HomeMy WebLinkAboutPermit Mechanical 1989-12-6
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SPAI,IELD
WOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
D7
225 Fifth Street Office: 726-3759
Springfield, Oregon 97477 AJ' INSPECTION LINE: 726-3769
-'7 "7-7...n ,tV.? tl 71.-) .
Job Location: 31"- {.'r~ '"5~W,C9~
Assessors Map #: \" 03a& A4 ' llax Lot #: ()3qrD
Owner: Ie, en n.<2.....-f-h... ILl. FE Id""-.G...l-f . / _ b'if7~</~
Address: ?--;2...to tU 2- -z-d Phone lIf:ll<g~~-"2-? ~z
City: C'v-. '1 e VI ~ State: c:b r Zip: ? ?YC9S
Value Of~~dc~~oV~Insert:$ 2C(j }~--" Aco,CX?or'\ ~
(ple ~ appropnate appliance)
Preliminary Inspection is $15.00 (prior to installation of
Wood Stove/Insert Permit is $15.00 + $0.75 state surcharge
l1J p t9:L 'SIP,ft-
insert)
Type of Inspection Requested:
Contractor\ ~ ~ \( \'\N. 0\\
Address:
Phone #:
City:
State:
Zip:
Construction Contractors Registration #:
Expi res:
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
,/ wood !~~Wnces .:: prel iminary inspection standa~d~ -{; _ ~
/ :'lgnature uate
FOR OFFICE USE
REQUIRED INSPECTION(S): 000 STOVE/ SERT
Date of Application: \~. o. R
- 8 \ . 'S() A.
Issued By:(~I~
~ PRELIMINARY
Job #: eq\Q~-4
Total Amount Collected:
\SS\\
Receipt #:
Checked for Delinquencies:
Checked for Historical Status: