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HomeMy WebLinkAboutPermit Mechanical 1990-3-20 - , 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 - .. -- - Owner: A'JoA./-fJ tf..j.41J74M.lL /JA1/l-tl.-IJ - i1 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. c3~ 9~.JL :'rgri~ r' 3-cJty-'10 Uate FOR OFFICE USE .....' 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 qrY)~~S ~(~