HomeMy WebLinkAboutPermit Mechanical 1990-03-06CITY OF SPR"VGFIELD, OREGO'V
SPRINGFIELD
I,IOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, 0regon 97477
Offi ce:
INSPECTION LINE:
726-3759
7 26-37 69
Value of l,lood Stov
(please circl
Job Location:Spe d *n
Assessors Map #:Tax Lot #:
Owner:Cco E-&
Addres s :6 8a t/,{d Phone #:- /o
C'ity ,&K,:t&.ruy_State:Zi p:ery7P
/ ro=r,N
prTate appliance)
Preliminary Inspection is $15.00 prior to installation of insert)
Wood Stove/Insert Permit'is + $0.75 state surcharqe
Type of Inspection Requested
Contractor:
City:State:Zi p:
Construction Contractors Reg'istration #:Ex pi res :
By signing this permit/applicat'ion, I agree to call for an inspection(s) as
required (726-3769). I also state that all informat'ion on this app'lication/
permit'is correct and that I was provided w'ith the Wood Stove Safety informationfor wood burning appliances and pre'liminary inspection standards.
YrTnature G,EUSE
REQUIRED INSPECTION (S ) :I.IOOD STOVE/INSERT PREL IM I NARY
Date of Application:-q Job#, QCn a6o,
Total Amount Collected:
Rece i p t *'\G\q7
Checked for Delinquencies:
Issued
Checked for Historical Status:
CK
Phone #:Address: