HomeMy WebLinkAboutMiscellaneous Application 1990-9-9
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SPA'FIELD
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: 6-3 ~S" OAI:S1 5T
Assessors Map #:
sf. #-9 -'(
Tax Lot #:
Owner: RflNDj ..:JAc..\LSo'v
Address: 5335 OAI:S~ ST
City: ~PI(;r;N{pF];EW State:
Va 1 ue of od S e/Insert: 1/ Roo. 00
(pl a circle appropriate appliance)
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SPit '71 Phone #: 1/ R1- ;:L~ql
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Zip:.'i'74'l ~
Preliminary'Inspection is $15.00 (prior to installation of insert)
Wood Stove/Insert Permit is $15.00 + $0.75 state surcharge
Type of Inspect ion Requested: l" ') 000 J I;vSE~ '\ V E 12Vw'\.:t:\
srouE. I
Contractor: f~'/_r/U'lE <:. c..orJ ST~lAC'\I:Ot0
Address:
Phone #: 5 L( Lf ~ '::::>~ ~"L
City: tuGc,vc
State: r!)tR-E-G c)r.J
Zip:
Expires: 9- q-q()
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Construction Contractors Registration #: 4'8 '8 &; I
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.
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.Uate
FOR OFFICE USE
REQUIRED INSPECTION (S) .
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Date of Application:
Total Amount Collected:
Receipt #: Ii f):? / X
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Job #:
PRELIMINARY
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Checked for Delinquencies:
Issued
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By:.
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Checked for Historical Status: ~I