HomeMy WebLinkAboutPermit Mechanical 1990-12-12}IOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
0ffice:
INSPECTION LINE:
225 Fifth Street
Springfield, Oregon 97477
Job Location:
Assessors Map #:
Ovner:
Address:
Ci ty:
Value of
726-3759
726-3769
Tax Lot S:
Phone *:
State:zl p:
ellet Stove/Insert:
Ie approprlate appllance
lon is $15.00 (prlor to installation of .lnsert)
ov IIet/Insert Permit s1s 00+$1p.00 Iss $1.25 state surcharge.uance
Type of Inspection Requested:
Contractor:
Address:Phone *:
Ci ty:State:zi p:
Construction Contractors Reglstration #:lres:
By signing this permit/applicatlon, I agree to caII for an inspection(s) as required
(726-3769>. I state that all informatlon on this application/permit is correct and
that I vas provided vith the llood Stove Safety informatlon for vood burnihg
app Iiances and prellminary lnspection standards. I also understand that if I am
reques t i a Iiminary pection, the vaII covering may be required to be removed.
/t;2 Qd
ture te
FOR- OFFICE USE
CITY OF SPR"VGFIELD OREGO'V
Prellmina
REOUIRED INSPBCTION(S) :UOODSTOVE / PELLET/ INSERT
Date of Applicatlon:
Y
Job *:
Total Amoun
Receipt $:
tCo ed:
Checked for Delinquencies:
Issued By:
Checked for Historical Status:
SPRINGFIELD
/n nq-IS(I)