:::x:::>. D~
(plea~~ ~irf1e appropriate appliance)
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Tax Lot #:
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Phone #: t;2.b 0&CJ,
Zip: ~Y':I~
Preliminary Inspection is $15.00 (prior to installation of
Wood Stove/Ins.ert Permit is $15.00 + $0.75 state surcharge
Type of Inspection ReqUested:' IAJ7JOr1 ~
Contractor: (-Y{)6c1 OUd., !IJJ)-& Pf()~S
Address: G3~;).. m~ ~I .
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Phone #:
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City:
State:
Construction Contractors Registration #:
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Zip:
Expires :J- )CI=::-q 0
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
. ~WOOd b~OapPl~ces and preliminary inspection sta~~J-O_ 90
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FOR OFFICE USE
REQUIRED INSPECTIDN(S)~O~ ~INSERT
Date of Application: rl.~O.L{T)
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Job #:
PRELIMINARY
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Total Amount Collected:
Receipt #:~ r
Issued By:
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Checked for Delinquencies: ~'
Checked for Historical Status:
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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: ~~3Q{5 . Lxz..\~ ~ ~ '.")J-
Assessors Map #:
0t>rlr~J~\~\c-\' ~r
Tax lot #:
cn+1~
;:
Own~D(\O-\d. ~, O-"-~
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Address: 3&2>5 ~\0j l~~ Phone #: "'"bl66&Cj,
City: ~,n\e.-d State:-Dr- Zip: q,y:,~
Value of ~Od 'Sto /Insert: ld:::o. D5'
(plea~~ ~lrc e appropriate appliance)
Preliminary Inspection is $15.00 (prior to installation of
Wood Stove/Insert Permit is $15.00 + $0.75 state surcharge
Type of Inspection Requested: IAJ1)Or) s,~
Contractor: (1D6rJ Ot4L f/;'lJj-~ {JffJdlUJJ
Address: G3~~ m~ Y1-.
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Phone #:
10& -Ud-;)..t
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 application/
permit is correct and that I was provided with the Wood Stove Safety information
, for wood burnin~\appliances and preliminary inspection standards.
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REQUIRED INSPECTION(S): WOOD STOVE/INSERT \2J PRELIMINARY
, 06
Date of Application:
Job #:
I
Total Amount Collected:
Receipt #:~ r
IS, 1,t:)
Issued By:
. -
Checked for Delinquencies: ~
Checked for Historical Status:
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