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HomeMy WebLinkAboutPermit Mechanical 1991-12-17 ~ .. ..' SPRINGFIELD VOOD STOVE/INSERT INSPECTION APPLICATION: CITY OF SPRINGFIELD ",' BUILDING SAFETY DIVISION '. JI1f1't., , . Of~fit;.~;~f.?~:-3759 . INSPECTIONtINE~'Jt!72 6-3 7 69 225 Fifth Street Springfield, Oregon 97477 Job Location: /1"> 9,.., . L,'NdCi . l.N Sov-,';\/~'p/d . V . Tax Lot #: ~(5'CY/ Assessors Map ft: /$ -t::>z -c>0e5Ci' Ovner:, L J19RR)/ .... fO.u.lf'I fA )f[,:r:.;::;/? Address: /1")9n L/N'cJa LA/ ~"''ii+?e1d_Phone II: City: ',. c:;:.PFLD State: ,6R Value' of Vood Stove/Pellet Stove/Insert: ~. 6 00 (please circle appropriate appliance) 72(g -099.~ Zip: 971/77' preliminary Inspection is $15.00' (prior to ,installation of ,insert) Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $~state surcharge. ~I\So.(Jeq_' '~.'7)' Type of Inspection Requested~ hilt ()LIKJ{;. .,::{;!? f)EuET L.u'~.:r . Contractor: (tUBr,:&7nA 1<;: \PiUl,c;=:S.<; l~lI4~ . (' H;mrJl9- ~ltU:; Address: 7,,, F l\?'''"' Plpne II: Qo(4-QS'"'R'7 City:L~)c-i='Il~~State: n Zip: ([71./0J- ,Construction Contractors Registration ft: (~")72X" 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 vas 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. /"u/~ ~. Sidfdature '1 g i~ Date' .;7-,9/' FOR. OFFICE USE REQUIRED INSPECTION(S): VOODSTOVR1PE1LET/INSERlrJ~ Date of Application: 1;;:'-/7-9/ YO.7~ Job ft: PRELIMINARY ~ q//c;!tbB " Total Amount Collected: Re~eipt #:.'3'7"36. Issued By: ~~~---=> '/' " t- - -~- Checked for I1istorical Status: Cliecked for Delinquencies: " ...,.~l.'