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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: