HomeMy WebLinkAboutPermit Mechanical 1990-10-30
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UOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: "'35"" ,~~ 4~;trr
Assessors Map #: /7--<:::> 3 - ~<-'-I/
Owner: S+eu<v/\ ~b:!)h e.-r
Address: '~S-- An" C o~-\-
Ci ty: '<"r~ v-e-l c,~{ 1 OY'e.. State: ~
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Value of lrlood Stove/Pellet Stove/Insert: #2l '8'~., 00
(please circle appropriate appliance)
Tax Lot #: 0/0'0-0
Phone #: 7 c.f 7 7 IJ :5
Zip: Q'7tf77
Preliminary Inspection is $15.00 (prior to installation of insert)
Uood Stove~ellet)Insert Permit is $15.00 + ~ state surcharge + $10.00 Issuance
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Type of Inspection Requested:
Contractor: .(I!1J//e:>d~ 5~~/'/~ c:>A ~/T"~C5'e"'x..
Address:-,/~_~X :::>$'O / Phone #:
City: C:;-~~~ State: Zip:
Construction Contractors Registration #: t4(z:>~:;- Expires: /~---<S-7'/
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 Uood 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.
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Signature
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Date .
FOR OFFICE USE
REQUIRED INSPECTION(S): lrlOODSTOV~LE~SERjt)
Date of Application: ~~}I-~~ Job #:
PRELIMINARY
Receipt
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Issued By:-4~~
Checked for Historical Status:
Total Amount Collected:
Checked for Delinquencies: