HomeMy WebLinkAboutPermit Mechanical 1990-03-05CITY OF SPR'A'GFIELD, OREGON
SPRIITIGFIELD
I,IOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 F ifth Street
Springfield, 0regon 97 477
Off i ce:
INSPECTION LINE:
726-3759
726-3769
Job Locat'ion: 4A4 li..l nd^5i-
Assessors Map #:3"1 3 Tax Lot #: l*> Oo
Owner:
Address:
City: fu.c-r-E€- S t*"
7o a- 0 o
f>r-
Val ue / I nsert :
p c rcle appropr a app ance
Phone #: ,343 * 7075
Zi pz 4) 4a,:
Prelim.inary Inspection is $15.00-(priqt !g i1s!allation of insert)
WooO StoveTtnseii-iermit is $15.00'+ $0.75 state surcharge
Type of InsPection Requested:{
l,lood
Bvsiqninqth.ispermit/app.licat.ion,Iagreeto.callforaninspect.ion(s)aS
r6quiieo (ZzO-3769). I alro stuie'tna['uii inrot*ition on this aoo]'ication/
oermit is correct and that I *ur"i.orjieo witn il'e-r,rooJ itou. saf'ety information
'r[r"'*ooi'b;;i ;; ".;;i i inc.s- uno pi.i imi narv'i nspect i on standards'
Contractor:
Address:Phone #:
Construction Contractors Registration #' Expires:
Date
51[nature FOR OFFICE USE
REQUIRED INSPECTION (S RT PRELIMI NARY
Date of APPlication:D Job #:
Total Amount Collected:5'r
Rece'ipt #:Issued BY:
00D STOVE/
Checked for Def inquencies:
4 <tn F Z4-tv *rte-
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