HomeMy WebLinkAboutPermit Mechanical 1990-10-23CITY OF SPF"VGFIELD, OREGO'V
VOOD STOVE/INSERT INSPBCTION APPLICATION
CITY OP SPRINGFIELD
BUILDING SAFETY DIVISION
SPRINGFlELO
0ffice:
INSPECTION LINE:
225 Fifth Street
Springfield, Oregon 97477
726-3759
726-3769
&Job Location:
Assessors Hap *,U Tax Lot *: 0uc/u ll
0vner:
Address t ,15O -,1*rH" 479 .
Phone *: 7J2-otot,
Ci ty:State: Ot Zip:Q74o5
Value of llood Stove Insert- /F54
(please circle approprlate appllance)
Pr.ellminary Inspectlon is $15.00 (prlor to installation of-insert)
I{ood Stove/Pe}Iet/Insert Permit ts $15.00 + $.00 Issuance + $1.25 state surcharge.
Type of Inspection Requested:@tmu,nV
Contractor:lrnrL -J fr-nofu*h"+-
Address:Phone *: 344- gs* a
Ci ty:State:zi p:
Construction Contractors Regl stration *, 4fy; t lres: ?// / ft
By signing this permit/applicatlon, I agree to call for an inspection(s) as required
(726-3769r. I state that all informatlon on this appllcatlon/permit is correct and
that I vas provided vlth the llood Stove Safety information for vood burnihg
appliances and prellminary inspection standards. I also understand that if I am
requesting a preliminary inspectlon, the vaII eovering may be required to be removed.
f 0s /'han4{-Ahd *rn * / Yz*to,t 1ilL 1ok3//a
Sig_nature ,4
FOR. OT'FICE USE
Date
REQUIRED INSPECTION(S) :PRELIMINARY
Date of Applicationz tb 'll 1-{iO ua *, c1 0l/-?/i
Total Amount Collectedz @ 'll-Ztt
Reeeipt *:tg53L Issued By:d^"^."-
Checked for Delinquencies , ',/
Checked for Historical Status z ,/
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