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HomeMy WebLinkAboutPermit Mechanical 1990-10-30 \j\jD - "-, , /, 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: ~ -y I / 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 + $10.00 Issuance ' JJI.zj Type of Inspection Requested: Contractor: .(I!1J//e:>d~ 5~~/'/~ c:>A ~/T"~C5'e"'x.. Address:-,/~_~X :::>$'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. ~3o~~ Signature /o-Jo-7o Date . FOR OFFICE USE REQUIRED INSPECTION(S): lrlOODSTOV~LE~SERjt) Date of Application: ~~}I-~~ Job #: PRELIMINARY Receipt #:~?t:./ / :9iP/5 &2, -=<6.2S- -4 c:- " ' Issued By:-4~~ Checked for Historical Status: Total Amount Collected: Checked for Delinquencies: