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: