HomeMy WebLinkAboutPermit Mechanical 1991-9-26
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SPRINGFIELD
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Offi~e: 726~3759
INSPECTION LINE: 726-3769
Job Location:J, / /j.,/ R (70 d () d p ><- d? ,; I'L
Assessors Map 0: 17'~-<"I' $"'2. '
Ovner: DilY ye. l- /..-- a, Cv' 'Cl.d /-gc. r-r
Address: 1-1 1.1 R (l~ d" l-e.kd--i(J.,.,.,
City: c. P.... j l"b-Flre J,r[ State: to.,.e~ ~
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" Tax Lot 0: P C5'e:;es
7if" Gb ("f. N.'.,.....€...
Phone D: /.1-<1,,' -~75 7 w~ y/T
Zip: <77 '-1'7
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Value of Vood Stove/Pellet Stove/Insert: -:;:> <"<<. .......
(please circle appropriate appliance)
Pr.eliminary Inspection is ~(prior to installation of .insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $1.25 state surcharge.
. Type of Inspection Requested: l?-;qc f .hrr ~/uP~=/1.7
Contractor: #.-.'7/'""..vA-t" e;?, ~~c ~~~~_c:;-
Address:
/? -c::z Cb>r ? 5C' /'
City:
E~cN"dF_
State:
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Phone D:. 6B3-'?<-/C?
Zip: 97 crt:? 2 .
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Construction Contractors Registration D:
Expires: J6J-.::?!il--fi: '"
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
;"ppliances and preliminary inspection standards. I also understand that if I am
requesting a preliminary inspection, the vall covering may be required to be removed.
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Date
Signature
FOR. OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVE(fELLET/INSEaI:> ~
PRELIMINARY
x
Date of Application: t::?~"Zt?--G7 r
Job 0:
q///~c:;.
Total Amount Collected: ~/_ 2'5-
Receipt D: '213.t::!? Issued BY:4~..2;-:-..~'
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Checked for Delinquencies: Checked for lIistorical Status: