HomeMy WebLinkAboutPermit Mechanical 1990-09-26C'TY OF SPR"VGFIELD, OREGO'V
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDtrNG SAFETY DIVISION
SPRIII|GFIELD
0ffice:
INSPECf,ION LINE:
225 Fifth Street
Springfield, 0regon 97477
726-3759
726-3769
Job Location:t]45 A), 24 (-!-/-*(
Assessors Map *:0 At
Ovner:
Tax Lot *:
Phone *:25
ZL p , Q1rl11
33
c
449 t J, 24 Stft!+Address:
Ci ty:State:
Value of llood Stove/Pe1let Stove/Insert:
(please clrcle approprlate appllance
Prellminary Inspec ti
llood Stove/Pellet
Type of Inspeetion Requested:
'lnq/k
00 (prlor to installatlon of-insert)
t is $15.00 + $10.00 Issuance + $1.25 state surcharge.
5b.ao
Contractor:
Address:
Ci ty:
3cS Phone *:
s State:zi p:
i
Construction Contractors Reglstration *:Explres:
By signing this permit/applicatlon, I agree to call for an inspection(s) as required
(726-3769). I state that aII informatlon on this appllcatlon/permlt is correct and
that I vas provided wlth the Uood Stove Safety lnformatlon for vood burnihg
appllances and prellminary inspectlon standards. I also understand that if I am
requesting a preliminary inspection, the vali covering may be requlred to be removed.
0
S ture te
FOR- OFFICE USB
ert Pe
REQUTRED TNSPECTTON(S) :IIOODSTOVE/
Date of Appllcatlon:
Tota} Amount Collected:
PRELIMINARY
Job *:
s
0
Issued By:
/
Receipt *:
Checked for Delinquencies:Checked for Historical Status:
CITY OF SPRINGFIELD, OREGO'V
VOOD STOVE/INSERT TNSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPFIilGFIELO
Offlce:
INSPECTION LINE:
726-3759
726-3769
225 Fifth Street
Springfield, 0regon 97477
Job Location: U Ll6 l^.l Z \..1 -Sf
Assessors Map *:rax Lot *: 0>9Ocl
Ovner:
Address , 4'15 xl Z3 , J Sr Phone *: 7./ / 'l 77F
Ci ty:State: 0 L
Value of llood Stove/Pellet S r I
(please circle appropriate ance
Prelimlnary Inspeetion is $15.00 (prior to installation of insert)
IIood Stove/Pellet/fnsert Permit is $15.00 + $0.75 state surcharge
Type of Inspection Reques tea: ].r r e li ur.r i r.trs p-u-
zip:7
Contractor: CUt; nar(I
Address:Phone #:
Cityr State:ZT p!
Construetion Contractors Registration #:Expires:
By signing this permit/application, I agree to call for an inspection(s) as
required (726-3769). I state that aII information on this application/permit is
correct and that I vas provided vith the Vood Stove Safety information for wood
burning appliances and preliminary inspection standards. I aLso understand that
if I am requesting a preliminary inspection, the vall covering may be required
to be removed.
r-7-fo
ture Date
FOR OFFICE USE
REQUIRED INSPECTI0N(S) : VOODSTOVE /PELLET/INSERT PRELIHINARY
Date of Application:8'7 -?rt Job *:
Tota1 Amount Collected r\q -CD
Receipt #:Issued By:
Y
Checked for Delinquencies:Checked for Historical Status ' //"
ttz^ 7 Qrvu.-.0-