HomeMy WebLinkAboutPermit Miscellaneous 1991-11-21
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SPRINGFIELD
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
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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
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Address: 151 North 4th Street
Phone I: 726-4335
City:
Sprinqfield
State:
Oreqon
Zip:
97477 '
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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.
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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.
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Silttl6tu~ Date '
FOR_OFFICE USE
REQUIRED INSPECTION(S): ~OODSTO~ELLET/INSERT )(
Date of Application: /J. </.'7" Job I:
Total Amount Collected: -:2 $'. ?S-
PRELIMINARY
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Checked for Delinquencies:
Issued By: 4~::::..- ~ .'
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Checked for lIistorical Status:
Receipt I: 66 ';>/6"'/