HomeMy WebLinkAboutPermit Mechanical 1990-5-11
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SPRINGFIELD
WOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: G~q.... J tlariDlAJ '[[J)
Assessors Map #: /1/D-3---;)I-I,;2., Tax Lot #:
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Address:
Phone #:
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Owner:
City:
State:
Stov /Pellet Stove/Insert: it L)[)6 .00
. cle appropriate appliance)
Zip:
P~eliminary Inspection is $15.00 (prior to installation
WODd Stove/Pellet/Insert Permit is $15.00 + $0.75 state
Type of Inspection Requested: !1){)OcL (J1r/rl-
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surcharge
Contractor:
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 wi th, the Wood 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 ~::'; l?iJuiM-. ,~_ 11_ <fa
S1gnature / y' Date .
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REQUIRED INSPECTION(S):~E/PELLET/INSERT ~
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Date of Application:
Job #:
PRELIMINARY
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Total Amount Collected:
Receipt #: 1'7 D;)-C/
Issued By:
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Checked for Delinquencies:
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Checked for Historical Status: