HomeMy WebLinkAboutPermit Mechanical 1991-03-07SPFIII|GFIELO
IIOOD STOVE/TNSERT INSPECTTON APPLTCATTON
CITY OF SPRINGFTELD
BUILDING SAFETY DTVTSION
225 Fr,".h Street
Springfield, Oregon 97477 0ffice:
TNSPECTION LTNE:
726-3759
725-3769
CITY OF SPR OREGON
Job Location:
Assessors Map #s l"l bL 3 i t e
d-t
Tax Lot #: C7 ? OC
0wner:d )s-r /
Address:3try Pr"ru
Ci ty:
Value of l,Iood St
(please circl e
Preliminary fnspeetion is g15.
I{ood Stove/Pellet/fnsert permi
Type of fnspection Requested:
Con t rac tor:
Address:
00 (prior to installation of lnsert is $15.00 +
-state
surcharge
fit'zg
Phone *z aZG- SOIQ^
zip: i)q Z 7
t)
+ $10.00 Issuance
/-
State:
al-
fi
e
Phone #:
Zipz q)Ll r
Expires -lt lqt
Date
Ci ty:State:
Construction Contractors Registration # z ( ,,t ))LY
By signing
(726-376e).
that f was
appliances
reques t ing
ture
rOR OFFICE USE
I r-this permit/application, I agree to eaII for an inspeetion(s) as requiredI state that al-I information on this application/permit i"'"orr""t andprovided with the Iiood stove Safety information for vood burningand preliminary inspection standards. r also understand that ii I ama preliminary inspection, the vaII covering may be required to be removed.
*
Iet St
REQUIRED INSPECTION(S) :
Date of Application:
Total Amount Collected:
Receipt *:fi'ltt
Job *:
(,Us\a--
PRELIMINARY
0
Checked for Delinqueneies:
Issued By:
Checked for Historical Status:
t)35/S
Art,.9(YP
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