HomeMy WebLinkAboutPermit Mechanical 1990-09-18SPBIi.GFIELD
CITY OF SPRINGFIELD, OREGO'V
IIOOD STOVE/INSERT INSPEqTION APPLICATION
CITY OF SPRINGTIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, 0regon 97477
0ffice:
INSPECTION LINE:
726-3759
726-3769
Assessors Map #:18 OL D6 ?A
Job Location:
Owner:
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Address:q46 S {b.a sr Phone *r'14 ti -"1(tct K ,)",,-l'
Ci ty:State:0?-z1 p ,?l'178
Value of llood Stove/Pellet Stove/Insert ,fib*a: N l4r(please circle appropriate appliance)
Prellminary Inspectlon is $15.00 (prlor to installatlon of-insert)
Wood Stove/Pel}et/Insert Permit is $15.00 + $10.00 Issuance + $1.25 state surcharge.
Type of Inspection Reques
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Address:Phone *:
City, State:Zlpz
Construction Contractors Reglstration #:lres:
By slgning this permit/applicatlon, I agree to call for an lnspectlon(s) as required
(726-3769). I state that all information on this appllcatlon/permit is correct and
that I vas provided vlth the llood Stove Safety lnformatlon for nood burnihg
appllances and prellminary lnspection standards. I also understand that if I am
requesting a preliminary inspection, the vali covering may be required to be removed.
FOR. OFFICE USE
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Date of Application:1-rR-7D Job *:
PRELIMINARY X,
4o ttbo
Total Amount Collected z :' ,. ,-
Receipt *:Issued By:
Checked for Delincluencies: r''Checked for Historical Status 2 1/
REQUIRED INSPECTI0N ( S ) : II0ODSTOVE /PELLET /\NSERT