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HomeMy WebLinkAboutPermit Mechanical 1990-3-15 ,~ , SPR,I'ELD " 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? - I (j) Assessors Map #: \ IJ[) "38 ~4-4 Tax Lot #: D4 (J(Y) Owner: fJo../u.d jJ/U~.u tl Address: ';;7.25' YJtJth:L, Phone #: 7L/7-YI,I).L;"" City: ~~d' State: Value 0 fl6c ov~YInsert: ~777 (please circle approprlate appl1anCe) O;f 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. \1~.9~x ~^Znat~' N - FOR OFFICE USE '3 -/S-~ "10 Uate 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.--/