HomeMy WebLinkAboutPermit Mechanical 1991-7-24
.
.
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: fr} ~ I !C~(tVL)
Assessors Map I: (1 6 ~ '?:t ') ) L/ " Tax Lot
Owner:, fo~r' , rMtWX~ ~
Addres~1J '/c;oq IA JJ7A 1ftnlCtz.~~ Phone I:
City: ~~ State: 6e.-
Value o~~d~~ellet Stove/Insert: ~CiZ)
(pI c e appropriate appliance)-
I: ()()167
L/ r{l/r eJ-rd f L-f
Zip: Cf'7lLfo1
Preliminary 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 ~eqUested: {DcAt Cd~~ftor--/x'Lu-SlfiY~/I0u{s
Contractor: U
Address:
Phone ft:
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/permi t 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 be removed.
~;::frJiZMrsrPc e:;w A~~ .2-21/-<//
FOR. OFFICE USE
REQUIRED INSPECTION(S)~VOODS~/PELLET/INSER~~
Date of Application: J I' ~4 .q 1 J~b D:
Total Amount Collected: f:J{O' f.}..';
Receipt ft: ~[), <62- -Issued By: ~D. J\ ft- J
PRELIMINARY
C11{)f<UJ( /7
Checked for Delinquencies:
Checked for Historical Status:
.
.
~CIl.U
:,.""~~."",~.r..,",,,-;:..::t,.... "_ V"""".)M'~~", co.
CompanyGRealtors
" ,
....;
1342 HIGH STREET
EUGENE OREGON 97401
TELEPHONE 503.687-1101
DDN L. NAHNSEN
Sales Associate
Res. 484-2942