HomeMy WebLinkAboutPermit Mechanical 1990-10-26
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SPRINGFIELD
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Job Location:,~7~7.... r1I'liMt11...cr ffltld ~
Assessors Map #: II O~ 7,1~1-1 ~
Owner: ?(k~ C]-t.... ~a II ef-Y
Address: 332-2- 'fhf/()QIAd-' ';)//,)
Ci ty: ~V71f1V ~ (del State: O]l.
Value o~'stov;;YPellet Stove/Insert: ~()-60
(please circle appropriate appliance)
~ v~ 726-3759
~~SPECTION LI~ 726-3769
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Tax Lot #: oZ-laCD
Phone #: "7'17 g90x
Zip: q 7 '-177
Preliminary Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + .....state surcharge + $10.00 Issuance
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Type of Inspection ReqUested:~Y.ffS+JII\'JIi)1j WlJ}Jo.:~
Contractor: /l whiff ' '
Address:
Phone #:
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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Signai:ure
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FOR OFFICE USE
REQUIRED INSPECTION(S): ~STO~jpELLET/INSERT ~ PRELIMINARY
Date of Application: ID ....z.'(j-C;{) Job #: yli/ ~/.c;
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Total Amount Collected: ~(~_~~
Receipt 1I: /;-//J / q Issued By: ( UVhf;
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Checked for Delinquencies, v--- Checked for Historical Status\,-"
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