HomeMy WebLinkAboutPermit Mechanical 1989-12-19SPRINGFIELE'
I,IOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Spri ngfie'ld, 0regon 97 477
Offi ce :
INSPECTION LINE:
726-3759 -
726-3769
CITY OF OREGO'V
Job Location:
Assessors Map #: /7e7-?G^j Y Tax Lot #:ozz_e_
Ttt
0wner:
Addres s :Phone #:
City:
Value of Wood Stove/Insert: SCD'P(please circl e appropriate appliance)
State: D {'ip z?7427Z
Prel iminary Inspection is $15.00 (prior
Wood Stove/Insert Permit is $15.00 + $0
Type of Inspection Requested:
instal lation of insert)
state surcharge
to
.75
Contractor:
Addres s :Phone #:
City: _ _ State:Zi p:
Construction Contractors Reg'istration #: Ex pi res :
By s'ign'ing this perm'it/a
required (726-3769). I
permit is correct and thfor wood burn g appl ian
a e
pplication, I agree to call for an inspection(s) as
also state that all information on this application/at I was provided with the Wood Stove Safety information
ces and preliminary inspection standards.
a
FOR OFFICE USE
I.JOOD STOVEREQUIRED INSPECTION (S ):
Date of Application:
Total Amount Collected:
Rece i p t #: /€6o 7
NSERT .Y PRELIMINARY
Job #, Ba </732
Issued By:
Checked for Del inquencies:Checked for Historical Status:
lA-)4*s?