HomeMy WebLinkAboutPermit Mechanical 1990-11-5
--
--...
..--
SPRINGFIELD
"., '
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
Job Location: /53tt::> L./A/DE;;Y 4v~
Assessors Map II: /?-t:'"3-<7-~2
Owner: /.?/C#-/RP ~/Y~
(
Address: /5' X> U~/:e.-;;"; #V'~-
.. .
City: ~~F?b_- State:~).!:?' L
'Value of :Cod Stove/:ellet Stove/Insert: \ l{Jm
(please circle appropriate appliance) ,
Tax Lot II: &>c>"7~8
Phone II: ?~::<>I~
Zip: Q:?<,I'7?
-
(freliminary I!}i'lpp,:tion l~ C:;1'i..o.o (odor to inst"lla~f'>n of ins~rt' ">
Yood Stove~llet/lnsert Perm1t)Js $15.00 + state surcharge + $10.00 Issuance
J!I.Z7 ,
Type of Inspection Requested: 7hE/A/5~ f ~~t!E7~e: ~~7
Contractor: ~#-,.c:-T .::5~v~ /;A/.4.-TT~,I,/e'r j;. ~rc...LJ'1"""'~/.-l.; ("
.. .. -L /,".(.... P-i?~
Address: /S/S I Ub--y)r ,r::;75Z- -'ST ~ Phone II:
City:Et:../~~ State: 6/'1 Zip: q:?y~~
r
Construction Contractors Registration II:~~~
Expires: /<)~<&-9r
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.
Q~ p ~~
Signature
/ / - .~- - ? 0
DAte
FOR OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVE~L{ETiINSE~ ~
PRELIMINARY ~
Date of Application: /~~-~~
Total Amount Collected: '7/.:Z~
Job II: "7tP/:?9'?
Receipt #: /86' 7'1
Issued By:
- 73
~~~~n~~
Checked for Historical Status: ~~ _
Checked for Delinquencies: