HomeMy WebLinkAboutPermit Mechanical 1990-02-01Y:
!3PFIi'GFIELD
hIOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUiLDING SAFETY DIVISION
225 Fitth Street
Springfield, 0regon 97 477
Offi ce :
INSPECTION LINE:
726-3759
7 26-3t 69
OPEGOA'CITY OF SPR
Job Location:
Assessors Map #:RW Tax Lot #:
Owner:Su+r bwlc,ae
Addres s :84; E, 4)nL Phone #:74-t-2{rO
City:5 n {icicl OKState:
Insert:
AO,Y--
appropr a e app ance
In
nspection is $15.00 (prior to installat'ion of insert)
sert Permit is $15.00 + $0.75 state surcharge
Type of Inspection Requested
Zi p:
Val ue
(
od Stov
Contractor:
Addres s :Phone #:
city:- state:zi p:
Construction Contractors Registrat'ion #: Ex pires:
By signing this perm'it/
required (726-3769). I
perm'it s correct and tfi ng appl i
e
REQUiRED INSPECTION (S ) :
o
Amoun ol I ected:
ceipt #:
ap
a
p
1t
e
lication, I agree to call for an 'inspection(s) as
so state that al'l information on th'is application/I was provided with the Wood Stove Safety information
s and preliminary inspection standards.
?o
FOR OFFICE USE
/INSERT 3' PRELIMINARY
D Job #:Qoots?10n :
5,19
Issued By:
D STO
Checked for Del inquencies:Checked for Historical Status: t-'
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lfnocl. LWW-
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