HomeMy WebLinkAboutPermit Mechanical 1990-10-22
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SPRINGFIELD
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:_! Cj,7y) /11I.L./z.-f'.f-S'-
Assessors Map II: 170:; 2J5 =3 2-
Owner: flfl 1,\r1 It. . l~vU.Mr!(fck-
Address: 11?:iV '/IVLrLi/Ld- S!-
Ch" <:'~:zf;' ri ".." DP-
Value ~f if. od Stove ellet Stove/Insert:'~Z:V2> _~
(please ClrCle appropriate appliance)
*
Tax Lot II: () 2/n 0Tl
Phone II: 7 if 0 - I ro (I ~
Zip: q7477
Preliminary Inspection is $15.00 (prior to installation of insert)
~od Sto1ne<Pellet/Insert Permit is $15.00 +~state surcharge + $10.00 Issuance
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Type of Inspection ReqUested:Jl1lJ17d~Jj) J -&,..p.f '*'f>ld"il15
Contractor: _P)(IS-hI1't Slm/p
Address:
Phone II:
City:
State:
Zip:
Construction Contractors Registration II:
Expires:
By signing 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 Vood Stove Safety information for wood burning
appliances and preliminary inspection standards. I also understand that if I am
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Signaturl:) . -::-:::---. Date
FOR OFFICE USE
REQUIRED INSPECTION(S): ~ODSTOiiEJELLET/INSERT '7' PRELIMINARY
Date of Application: 10 -l.:z...-Cfo . Job 1I:C;nI26 g
v ~
Total Amount Collected: 7Jr-. .7t:;
Receipt
II: 19;t)T~
Issued By:
o JI^^^P_
Checked for Historical Status:
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Checked for Delinquencies:
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