HomeMy WebLinkAboutPermit Mechanical 1990-03-09CITY OF SPR OFEGO'U
l.lOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, 0regon 97477
Offi ce :
INSPECTION LINE:
726-3759
726-3769
Job Location: 1g 4A U o fth s[tu
Assessors Map #:cl 3
owner: lY\ur,'Q.,[ 0nn'itttvtE
Tax Lot #:o abc{)
Address: ) tr +o lU 5\'{.-,Phone #:1 { }'oroa-
Ci ty:(_\)a f, State:AL Zi p
Va lue of Insert: I f0O
(p1ea e appro prr-atE appTfan c e)
pr ior to installation of insert
Wood Stove/Insert Permit is $15 0 0+$0.7 state reharge
Type of InspecFipn
contracto.r UL i rlfro)(Zi
,4+(++
Preliminary inspection is $15.00 (
Requested:
zi
Address:Phone #:
C'ity : _ State:
Construction Contractors Reg'istration #: Ex pi res :
Dl"cr.*slq lf a
By sign'ing this permit/application, I agree to call for an inspection(s) as
required (726'3769). I also state that all information on this application/
permit is correct and that I was prov'ided with the Wood Stove Safety informationfor wood burning app'liances and pre'liminary inspection standards.
)
IlafeSi gnat/re
FOR OFFICE USE
REQUIRED INSPECTION (S )
Date of App'l i cat i on :
Total Amount Collected:
Receipt #:I (o lo Issued By:
RT L.." PRELIMINARY
Job #:
Checked for Delinquencies:\./Checked for Historical Status:
SP'II]TIGFIELD
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