HomeMy WebLinkAboutPermit Mechanical 1990-5-25
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SPRINGFIELD
YOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Job Location: I;;. ,-3 / d-4/)'..--l"x';'~
Assessors Map #: /1 0 3 ;; ~ 4/
Owner: A A flR((,MJ. 1!A12.LJJ L
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Address: f 7~ 3 I ()1.u~ b
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City: _~ State:
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Value of Vood Stove/Pellet Stove~
(please circle appropriate appliance)
Office:
INSPECTION LINE:
726--3759
726-3769
51
Tax Lot #: );2[, Oc:
Phone #:
rfL/I-/3/B
Zip: 91'-17'7
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Preliminary Inspection is $15.00 (prior to installation of insert)
Yood Stove/Pellet/Insert Permit is $15.00 + $0.75 state surcharge
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 Yood 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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Type of Inspection Requested: ~
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Contractor:
Address:
City:
State:
Construction Contractors Registration #:
FOR OFFICE USE
Phone #:
Zip:
Expires:
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25./7'-jCJ
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REQUIRED INSPECTION(S): YOODSTOVE/PELLET/INSERT
PRELIMINARY
x
Date of Application: f)- c2!). ?o
Total Amount Collected: :I /-"'-. PO
Receipt #:
I 7/ 7c.,
Issued By:
Checked for Delinquencies:
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Checked for Historical Status:
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Job #:
700101:,(,.
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