HomeMy WebLinkAboutPermit Mechanical 1990-11-27318' r'ltrLl
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPFII{GFIELI,
0ffice:
INSPECTION LINE:
225 Fifth StreetSpringfield, Oregon 91477
Job Location:
Assessors Hap #t 1,0 3.L5,L(
0vner:
Address:bli
Ci ty:rin
Tax Lot *:2300
726-3759
726-3769
/
VU Phone #:
S tate:(-zip:
Va1ue of llood Sto
or:€fatlU
."P d'it"(please clrcle approprlate appl t ance
Prellmina ry Inspection is 515.00 (prlor to ins tallation of .inser t)llood Sto velPe11e t /fnser t Permit is 915.00 + 91 0.00 Issuance + $1.25 state surcharge.Type of
Con trac t
Address:
fnspection ues ted :
Phone #:
Ci ty:state fJtrL z1 p3
Construction Contractors Registration #:5 Explres:3.By signing this permi t/applicatlon , f agree to ca 11 for an ins pection(s) as required(726-3169). r s tate that aII in formatlon on thi s appllcatlon/permlt ls co rrect andthat f vas provided vl th the Ilood Stove Safe tyi nformation for vood burn iheappliancesand preliminary i nspection s tandards I also unders tand that if I am
reques t ng a prel nary pection, the vali covering may be required to be removed.
ture
FOR. OFFTCE USE
te
REQUTRED rNspEcrroN(s) : rlooDsrovE /IELLET/rNsERT PRELTUINARY
Date of Application:
t ftt
Total Amount Collected:15,oc
Job *:
Receipt #:3v
CITY OF SPRINGFIELD,OFEGO'V
Che cked for Delinquencies:
fssued By:
Checked for Historical Status:
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