HomeMy WebLinkAboutPermit Mechanical 1990-06-06CITY OF SPR'NGF'ELD, OREGO'V
SPRI]TIGFIELD
IJOOD STOVE/INSERT INSPECTION APPLICATION ,
CITY OF SPRINGFIELD
BUILDTNG SAFETY DIVISION ".
225 Fifth Street Officez 726-3759
Springfield, Oregon 97477 INSPECTION LINEz 726-3769
Job Location: |1,|fi [,\ 38fr' tr
Assessors Map *:11 o)3or+^{Tax tot #: ()3)Ol
Ovner:o)r)
Address, ay-LK /ri 2.r8# Y Phone *: *l ) b lZtL+
zi p:Ci ty:
Value of
( ple
State:$u
Ilet Stove/Insertr 3 l?2So'appropri ate appliance)
Preliminary rnspection is $15.00 (prior to lnstarration of insert)
llood Stove/Pellet/Insert Permit is $15.00 + $0.75 state surcharge
Type of Inspection Requested:\ .,t ).1"..1 \rA'{'-
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Contractor:
Address | 1\})Phone #:4bQ
Ci ty:State: OQ zip: 4-l q l!
Construction Contractors Regi stration *: ) l,r1 '-13 Expires, ?/ao
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By signing this permit/application, I agree to caII for an inspection(s) asrequired (726-3769). I state that all information on this application/permit iscorrect and that I was provided vith the llood Stove Safety information for vood
burning appliances and preliminary inspection standards. I also understand thatif I am requesting a preliminary inspection, the vaIl eovering may be requiredto be removed.
bl,^l 4o
S*+
ture Date
FOR OFFICE USE
REQUIRED INSPECTION( S) :
Date of Application:(,"
Total Amount Collected: )6.14
Receipt #: I -l 1l [,y Issued By:fr
(@@TPELLET/rN'ERr lf PRELIMINARY
Job *: 4 Af]J -)ffi
Checked for Delinquencies:Checked for Historical Statusr ]..-
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