HomeMy WebLinkAboutPermit Mechanical 1990-09-07SPFINEFIELD
IIOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
Office:
INSPECTION LINE:
726-37s9
?26-3769225 Fifth Street
Sprlngfield, Oregon 97477
Lto A/gtv, Sf
CITY OF Spntruc FIELD,Onecotv
Job Location:Z
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Value of l{ood Stove/Pellet St #.r'
(pl-ease circle aPProPriate a ance
Preliminary Inspection is $15.00 (prior to installation of insert)
llood Stove/Pel1et/Insert Permit is $15.00 +ff state surcharge + $10.00 Issuanceal'2'
Type of InspectionRequested'. ...,,i',L,rt r:r r
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Address:
Ci ty:State:
Construction Contractors Registration *:
gnature
Phone *:
zip:
Expires:
By signing this permit/application, I agree to call for an inspeetion(s) as required(726-3769). r state that aII informatlon on this applicatton/permit is."or."cf anothat r was provided with the llood Stove Safety infoimation for vood burnlngappliances and preliminary inspectlon standards. I also understand that tf r amrequesting a preliminary inspection, the vaIl coverlng may be required to be removed.
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FOR OFFICE USE
REOUIRED INSPEoTION(S) : IIOODSTOVE/PELLET/INSERT
Date of Appltcation:D
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Issued By:&
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Job *:(l
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Total Amount Collected:
IReceipt *: I 'Luvr--cc-
Checked for Delinquencies z \/Checked for Historical Status:
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