HomeMy WebLinkAboutPermit Mechanical 1989-12-20SPFTilGFIELr,
I,IOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
2?5 F1 fth Street
Springfield, 0regon 97477
Offi ce :
INSPECTION LINE:
726-3759
726-3769
C'TY OF SPRINGFIELD, OREGO'V
Job Location:I1E S Jt-Au-l-'t#4
Assessors Map #:l1'' D?'3 2 - 7 t Tax Lot #: 0Z
/titu fturr,smOwner:
Address , 2!lg 5, tBrL Phone #:
City:
Value of Wood Stove
(p'lease circle
7.i p
instaIIation of insert)
state surcharge
&-A- .1 f"
pr a
State:
oO
e app ance
Prel im'inary Inspection is $15.00 (prior
Wood Stove/Insert Permit is $15.00 + $0.
to
75
Type of Inspection Req uested , (ht. tusu4hry? ln*u l-
nse
Contractor:
Addres s :Phone #:t) tn
City:State: AJIA Zi p:
^/
lF
Construction Contractors Registration #: /r, ,,i,i Expires z N lft
By sign'ing this permit/appf icat'ion, I agree to cal I for an 'inspection(s) as
required (726-3769). I also state that all 'information on this application/
permit is correct and that I was provided with the Wood Stove Safety informationfor wood burning appliances and preliminary inspection standards.
/ 2-)o Eg
gna e Date
FOR OFFICE USE
REQUIRED INSPECTI0N (S): I,J000 STOVE L-- PRELIMINARY
Date of Application:l) -0-
Total Amount Collected:
Rece i p t #,-15a1!/Issued By:
Job #:5t
A/vuL
NSERT
Checked for Del inquencies:Checked for Historical Status:
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