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HomeMy WebLinkAboutPermit Mechanical 1991-01-15}IOOD STOVE/INSERT INSPECTION APPL CATION CITY OF SPRINGFIELD BUILDtrNG SAFETY DIVISION SPFTI\,GFIELO 0fflce: INSPECTION LINE:225 Fifth Street Sprlngfield, 0regon 97477 726-3759 726-3769 OREGONclrY oF Job Location:3N DOas frJ Assessors Ma *: Owner: Tax Lot *: Address:St3 N aolN Phone *: City:State !a Value of llood S /rnsert 3' nq<,oo (please circle ate ap pllance) PrellminarY I ctlon Uood Stove Type of Inspection Requested: is $15.00 (prior to lnstallatlon of'lnsert) rt Permit ls-$15.00 + $10.00 Issuance + $1.25 state surcharge. zlp:Q1q -) -) c E+ -\t-l -.\ Pellet St Contrac tor: Ci ty: Construction Contract Address:Qo Bo v fso Phone *: State: Og zlp: Reglstration #:bro-S-Bxplres:io-q I4 l^ ts-q I Date FOR. OFFICE USE By slgning this permlt/applicatlon, I agree to caII for an lnspectlon(s) as required (iZO-|tOg\, I siate tt"i'aII lnformatlon on this appLlcatlon/permlt ls correct and iit;i i'r"" prorided vlth the Uood Stove Safety lnformatlon for vood burnlng iffft""".s and prellminary lnspection standards. I also understand that if I am rlquesting a prltiminary inspettlon, the vali coverlng may be requlred to be removed. n REQUTRED TNSPECTTON(S) :d PRELIMINARY Date of Applicatlont I - lS-Q I Job S:Qorsd I Tota1 Amount Colleeted:a L)( 9EReceipt Xz \41fl1 Checked for Delinquencies: Issued By: Lat-Checlced for Historical Status: 1LJ4 . ODU) Ln*,X -?e1*+ *-,vo }IOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION SPRI]\lGFlELD 0ffice: INSPECTION LINE: 225 Fifth Street Springfield, 0regon 97477 726-3759 726-3769 CITY OF SPR INGFIELD,OREGO'V Job Locat ionz '25b1 A( 20-r^ y-- Assessors Map f,: lToz tl Lt Z-Tax Lot *z 0 77 72, 0wner: Address z 'Zfi/r>4 /\/ 7d-fi^ Sl-Phone *: 74'/DD4Z Ci ty:State:cL-zl p:?zqzz Value of llood Stove/Pflie ts (please circle approprla te appllan Prellmlnary Inspectlon is $15.00 (prior to installatlon of-insert) good Stove/Pellet/Insert Permlt is $15.00 + $10.00 Issuance + $1.25 state surcharge. Type of Inspection Req i uested 2 pfq t nn r1t1 dail- contractor: ( r-ofi S#; C" - 0 Address,lo bot Zrjot Phone il: Ci ty:State:0e ,7t,{oLzlp Construction Contractors Reglstration *:4b5o5 Ex pt res: l0 -21 I I By signing this permit/applicatlon, I agree to caII for an lnspection(s) as required (726-3?69). I state that all lnformatlon on thls appllcatlon/permit ls correct and that I vas provided vith the Uood Stove Safety informatlon for vood burnihg appliances and prellminary lnspection standards. I also understand that lf I am requesting a prelimlnary lnspectlon, the vali coverlng may be requlred to be renoved. /Q-3t -?o Date OFFICE USE ture REQUIRED INSPECTI0N(S) : II0ODST0VE/PBLLET/INSERT Date of Appllcatlonz lL --Arr ,.4O Total Amount Collected: Receipt fi:Issued By: / LT PRELIHINARY Job S:4ot5o t Checked for Delinquencies:Cheelced for llistorical Status z y' p\il-,-l- / , Bt-*-.,^*, tg1 71