HomeMy WebLinkAboutPermit Mechanical 1990-8-13
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SPRINGFIELD
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YOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Job Location: ?9,C:;fP ~~ ~
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Assessor~ap 1I: / If? ~b 2 - 00 - I t/
Ovoer: f(d~ j8~~
Address: 39 5<;' .p~...hv-- g. Phone 1I:
Ci ty: / 4-.':7 ~;~Lf State: (()~ /r"-
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Value of<.Yood StoveYPellet Stove/I~sert;J 5C?o _ -
(please clrc~ appropriate appliance)
Tax Lot 1I: 09715n
7 f/ 7 -'708 5J
Zip: 9;?C/ 77
Preliminary Inspection is $15~00 (prior to installation of insert)
Yood Stove/Pellet/Insert Permit is $15.00 + $0.75 state surcharge
Type of Inspection Requested:,?(".pJ,Wt/\/lf') VO.)
Contractor: .j?)(7Z,-h Yl3 <>1nJ€.-
Address:
Phone 1I:
City:
State:
Zip:
Construction Contractors Registration 1I:
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 vas provided vith, the Yood Stove Safety information for vood
burning appliances and preliminary inspection standards. I also understand that
if I am requesting a preliminary inspection, the vall covering may be required
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Signature
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bate
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FOR OFFICE USE
REQUIRED INSPECTION(S): "~STOV~ELLET/~) PRELIMINARY ~
Date of Application: C;Sr/3-70 Job II: QOf02-1
Total Amount Collected: /fj.6l)
Receipt II:
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Issued By: CV\AAJ( _
Checked for Delinquencies: ~
Checked for Historical Status:
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