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HomeMy WebLinkAboutPermit Mechanical 1990-10-16 . . 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. ,,~M"j,~ /0 -/6 - fO Date FOR OFFICE USE REQUIRED INSPECTION(S): VOODSTOVE~P~~~' PRELIMINARY o - 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&;-- /-