HomeMy WebLinkAboutPermit Mechanical 1990-08-31SPFIiIGFTELO
0ffice:
INSPECTION LINE:
726-3759
726-3769
225 Fifth Street
Springfield, Oregon 97477
OFEGO'VCITY OF SPR
Job Location: ffi4 /V Zbtvt S+
Assessors Map #, lJ t,-7 7a / I tax Lot *:
Owner:
Address:7v,Phone *: 74tr -t'r3 I
Ci ty:state: 0 ?*Zip:
Value of lIood Stove/Pellet Stove/Insert z f1/5i -a7:7
(please circle appropriate appllance)
Preliminary Inspection is $15.00 (prior to installation of lnsert)
I.Iood Stove/Pellet/Insert Permit is $L5.00 + $0.75 state surcharge
Type of Inspection Requested:nd)n
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Contractor:
Address:Phone #:
Citv: State:zip:
Construction Contractors Registration *: ,Expires:
By signing this permit/application, I agree to caII for an inspection(s) as
required (726-3769>. I state that aII information on this application/permit is
correct and that I vas provided vith the l{ood Stove Safety information for vood
burning appliances and preliminary inspection standards. I also understand that
if r
to be
am ting a preliminary inspection, the vaII covering may be required
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FOR OFFICE USE
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REQUIRED INSPECTION(S) :
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$t00DsrovEy PELLET/INSERT V. PRELIHINARY
Date of Application:Job *:?olcx
Total Amount Collected:t5.7 5
Receipt #:Issued By:0- ru y-{
Checked for Delinquencies:Checked for Historical Status: -
IJOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
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