The URL can be used to link to this page

Home My WebLink AboutPermit Building 2004-6-4 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line . - CITY OF SPRIr~ul'lJ'.L1J. Building/Combination Permit PERMIT NO: COM2004-00552 ISSUED: 06/04/2004 APPLIED: 05/10/2004 EXPIRES: 12/04/2004 VALUE: $ 202,237.00 SITE ADDRESS: 6867 Holly St ASSESSOR'S PARCEL NO.: 1802022310100 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: PROJECT DESCRIPTION: Single Family Residence, South Hill N.lot 32 - SFR New Residential Owner: NOWAK DIANNE & DENNIS Address: 720 S 73RD ST SPRINGFIELD OR 97478 Contractor Type General Electrical Plumbing Phone Numher: 541-746-7951 I CONTRACTu,," ,,,FORMATION, License 103605 Contractor DENNIS NOWAK GLEN NEAL THOMAS ANTHONY RYDER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: 29.00 5.00 15.00 22.00 0.00 Expiration Date 01/18/2005 Phone 541-746-7591 152323 07126/2004 541-343-0975 I BUILDING INFORMATION I I R-3 U-l VN # of Stories: 2 Lot Size: Height of Structure 29.00 law ~8dltl~t I]IO()~:1 Type of Helj1.=iTENl'Ot~~I~re;~ th~qJ<;t~1Rlooi\:J Water TYP'olloW rules acm~,cl11c y e $"IM-~ ftMC;!1!ent:rth Range TY~~otifiCation CeiEleetrit'os S~~F6~"!Jg~<:liiJ'port Energy Pat :'Q~R 952-001-li'i\t~ ihro~ 't\ctlt~y;jleS by Sprinkled :mffl!'llbU may olltiitn cop~ cup,a~~Lo8l\a . _... '1'lntA" thene fll' ,. EZ.lli!.!":.'-.."'"" .",,:; ~. Utility NotIllC,U'VI' I DEVELOPl\-,,,,,,, u{lfUt<lY\AJ:WI\j lregon t. Center is 1-800-332.2341h:QUlRED PARKING Overlay Dist: Hillside Total: 2 # Street Trees Rqd: 2 Handicapped: Paved Drive Rqd: Yes Compact: % of Lot Coverage: 35.00 6,500 976 1,097 3 483 274 I PUBLIC IMPROVEMENTS I Fully Improved NOTICE: Sidewalk Type: Curbside 5' Yes THIS PERMIT Sp.!I~l!sp'!,~rf\hlmE WOl<iJl1rb and Gutter AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Page I of 4 . - CITY OF SPRINGFIELD Status Issued Building/Combination Permit PERMIT NO: COM2004-00552 ISSUED: 06/04/2004 APPLIED: 05/10/2004 EXPIRES: 12/04/2004 VALUE: $ 202,237.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descrintion J Dwellin!!s Dwellin!!s Gara!!e V Wood Frame V Wood Frame Gara!!e $ Per Sq Ft or multiplier $92.40 $92.40 $24.30 Square Footage or Bid Amount 1,799.00 274.00 440.00 Value Date Calculated Description Tvpe of Construction Total Value of Project $166,227.60 $25,317.60 $10,692.00 $202,237.20 05/10/2004 OS/28/2004 05/1 0/2004 ~. pqitll Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $530.34 5/1 0/04 1200400000000000703 -Mechanical Issuance Fee- $10.00 6/4/04 1200400000000000846 + 10% Administrative Fee $152.04 6/4/04 1200400000000000846 + 7% State Surcharge $106.43 6/4/04 1200400000000000846 3 Baths One & Two Family $306.00 6/4/04 1200400000000000846 Addressing Assignment $31.00 6/4/04 1200400000000000846 Annexed 1994 $-32.51 6/4/04 1200400000000000846 Building Permit $900.40 6/4/04 1200400000000000846 Curbcut Permit $75.00 6/4/04 1200400000000000846 Dryer Vent $6.00 6/4/04 1200400000000000846 Exhaust Hoods $9.00 6/4/04 1200400000000000846 Furnace - up to 100,000 btu $12.00 6/4/04 1200400000000000846 Gas Fireplace $15.00 6/4/04 1200400000000000846 Gas Outlets 1-4 $4.00 6/4/04 1200400000000000846 Heat Pump $12.00 6/4/04 1200400000000000846 Plan Review - Planning $71.00 6/4/04 1200400000000000846 Plan Review Residential $54.92 6/4/04 1200400000000000846 PW Mult Disc - 2nd Permit $-30.00 6/4/04 1200400000000000846 Residence Wiring 1000 Sq Ft $106.00 6/4/04 1200400000000000846 Residence Wiring Ea Addtl 500 $76.00 6/4/04 1200400000000000846 Sanitary Sewer - Improvement $464.67 6/4/04 1200400000000000846 Sanitary Sewer - Reimbursement $611.28 6/4/04. 