HomeMy WebLinkAboutPermit Mechanical 1991-08-27SPFIN(jFIELD
Offlce:
INSPECTTON LINE:
IIOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Sprlngfleld, Oregon 97477
Job Location:
Assessors Map *:
0vner:
726-3759
726-3769
Tax Lot *:
Address:
Ci ty:State:Zlpt
Value
(
IIet Stove/Insert:c
approprlate appl
Prellminary Inspectlon ls $15.00 (prlor to lnstallatlon of.insert)
Uood Stove/Pellet/Insert Permit ls 15.00 + $10.00 Is + $1.25 state surcharge.
Type of Inspection Requested:
Contractor: t lr ^f O7^f/\ )
+, '<'l 23
a
I -c,'TY OF SPR'NGF'ELD,
rl
Address:Phone $:
State:zt p:
Construction Contractors Reglstratlon *:Explres:
By'slgning this permlt/applicatlon, I agree to call for an lnspectlon(s) as required'(726-3769r, r state that aII informatlon on this appllcatton/permlt is'correci andthat I vas provided vlth the Wood Stove Safety informatlon for vood burnihg
appllances and prellmlnary lnspectlon standards. I also understand that if I amesting a prelim tion, the vali coverlng may be required to be removed.
-?7 -7
ure te
FOR. OFFICE USE
REQUIRED INSPECTION(S /INSERT PRELII,IINARY
Date of Appltc I Job *:
Total Amount Collected:
Receipt $:
Checlced for Delinquencies:
ssued By:
Checlced for Ilistorical Status:
Ci ty:
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