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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/'