HomeMy WebLinkAboutPermit Mechanical 1990-10-16
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SPRINGFIELD
VOOD 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: q iJ TdruI j Sf
Assessors Map #: 170 :2,:2,L/ '),1 Tax Lot #: ()() 760
Owner: ;:!iYV1 /AI VI e..pJev
Address: q If L-<;:,-t.,J "S,-r Phone #: 7 ZJ? - (6723
City: . SpVil1.~h'.P Id State: ()r2- Zip: Q7c.(77
Value of Vood Stove~Stovenn~h I \It ~ 07")
(please circle appropriate ~nce) v u -
Preliminar~I~~~tion is $15.00 (prior to installation of insert)
Vood Stove/~!Q~Permit is $15.00 +..... state surcharge + $IO.OO Issuance
n n ~h20
Type of Inspection Requested:j-+{lI(~ If O-P (Itr iY79'A4-
- I -
Contractor: !J7AfIIJ 01(
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 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.
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Date
FOR OFFICE USE
REQUIRED INSPECTION(S):
VOODSTOVE~P~~~' PRELIMINARY
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Job #: (tJf2-42-
- Date of Application: ( i1 - J 111 -Cjl',
Total Amount Collected: '7...10 -7J::,
Receipt #: jf-t; ~ I Issued By: tLvvv"-L
Checked for Delinquencies: / Checked for Historical Statu&;-- /-