1200400000000000846 SDC MWMC Administration $10.00 6/4/04 1200400000000000846 SDC MWMC Improvement $214.23 6/4/04 1200400000000000846 SDC MWMC Reimbursement $314.63 6/4/04 1200400000000000846 SDC Sanitary/Storm Admin $109.29 6/4/04 1200400000000000846 SDC Transpo Admin $52.87 6/4/04 1200400000000000846 SDC Transpo Improvement $727.42 6/4/04 1200400000000000846 SDC Transpo Reimbursement $164.89 6/4/04 1200400000000000846 Sidewalk Permit $75.00 6/4/04 1200400000000000846 Storm Drainage Impervious Area $768.57 6/4/04 1200400000000000846 Temp Power 200 amps or less $50.00 6/4/04 1200400000000000846 Vent Fan $24.00 6/4/04 1200400000000000846 Willamalane Single Family $1,000.00 6/4/04 1200400000000000846 Pa!!e 2 of 4 , - CITY OF SPRINGFIELD' Status Issued Building/Combination Permit PERMIT NO: COM2004-00552 ISSUED: 06/04/2004 APPLIED: 05/10/2004 EXPIRES: 12/04/2004 VALUE: $ 202,237.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Amount Paid $7,001.47 I Plan Reviews I Initial Review 05/11/2004 05/11/2004 OK RJB Plan nine Review 05/11/2004 OS/21/2004 APP TAJ PubUc Works Review 05/11/2004 05/13/2004 WE VRJ Site plan incomplete. Left message for Mr. Nowack requesting revised siteplan, 10:34am 5/13/2004. Public Works Review 05/18/2004 05/18/2004 APP VRJ Mr. Nowak submitted new site plan. Structural Review 05/11/2004 06/03/2004 APP RJB To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. I Reonirprt Tnt:nel"tinns I 1 Curbcut - Standard: After forms are erected but prior to placement of concrete. 2 Sidewalk - Curbside: After forms are erected but prior to placement of concrete. 3 Erosion/Grading Inspection: After all erosion measures are in place. 4 Ufer Electrical Ground: InstaU ground rod at footing and caU for inspection in conjunction with footing and/or foundation inspection. 5 Footing: After trenches are excavated. 6 Foundation: After forms are erected but prior to concrete placement. 7 Post and Beam: Prior to floor insulation or decking. 8 Floor Insulation: Prior to decking. 9 Shear Wall Nailing: Before covering sheatbing with finish materials. 10 Framing Inspection: Prior to cover and after aU rough in inspections have been approved. 11 Wall Insulation: Prior to cover. 12 Ceiling Insulation: Prior to cover. 13 Drywall: Prior to taping. 14 Hold Downs InstaUed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. 15 Final Building: After all required inspections have been requested and approved and the building is complete. 16 Underfloor Plumbing: Prior to insulation or decking. 17 Rough Plumbing: Prior to cover and including required testing. 18 Water Line: Prior to filling trench and including required testing. 19 Sanitary Sewer Line: Prior to filling trench and including required testing. 20 Storm Sewer Line: Prior to filling trench. 21 Final Plumbing: When all plumbing work is complete. 22 Underfloor Mechanical. Prior to insulation or decking and including required testing. 23 Underfloor Gas: After line is instaUed and required testing and capped if not attached to an appliance. 