HomeMy WebLinkAboutPermit Mechanical 1990-03-07CITY OF SPR"VGFIELD, OREGO'V
SPRIT{GFIELO
l^lOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, 0regon 97 477
Offi ce :
INSPECTION LINE:
7?6-3759
726-3769
Job Location:
Assessors Map #:
0wnert 1A- /,
t-Tax Lot #:2f oo
/?.1,;e trn-
Addressz 3fra3 vtnr).nr"n_-St_ phone #z aZhStt-
State :
--f,
,<u p:,lz?77ZiCity:
Val ue
(
Insertz )frea *
e appropriate hppf iance)
Preliminary Inspection is $15.00
Wood Stove/Insert Permit is $15.
(
00
NloL I tau<*
to installation of insert)
75 state surcharge
ior
$0.
pr
+
Type of Inspection Requested:
Contractor: /t ne /a IS {-a n s $
Address : C62Z a)*-<,ac.{rr--, c-- ilrl _Phone #: 3 4 YSSEry(I
City:State: d.,,.--Zi pzqT.las
Construction Contractors Registration #: ? ff8 t I lxpi res: 16 - q/
By s i gn'i
requ'ired
perm'it ifor wood
ng this perm'it/applicat'ion, I agree to call for an inspection(s) as
(726'3769). I also state that all information on this applicat'ion/
s correct and that I was provided with the Wood Stove Safety information
rning app I i ances and prel iminary'inspect'ion standards.
FOR OFFICE USE
.2o
gna u ea
ood Sto V
WOOD STOREQUIRED INSPECTION (S
Date of App'l i cation :-Jo
Total Amount Collected:/{.7{
Receipt #:/t zo3 Issued By:
/INSERT il), 5. PRELIMINARY
Job #:?ot;as
Checked for Delinquencies:11 Checked for Historical Status:t/'