HomeMy WebLinkAboutPermit Mechanical 1990-06-04ITOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
IiPFIilGFIELO
0ffice:
INSPECTION LINE:
726-3759
726-3769
t
l,/
225 Fifth Street
Springfield, 0regon 97477
)OREGO'VCITY OF
Job Location: I LI3 I N. 1 /dN
Assessors Map *r lJ O j ? Uq j Tax Lot *: A 1 bOct
Ovner:p
Address:'l qli N IHN Phone *:).o
Ci ty:State:AR
Value of eIIet Stove/fnsert:$ Q.c'aa<;
( pleas ec rc Ie appropriate appliance)
Preliminary Inspection is $15.00 (prior to installation of insert)
Ilood Stove/Pellet/Insert Permit is $15.00 + $0.75 state surcharge
Type of Inspection Requested: \,,f.)fr,a{ ='J-o
wt-
Contractor: C)r r-rn r fur
zip , 6l)q) 7
od St
Address:Phone *:
City: State:Zip:
Construction Contractors Registration #:lres 3
By signing this permit/application, I agree to call for an inspection(s) as
required (726-3769). I state that all information on thls application/permit is
correct and that I vas provided vith the llood Stove Safety information for vood
burning appliances and preliminary inspection standards. I also understand that
if I am requesting a preliminary inspection, the vall eovering may be required
to be removed.
te
FOR OFFICE USE
REQUTRED INSPECTTON(S) :/INSERT ,Y PRELIMINARY
Date of Application:a lq\ca ua *z 4oobQ4
Total Amount Collected A lS rS
Receip t *: l-]BS Issued By:$R
Checked for Delinquencies:>-' Checked for Historical Status, -(
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