HomeMy WebLinkAboutPermit Mechanical 1990-10-11
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VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Job Location: (jU T.e::;(Il/IJrJ Sf-
Assessors Map #: 17 D:, '0 LI 7.'
Owner: -::Ti\~ lI\ \A)h-e.p.l 'l" ,I'""
Address: qll -;cd a n~ ~
CitY:~)njR eJ (JJ State: ()fZ-
Value of Vood Stove~Stove/Insert: Ed.'9rr.'1 .~7J
(please circle appropriate appliance) .
Office:
INSPECTION LINE:
726-3759
726-3769
Tax Lot #: 607 c)t'I
Phone #: 7/./O -??7 ?~~
Zip: Q.7 Y //
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Preliminary Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + ~ state surcharge + $10.00 Issuance
I $1.25
Type of Inspection Requested: fr.e.lJtI\A'lACLvtt
Contractor: () t.UV\ PJ,'
Address:
City:
State:
Construction Contractors Registration #:
Phone #:
Zip:
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.
S1~
FOR OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVE/PELLET/INSERT
Date of Application: ID -t ( -90
Total Amount Collected: 11). c5D
Job #:
Receipt #: I~ql
Issued By:- nA/lJ\.--.--J...
Checked for Delinquencies:
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Checked for Historical Status: ,.,-----
10-/1-90
Date
PRELIMINARY X
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