HomeMy WebLinkAboutPermit Mechanical 1990-3-20
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, WOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELO
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: d5SS Jdt2t"4AAJ budf'> R/J71d, ~;tu~h.~d 9747'Z
Assessors Map II: \fjC)~Q44\ Tax Lot 1I:_M~ro
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Owner: A'JoA./-fJ tf..j.41J74M.lL /JA1/l-tl.-IJ
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Address: 025~S 0a.t;J.e&-,A),I/lt' JPIJ71 Ill.
City:~!A:'! uJ1d State:. (7)J?
Value of' ood Stov Insert:$'; 777
(please circ e approprlate appllanceJ
Phone II:
7tJ7-bSS-.s-
Zip: 97~77
Preliminary Inspection is $15.00 (prior to installation of insert)
Wood Stove/Insert Permit is $15.00 + $0.75 state surcharge
Type of Inspection Requested: 1?1/JJ Jl,,:/L1J;;//(lJ;fr>.1>
Contractor: f.u0.t Y' 1'/n?1A;uhnu
Address:
City:
State:
Phone II: 3-</t.J-.~.<,-9:l
Zip:
Expires: 9/9/90
,
Construction Contractors Registration II: <I~;PhJ
By signing this permit/application, I agree to call for an inspection(s) as
required (726-3769). I also state that all information on this application/
permit is correct and that I was provided with the Wood Stove Safety information
for wood burning appliances and preliminary inspection standards.
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FOR OFFICE USE
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REQUIRED INSPECTION(S): WOOD STOVE/INSERt ~
Date of Application: 6 '/J0.Q() Job II:
Total Amount Collected: I ~..'\ 5
Receipt II: (l,,~ r;' Issued By:
Checked fO~DelinqUencies:~~ Checked for Historical Status:
PRELIM I NARY
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