HomeMy WebLinkAboutPermit Mechanical 1990-3-15
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WOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: .;:)7,;{ 5 12tn.h1..... v1j)./uA'71l:-..!o/~ ()f?
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Assessors Map #: \ IJ[) "38 ~4-4 Tax Lot #: D4 (J(Y)
Owner: fJo../u.d jJ/U~.u
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Address: ';;7.25' YJtJth:L, Phone #: 7L/7-YI,I).L;""
City: ~~d' State:
Value 0 fl6c ov~YInsert: ~777
(please circle approprlate appl1anCe)
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Zip:
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: /ILIA} ../~~~A~<eJ
Contractor: fYA~/' ;j' (1J'r'YJ'/l7A,//L-w
Address:
Phone #: ,~.</4 - ,"'):")%.;1"
City:
State:
Zip:
Expires: 9,/Qj9tJ
Construction Contractors Registration #: -ylJ"J16/
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
'3 -/S-~ "10
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REQUIRED INSPECTION(S)~D STO~NSERT ~ PRELIMINARY
Date of Application: ~. \:::J .Ll() Job #: qnn~rl
Total Amount Collected: ( s.r; S, . - -
Receipt #: \~otC\S Issued By: eJ\~
Checked for Delinquencies:\)Gt~ Checked for Historical Status: L.--/