HomeMy WebLinkAboutPermit Mechanical 1989-12-18
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SPRINGFIELD
WOOO STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
Job Location:
225 Fifth Street
Springfield, Oregon 97477
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Office: 726-3759.
INSPECTION LINE: 726-3769
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Assessors Map
Owner: f\,,,,jd
Tax Lot II:
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Address: Jlb/J 2jjfl--
City: _<d d IIcJM p
Va 1 ue of ~Od Stov~Insert: .$1,.fJ{) ~
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Phone /I: ~ t. ? - ;'5';10
State:
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Zip:.i1...~ s<"&
Preliminary Inspection is $15.00 (prior to installation of insert)
Wood Stove/Insert Permit is $15.00 + $0.75 state surcharge
*
Type of Inspection Requested:
Contractor:{" If
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 also state that all information on this application/
permit is correct and that I was provided with the Wood Stove Safety information
for wood burning appliances and preliminary inspection standards.
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FOR OFFICE USE
REQUIRED INSPECTION(S): ~D STOVEf)NSERT
Date of Application:~J.Q,2~- ~
Total Amount Collected: I~. 1)
Receipt II: .1503L\
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PRELIMINARY
Job II:
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Checked for
Issued By:
Delinquencies:4'01 tr\. -! Checked
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for Historical Status:
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