HomeMy WebLinkAboutPermit Mechanical 1990-01-08CITY OF SPRINGF'ELD, OREGO'V
SPRI]t.GFIELD
t^lOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
?25 Fifth Street
Springf ie'ld, 0regon 97477
Job Location:
Assessors Map #:
Owner:
Address:
City:
Offi ce :
INSPECTION LINE:
726-3759
726-3769
Tax Lot #<.
Phone #:
Zi p:
'O nr
State:
nsert:
appr0 pr a app ance
ac)Value of
(pl
Preliminary Inspection is $15.00
Wood Stove/Insert Permit 'is $15.0
Type of Insp
Contractor:
ection Re quested:
nstallation of insert)tate surch arge
(prior to i
0 + $0.75 s
Address:
City: - _State:
Construction Contractors Registration #:
Phone #:
-*'Zi p: '*
Ex pires:
-i:3*\
By signing_!!i9_perm'it/appfication, I agree to calI for an inspection(s) asrequired (726-3769). I also state that all information on thii appliiation/perm'it is correct and that I was provfded with the Wood Stove Safety informationfor wood burning app'liances and preliminary inspection standards.
na e a e
FOR OFFICE USE
REQUIRED INSPECTION (S )NSERT PREL IM I NARY
Date of Application:Job #:
Total Amount Collected:
Rece'ipt #:Issued By:
l.l00t) STO
Checked for Del inquenc'ies:Chec ked
',y'or Historical Status. L/
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