HomeMy WebLinkAboutPermit Mechanical 1991-8-29
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VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
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BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
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Offi~e: 726~3759
INSPECTION .LINE: 726-3769
Job Location:
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Assessors Map I: /52 0 2.. ~'" ?~~ ~
Owner: - D;#/?/JeL.t--. I' Jo#.h"~
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Value of Vood Stove/Pellet StovelInsert: -:z I ~ '-/-. c>-c>
(please circle .appropriate appliance)
/' Tax Lot. I:
r!> ~ ?C70
City:
State: .
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Zip:
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Address:
Phone I: 7C/h" -22?SC:>
Preliminary Inspection is $15.00 (prior to installation of -insert)
Vood Stov~elle~Insert Permit is $15.00 + $10.00 Issuance + $1.25 state surcharge.
. Type of Inspection Requested: Pcc.~c:7. L;j-otrE .
contractor:,~ /~~rT _~/2SVc-'; C cg 7r=-/Z<
Address: /<<"7S ~/~-r- b ~ ~V~. Phone I: 7"~<)-O~:<"~
City: b.-rC::; ~<,c-State: D~ . Zip: q.) '51'02...
Construction Contractors Registration I: L//- 5~C:-- Expires: /,c?-Z-,/R.q/
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 unders.tand that if I am
reques ng a preliminary inspection, the wall covering may be required to be removed.
. / ~ ~ a/d rO/. QI
S-ignature (/ Da}k
FOR_OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVz1PELLET~SERT X"
Date of Application: (;;;;;;'-";;::>9-9/ Job I:
Total Amount Collected: '26.~S-
PRELIMINARY
9' //~/6
Checked for Delinquencies:
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ty/ (- .:-- y - ,,-
Checked for nistorical Status:
Receipt I: -::< 1/57 Issued By: