HomeMy WebLinkAboutPermit Mechanical 1990-5-11
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SPRINGFIELD
YOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, OregDn 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job LocatiDn: p) gq.ff i1JA {mJ {:!d,
Assessors Map II: / {/ rY3 -;;rn. - J d-- Tax
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Lot
II: '!)J7DD
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121 € - L.J D.::3 / (~~t..)
Owner: ,
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Address:
Phone II:
PHcL
State:
Zip:
Pellet Stove/Insert: 11 t/1J(). l)D
appropriate appliance)
Preliminary Inspection is $15.00 (prior to installation of insert)
YDDd Stove/Pellet/Insert Permit is $15.00 + $0.75 state surcharge
Type
of Inspection Requested:
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(Y1,(I-~d.
Contractor:
-'
Address:
Phone II:
City:
State:
Zip:
Construction Contractors Registration II:
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 Yood Stove Safety information for wDod
burning appliances and preliminary inspection standards. I also understand that
if I am requesting a preliminary inspection, the wall covering may be required
to %/?P~LJ
u- If - 20
Date
Signature
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REQUIRED INSPECTION(S):
FOR OFFICE USE
Receipt II:
Collected:
)"10 rl
t./"
PRELIMINARY
q()ll547
Date of Application:
Job II:
Total Aniount
Issued By:
,J1A JJ~
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V Checked for Historical Status: ...__'
Checked for Delinquencies:
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VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Job Location: t)y0-- -r. --Hu'lmJ K-ct
Assessors Map #: 11- tf3 - ;2. 7 -( d- Tax Lot
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Address:
Phone #:
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Owner:
City:
Value
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State:
Vood Sto~pellet Stove/Insert: JJ; L-!()O. [)O
ease~e appropriate applian~e)' .
Zip:
Preliminary Inspection is $15.00 (prior to installation
VODd Stove/Pellet/Insert Permit is $15.00 + $0.75 state
U ') fJDIi ~hslrG
r- fJ sJ-u..1.-&cl
of insert)
surcharge
Type of Inspection Requested:
Contractor:
m /Iur1A/l
../
Address:
Phone #:
City:
State:
Zip:
Construction Contractors Registration #:
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 VODd Stove Safety information fDr wood
burning appliances and preliminary inspection standards. I also understand that
if I am requesting a preliminary inspection, the wall cDvering may be required
to be ~ved. ,/ /
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Si-gna ture -
-4.J f Fw?-
REQUIRED INSPECTION(S):
s- /f-iff)
Date
FOR OFFICE USE
Date of Application:
/PELLET/INSERT ~
Total AmDunt Collected:
Receipt #: /1 {)J-Lj
__11_ qD
1e;.7r-
Job #:
PRELIMINARY
q ()f) r;;q y
Checked for Delinquencies:
Issued
/
By: /IAj~
Checked fDr Historical Status:~