HomeMy WebLinkAboutPermit Mechanical 1991-01-07IIOOD STOVE/TNSBRT INSPECTION APPL CATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPRINGFIELD
0ffice:
INSPECTION LINE:
225 Fifth Street
Springfleld, Oregon 97477
726-3759
726-3769
OFEGO'VCITY OF SPR
Job Location:
Assessors Hap *:
rn qA'r+
raxLot*: O QtOl)
Phone fr:741-?z o;\
zlp:? 7//r7Ci ty:State:
VaLue of llood tove/Pellet Stove/Insert :
(please circle approprlate appllance)
? Preltminary Inspection
Uood Stove/Pellet/Inser t $
Type of Inspection Requestedi
4isfi^l SzAu<
Nre(v)rOwner:
1or to installatlon of-insert)
15.00 + $10.00 Issuance + $1.25 state surcharge.fL
da
$1s.00
Con trac tor !
Address:Phone *:
Ci ty:State:zlp:
Construction Contractors Reglstration f,:Explres:
By signing this permlt/applicatlon, I agree to call for an lnspectlon(s) as required
<726-3769). I state that aLl lnformatlon on this appllcatlon/permit is correct and
that I vas provided wlth the lJood Stove Safety informatlon for vood burnihg
appliances and prelimlnary inspectlon standards. I also understand that if I am
requesting a preliminary inspection, the vali coverlng may be requlred to be removed.
%f*-r--s //h,r.f -7-?l
Signature te
FOR. OFFICE USE
Date of Appllcatlon:l*1 -?/
Total Amount Collected:6D
Receipt *:Issued By:
PRELIMINARY I./
Job *:Q too tZ
Checked for Delinqueneies:Checlced f or Historieal Status:
Address, 25O -Suwrmi+
D4-
REQUIRED INSPECTI0N(S) : IIOODSTOVE/PELLET/INSERT
oe$