HomeMy WebLinkAboutPermit Mechanical 1989-12-28CITY OF SPR'A'GFIELD, OREGO'U
SPRlh.iFlELD
I^,OOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springf ield, Oregon 97 477
Offi ce :
INSPECTION LINE:
726-3759
726-3769
Job Location:l'Dralr UvL SweeP
Assessors Map #:11- D3 -3 ->l
Owner:te
Address:l-D (((*
Tax Lot #:
City:State, DIZ-
Phone #:1'1a - D*91
Zi p 41t/11
ueVal e/Insert: 4 '/,bL'o
p e appropri ate appffance)rcl
Preliminary Inspection is $15.00 (prior to installation of insert)
Wood Stove/Insert Permit is $15.00 + 59.75 state surcharge
Type of Inspection Req uested,)D{,&S{-n14-
Contractor: TTI ,TV -! )1-
odS
Address:Phone #:
City: State:Zi p:
Construction Contractors Reg'istration #: Ex p'ires :
By s'igning th'is permit/application, I agree to call for an'inspection(s) as
required (726-3769). I also state that all information on this applicat'ion/permit'is correct and that I was provided with the Wood Stove Safety informationfor wood rning appliances and pref iminary inspection standards.(2- >tr- B
ure e
FOR OFFICE USE
REQUIRED INSPECTION (S) :NSERT PREL IM I NARY
Total Amount Collected:15,1,
Rece'ip t *, l5bLl Issued By:
Date of App l'ication: i)- 2 Job #:r 1 gq tz15
V
OOD STOV
Checked for Delinquencies:Checked for Historical Status: