HomeMy WebLinkAboutPermit Mechanical 1990-12-03}IOOD STOVE/INSERT INSPBCTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPBI]\IGFIELO
0ffice:
INSPECTION LINE:
225 Fifth Street
Springfield, 0regon 97477
726-37s9
726-3769
Job Location:
Assessors Hap *:Tax Lot *:
Address:- Phone *:
Ci ty:State:zip:
Value of
(pI
PeIIet Stove/Insert:
e appropriate appllance
Prellminary Inspection is S15.00 (prior to installation of-insert)
llood Stove/Pellet/Insert Permit is $15.00 +$10.00 Issuance + $1.25 state
Type of Inspe ction Requested:
Contracto
Address:Phone *:
Ci ty:State:zi p:
Construction Contractors Registration *:res 3
By signing this permit/applicatlon, I agree to call for an inspection(s) as required
(726-3769). I state that all informatlon on this application/permit is correct and
that I vas provided vith the llood Stove Safety information for vood burnihg
appliances and preliminary inspection standards. I also understand that if I am
requesting a preliminary inspectlon, the vaII covering may be required to be removed.
/2- 3-7o
ure Date
FOR. OFPICE USE
CITY OF SPR OREGO'V
REQUIRED INSPECTION(S) :
Date of Application:
Total Amount Collected:
Receipt *:
/INSERT PRELIHINARY
Job *:
Checked for Delinquencies:
Issued By:
Checked for Historical Status:
Owner:
C)O