HomeMy WebLinkAboutPermit Mechanical 1990-11-21
.
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Job Location: I ~~ 0 mt'Jilo Lo6t?'
Assessors Map 11: ~,1. D~ - :z-g ./..--/ 0 .
Owner: ,~rrc mU(/ h(t1.SS{).JJ.lf
Address: I ~ 4-0 fVltn I D Lob f'
City: .C;prlncfidd. State: f)rL
Value of Vo~d St~ve/pellet Stove<fInser~J t L-/()O. ()f)..
(please circle appropriate.~p~~ance) .
Tax Lot 11:
o 2-1/J[) L/
*
Phone
11: 747, OLoOJ
Zip: 0;1'-/77
Pr,eliminary Inspection is $15.00 (prior to installation of .insert)
Vood Stove/Pellet/Insert Permit is $15.00+ $10.00 Issuance + $1.25
frtJ 1m iYliifj
state surcharge.
Type of Inspection Requested:
Contractor:
rf1.~ J}1}J/ ./
Address:
Phone 11:
City:
State:
Zip:
Construction Contractors Registration 11:
Expires:
By signing this permit/application, I agree to call for an inspection(~) as required
(726-3769). I sta,te that all information on this application/permit is correct and
that I was provided with the Vood'Stove Safety information for wood burning
appliances and preliminary inspection standards. I also understand that if I am
requesting a preliminary inspection, the wall covering may be required to be removed.
c~-:?--_,~
Signature
II 27~o-l.
Date
FOR,OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVE/PELL~T~~D~
Date of Application: I J I -z-,t, qO ,.. Job 11:'
Total Amount Collected:" IS,OD
Receipt 11: I ~g I b
PRELIMINARY
q D J LfOq
1/
Issued By:
II) f ~(1. Ml
Checked for Delinquencies:
1........-'
Checked for Historical Status:
t_
to..'.", .T~r(jY~
I ., ~'U~Uj-J.:::.A.r~
.
, SP.GFIELD ,- , \
O:r.it'~~'~"~" ',,'
. ; ~. '.." ',. .", , " _ ~. -ct, of' "1',',','-"", .'
, "''''rt::;..?~''-- ~~.
.;:'~~:i~t.. '.~-ta: . ~.~._:,
225 Fifth Street
Springfield, Oregon.97477
Office:
INSPECTION LINE:
~
726-3759
726-3769' '
YOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
Job Location: I ~L-/ 0 mm/O 1---D6f
Assessors Map U: l1. D~ - ~g ./...--f O'
Owner: ~rbc mCU((./ hr/J-SS()).,Llf
Add res s : I g l-fo fVllj) I D Loo f
City: .C;prifljfidd. S~te: f)lL
Value of Yo~d Stove/Pellet Stove(InsertJ 1/; 4IJD. [)JJ..
(please circle appropriate app~lance) .
Tax Lot U:
o 2-1/J() 4
Phone
U: 747, O!J;{)J
Zip: 01'-/71
pr,eliminary Inspection is $15.00 (prior, to installation of -insert)
Yood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $1.25
PreJ 1m i YlMj
state surcharge.
Type of Inspection Requested:
Ci~y:_
State:
UI-d/ . 11 ;/
j; ~{J. (J- fo
Phone U: 'J/i.rn. ttc:.. ,uflJi
ZiP:J ~I~ f a/-vJLf1,
EXPires:~ ~
,
Contractor:
7flA rYtf Jl ./
c-
Address:
Construction Contractors Registration U:
By signirig this permit/application, I agree to call for an inspection(s) as required
(726-3769); I state that all information on this application/permit is correct and
that I was provided with the Yood'Stove Safety information for wood burning
appliances and preliminary inspection standards. I also understand that if I am
requesting a preliminary inspection, the wall covering may be required to be removed.
Signature'
Date'
FOR. OFFICE USE
, REQUIRED INSPECTION(S): YOODSTOVE/PELLET~~ tJDi!!!J
Date of Application: I J / Z,l. qO ,,- Job U:
. IS,DD
PRELIMINARY
CJD JLfOq
1/
Receipt U:
Collected:
I fJ I ()
Issued By:
lu. ~ ft (j_ JM1
Total Amount
Checked for Delinquencies:
/ ...-/
Checked for Historical Status:
(..-