HomeMy WebLinkAboutPermit Mechanical 1990-11-26
.
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
\ftfJ
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: '-?l6-376~
Job Location: 227/ (; rf' e.n bJr;' av ..51-
Assessors Map 1:l7ov2tJZI
owner:?fJ. +V., r ; CA g-t:> C~ P,Vfv
Address: 2-2-77 {-, Y:r> CI/7 h r,'av Sj-
City: c;p ptd State: () ~
Value of Vood Stove/Pellet Stove~ 'tf; ~(j-=-oo--M rr
(please circle appropriate appliance)
Tax Lot I: OOCj{/:)
Phone
I: 72-10 -I ~3.b
Zip: 97'-177
Preliminary Inspection is $15.00 (prior to installation of -insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $1.25 state surcharge.
Type of Inspection Requested: ?r -f:!ivvt 1 Il4.-VCf
Contractor: () WVi ev
Address:
Phone I:
City:
State:
Zip:
Construction Contractors Registration I:
_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 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.
Si~AIA/.A~ W2t./N')
FOR. OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVE/PELLET/INSERT PRELIMINARY
Date of Application: /1-2-" -'10 Job I: C{{)/L{17.
/-
Total Amount Collected:
Receipt I: Igg z4;.
Ie:;, 6D
Issued By:
C~
Checked for Delinquencies:
....-----
Checked for Historical Status: ----