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HomeMy WebLinkAboutPermit Miscellaneous 1991-11-21 ~ . . SPRINGFIELD VOOD 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: 205 Dorris Street. SDrinafiel~90cci5 Ranch) Assessors Map ,I: 18 03 02 00 ,,' Tax Lot I: Rn?, Owner: Willamalane Park and Recreation District /' Address: 151 North 4th Street Phone I: 726-4335 City: Sprinqfield State: Oreqon Zip: 97477 ' ~ Value of~ood Stov~Pellet Stove/Insert: $890. (please circle appropriate appliance) Preliminary Inspection is $15.00 (prior to installation of .insert) Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $1.2> state surcharge. , .. ?:) Type of Inspection Requested: Wdod Stove Contractor: ABC Chimney Sweep (Ted Huff) Address: P.O. Box 23506 Phone I: 937-3935 City: Eugene State: Oreqon Zip: 97402 Construction Contractors Registration I: 73806 Expires: 5/92 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 apPl)ces and preliminary inspection standards. I also understand that if I am reques ngr ae iminary inspection, the wall covering may be required to be removed. __~ ~ Ah:Z.,_n9/ Silttl6tu~ Date ' FOR_OFFICE USE REQUIRED INSPECTION(S): ~OODSTO~ELLET/INSERT )( Date of Application: /J. </.'7" Job I: Total Amount Collected: -:2 $'. ?S- PRELIMINARY .::7//98/" Checked for Delinquencies: Issued By: 4~::::..- ~ .' ,P Checked for lIistorical Status: Receipt I: 66 ';>/6"'/