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HomeMy WebLinkAboutPermit Mechanical 1989-12-21SPRIli.GFIELO l,lOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, 0regon 97477 Job Location: Assessors Map #: Owner: Offi ce: INSPECTION LINE: 726-3759 726-3769 Addre City: Val ue City: SS: State: Tax Lot #: Phone #: Phone #: Zi p: of In (p1 eas e appro prr-ate app lian c e) Prel im'inary Inspection is $15.00 (prior to insta'llation of insert) Wood Stove/Insert Permit is $15.00 + $0.75 state surcharge Type of Inspection Requested: Contractor: $ \bD,c() Addres s : State:Zi p: Construction Contractors Registration #:Ex pires: By s'igning this permit/appf ication, 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 burnin g app I i ances and preliminary inspection standards. na e FOR OFFICE USE REQUIRED INSPECTION (S )NSERT PREL IM I NARY Date of Application:I Job #: Total Amount Collected: Rece'ipt #:lstcn\Issued By: OREGO'VCITY OF I.IOOD STO Checked for Del inquenci "r, /Checked for Historical Status: