HomeMy WebLinkAboutPermit Mechanical 1991-07-29OREGO'VCITY OF SPF
1IOOD STOVE/INSERT INSPE TION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SiPRI]t.GFIELD
Office:
INSPECTION LINE:
225 Fifth Street
Springfield, Oregon 97477
726-3759
726-3769
Job Location: 4a\ n *oh
Assessors Hap *:
r 8
Tax Lot *:
ovner: Mk" 6y e":,1 L;\,^'.,o C.-." [f=
Address: 4a\ n 4o'l\Phone *: 1aG"-3
State: CC zl p , er\rt
lor to lnstallatlon of-insert)
15.00 + $10.00 Issuance + $1.25 state surcharge.
Ci ty:(.r Qt.\J
Value of llood Stove/Pe1let Stove/Insert:
(please circle appropriate appllance
pr
Type of Inspeetion Requested:
r.ellminary Inspectlon ls $1s.
Contractor:
Address:Phone t:
State:zlp:
Construction Contractors Reglstration fr :lres:
\nv
t?
sl ing this permlt/a
6 )I state tha
provided vith
and prelimlna
pplicatlon, I agree to call for an lnspection(s) as required
i'.ff lnfoimatlon on this app!.lcatlon/permlt ls correct and
the llood Stove Safety information for vood burning
ry inspection standards. I also understand that lf I am
irrspectton, the vali coverlng may be requlred to be removed.
7-aq*7/
that I
appl
reques t i relimlnarY
ture Date
FOR. OFFICE USE
PELLBT/INSERT
Issued By:
PRELIMINARY dREQUTRED TNSPECTIoN(
Date of APPllcatlon:
S):
Job ft:
Tota1 Amount Collected:
Receipt *:
Checked for Delinquencies:Checlced for Ilistorical Status:
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