HomeMy WebLinkAboutPermit Mechanical 1991-5-14
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VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Offic;e:
INSPECTION LINE:
726:-3759
726-3769
Job Location: ~Jl ~.. ~c....J 10qh
Assessors Map I: . I 7 fJ ?;; Z-J5 Z z.-
i2ti WI hi h1, Dr- .
Tax Lot I: 09'-/00
Ovner: . M~."o"" \.... ~ ~R"'~c.... L. \),.,....E4+..-,^-'
Address: \S<j5 ~"'_~\;"""I ~", Phone II: 7<17- Sd.S7
CitY:S~v~"'4~t/l...1.\ State: OR Zip: Q'}q77
Value ofGrood Stovdpellet Stove/Insert :~o....,v.l$ 3~O h.. I ~ 8'0
(please clrc~ appropriate appliance) .
Pr.eliminary Inspection is $15.00 (prior to installation of .insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10,00 Issuance + $1.25 state surcharge,
. Type of Inspection Requested: \-lJ"",d, S\aw.-
Contractor:
tV J~ - 1J7AJIII M/
Address:
Phone II:
City:
State:
Zip:
Construction Contractors Registration I:
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 vas provided vith the Vood'Stove Safety information for vood burning
appliances and preliminary inspection standards, I also unders.tand that if I am
requesting a preliminary inspection, the vall covering may be required to be removed,
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sl,.,,," 1"11
Date
FOR,OFFICE USE
REQUIRED INSPECTION(S): "VOODSTO~ELLET/INSERT ~
Da.te of Application: 5' -I Lj -'1/ Job I:
Total Amount Collected: 2/0, z0
PRELIMINARY
q loL-/g7
Receipt I: 2DTi.() I
Issued By: (/'A.A/'-....Q__
Checked for Delinquencies:
/'
Checked for lIistorical Status: ~