HomeMy WebLinkAboutPermit Mechanical 1990-7-7
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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
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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
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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
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REQUIRED INSPECTION(S): VOODSTOVE/ LET/INSERT
Date of Application: ~ - \... - qo
Total Amount Collected: \ fI,' S
Receipt #: \"l<t;~() Issued B;'-L)~ \..~
Job
PRELIMINARY
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Checked
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for Delinquencies:
-
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Checked for Historical Status: \.. \ J f\-
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