HomeMy WebLinkAboutPermit Mechanical 1991-2-21
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VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Offi~e: 726~3759
INSPECTION LINE: 726-3769
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Job Location:
Rest 0 Lt.). C\JL(lI\~f~) ,"~QQt-
Assessors Map*:\ ()n~2J, 4 ~ :\" 'Tax Lot *: () In (()
Owner: P tam fiN G t).Qill~ 1C '
Address: B::\ lo - L0. fJ t
City: ~\r\ '
Value of Voo~St\ve/pe~let Stove/Insert: ~ \ \ bOD.fJJ
(please circle appropriate appliance)
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Phone
*: -N,-Q'?!Ji,
Zip: ql4"l~'
Preliminary Inspection is $15.00 (prior to installation of ,insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $1.25 state surcharge.
Type of Inspec~i,on Requested: \D, ~\6 yP.I' L, ' '
Contractor:\ C1\\ \\QMl t ~ ~~ QO O~
Address: C\ ' - Phone t1:
City:
State:
Zip:
Construction Contractors Registration *:
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
requesting a preliminary inspection, the wall covering may be required to be removed.
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Date'
/0(31\
Checked for Delinquencies:
Checked for Historical Status:
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