CITY OF SPRINGFIELD, OHIO
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING REGULATIONS DIVISION -
76 East High Street Springfield, Ohio 45502 Phone: (937) 324-7389 Fax (937) 328-3558
Rev 6/10/13 jt
REQUESTED INSPECTION
ON-SITE
I hereby request an inspection of the structure located at:
ADDRESS
RESIDENTIAL CHECK ONE COMMERCIAL
Code compliance (for use group intended)
Purpose of inspection
Certificate of Occupancy
If vacant, when was building
last occupied
Proposed use of property
Current or last use of
property
I understand that travel time to and from the inspection site, and administrative time
required to prepare a written report will be calculated as part of the total hours expended.
Signature: ______________________________________ Date:________________
Printed Name: ____________________________________ Phone: _______________
Address: ________________________________________ Fax: ________________
________________________________________
For Office Use Only
INSPECTION
DAY & DATE TIME INSPECTOR
FEES
Receipt # Date
Rec’d
By
Code Compliance
Inspection
Includes Written Report $90.00
Certificate of
Occupancy Inspections
Includes Certificate of
Occupancy
$95.00
