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HomeMy WebLinkAboutPermit Mechanical 1990-7-7 ~. .l SPRINOFIELD 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: Jill' FJ ~ TJI .4 j/;; /VLLE sp;:;n, Assessors Map #: Tax Lot #: Owner: J)/Jn aid T (.J...hl7.<:()rL, Address: ,.2/I'? h'rrh /IN, Phone #: City: 0nr/Y1t')-ht:dd State: IOM/lO/L /~ -.J' ----'\ J ~ Value of Vood Sto~eYPellet Stove/Insert: $' JIn 7/) - (plea e cIrcle appropriate appliance) 7tfh - 776'1 Zip: q 7'177 Preliminary Inspection is $15.00 (prior to installation of insert) Vood Stove/Pellet/insert Permit is $15.00 + $0.75 state surcharge Type of Inspection Requested: /t.IIJ7'Jd .sin/Ie.. Contractor: JJOI/~Aop :J""':J Q::t--\ \.. ~~ \...... '~~r"'\ Address: Phone #: 9.~5- 1/37 City: State: f2/~~I7Jt/ Zip: Construction Contractors Registration #: 02 CJ.-:J 'if) 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 1'. remov _~ //' / ~ JYlrJ _ J.A , Ner-v/AifL/ / / ~ ~te~1J /1 /990 Signa ture . . FOR OFFICE USE .' REQUIRED INSPECTION(S): VOODSTOVE/ LET/INSERT Date of Application: ~ - \... - qo Total Amount Collected: \ fI,' S Receipt #: \"l<t;~() Issued B;'-L)~ \..~ Job PRELIMINARY #: Q.c:r-:s::.\ L\ C) '-- \ Checked \ ,/ for Delinquencies: - \..-.---"' Checked for Historical Status: \.. \ J f\- ....