HomeMy WebLinkAboutPermit Mechanical 1990-10-18SPRII{GFIELO
ITOOD STOVE/INSERT TNSPECTION APPLICATION
CITY OF SPRINGFTETD
BUILDING SAFETY DIVISION
225 Fitth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-37s9
726-3769
C'TY OF SPR OBEGO'V
Job Location:
.)I 3c lV, )-( Un
Assessors Hap *:I
Owner:,tuL..-
Addressr 4trC N),Z4
Ci ty:S tate:
Tax Lot *:
Phone #:(!'
Zip:
VaIue
(p
ellet Stove/Insert:o
e appropr iate appliance
Inspection is $15.00 (p rior to installation of insert )IIet/Insert Permit is $15.00 +state surcharge + $10.00,[
Type of Inspection Requested:
Cont ractor:
Address Phone *:
Ci ty:State:Zipz
Cons truc t ion ctors Registration #:res:
By slgning this permit/applieation, I agree to call for an inspection(s) as required(726-3769>. I state that aII information on this application/permlt is'correct andthat I vas provided with the llood Stove Safety information for vood burningappliances and preliminary inspection standards. I also understand that ii t am
reques t a preliminary inspection, the vaII covering may be required to be removed.
Date
FOR OFFICE USE
REQUIRED INSPECTION(S) :
Date of Appllcation:
Total Amount Ilected
Reeeipt $:
/INSERT /. PRELIUINARY
Job #:
Issued By:
(-.-Checked for Delinquencies:Checked for Historical Status: t-'-'