HomeMy WebLinkAboutPermit Mechanical 1990-05-14CITY OF SPB'A'GFIELD, OREGON
IIOOD STOVE/INSERT TNSPECTION APPLICATION
CTTY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPFIIi|GFIELE,
0ffice:
INSPECTION LINE:
726-3759
726-3769
225 Fifth Street
Springfield, Oregon 97477
Job Location:v
Tax Lot *: A 75 o,*
Phone #:
Zip:Ezy'z
${m @
Assess
Ovner:
Address:
Ci ty:
ors Map *:
State:
Value of llood Stove/Pellet Stove/fnsert:
(please circle appropriate appliance
Preliminary Inspection is $15.00 (prior to installation o inser t )
I.Iood Stove/Pellet/Insert Permit is $15.00 + $0.75 state surcharge
Type of Inspection Requested:
Contractor:
Address:Phone #:
City, State:_ZiPt_
Construction Contractors Registration *:lres:
By signing this permit/application, I agree to call for an inspection(s) as
required (726-3769). I state that all information on this application/permit is
correct and that I vas provided vith the l{ood Stove Safety information for vood
burning appliances and preliminary inspection standards. I also understand thatif I am requesting a preliminary inspection, the wall covering may be requlred
to
te
FOR OFFTCE USE
REQUIRED INSPECTION(S) :
Date of Applicati o", S// -7a
Total Amount Co1lected /,r.?-,
Receipt *:/22/7 Issued By:
PELLET/INSERT { PRELIMINARY
Job #t qao6e5-
Checked for Delinquencies:Checked for Historical Status:
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