24 Rough Gas: After line is installed and required testing and capped if not attached to an appliance. 25 Gas Service: After line is installed and line has been connected to a minimum of one appliance including required testing. Presure test done at this point. 26 Rough Mechanical: Prior to Cover 27 Final Mechanical: When all mechanical work is complete. 28 Temporary Electric: Approval required prior to Utility Company energizing pole. Paee 3 of 4 , - CITY V1' :srK11~\j1'IELD . Status Issued Building/Combination Permit PERMIT NO: COM2004-00552 ISSUED: 06/04/2004 APPLIED: 05/10/2004 EXPIRES: 12/04/2004 VALUE: $ 202,237.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspeetion Line 29 Rough Electric: Prior to Cover 30 Electric Service: Approval required prior to utility company energizing service. 31 Final Electric: When all electrical work is complete. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, th he permit card is located at the front of the property, and the approved set of plans will remain on the site at all ti durin:::~:n'4~ 6k/fC/ -, , /'" Owner or Contractors Signature Date Pal!e 4 of 4 .~ _ty of Springfield Official Receipt .evelopment Services Department Public Works Department 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 'i,COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 . COM2004-00552 '?"COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 COM2004-00552 RECEIPT #: 1200400000000000846 Date: 06/04/2004 9:04:27 AM DescrIption Addressing Assignment Willamalane Single Family Sidewalk Pennit Curbcut Pennit PW Mult Disc - 2nd Pennit Stonn Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Stonn Admin SDC Transpo Admin Annexed 1994 Plan Review - Planning Plan Review Residential Building Pennit 3 Baths One & Two Family Furnace - up to 100,000 btu Vent Fan Exhaust Hoods Dryer Vent Gas Outlets 1-4 Gas Fireplace Heat Pump -Mechanical Issuance Fee- Temp Power 200 amps or less Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 + 7% State Surcharge + 10% Administrative Fee Amount Due 31.00 1,000.00 75.00 75.00 (30.00) 768.57 611.28 464.67 164.89 727.42 314.63 214.23 10.00 109.29 52.87 (32.51) 71.00 54.92 900.40 306.00 t2.00 24.00 9.00 6.00 4.00 15.00 12.00 10.00 50.00 106.00 76.00 106.43 152.04 $6,471.13 Item Total: Check Number Authorization Received By Batch Number Number How Received Payments: Type of Payment PaId By Check 'iil ~~ 6/4/2004 Amount Paid DENNIS NOWAK djb 4934 In Person Payment Total: $6,471.13 $6,471.13 Pa~e I of I .' .. - Job. No.C.oti\8...to'i ~ SYSTEM DEVELOPMENT CHARGE WORKSHEET NAME: ~~~.N;.< ~~~~ PHONE: i,{c:'-l"\S( ADDRESS: 1<9-0S.. 1~ STATE: ZIP: tOCA TIQN OF PROPOSED BUILDING SITE: Street Address:. Cc.Bio1.~ \\ '-I <;'t-. . , Pial Name:' l8CQ..~'!. Tax Lot Number: \ D\cro 1 ~ '.QfVEL..PPMJ::'NT TYP.!,; (Checkapproprlate dwelfing(s). soe calculations and dwelfing t . we definitions are on the back.) A. SinoIA-Fl'lmilv DAtl'lchAQ ')0 Single Family home NO. OF UNITS \ Manufactured home not in a park . X $1,000 per unit =$ \ tJtTc) U2Zv B. SinQle-FC'lmilv Atfl'lchAQ NO. OF UNITS X $924 per unit $ C. Multi-Familv Aoartment, NO. OF UNITS X .$692 per unit - $ D. ,Ml'lntlfl'lcturAo HnmA P'llls. NO. OF UNITS .' WILLAMALANE SDC X $699 per unit = $ $ \ ()('f) cO ';j 2. SDC CREDIT (II applicable) Soc-payer must lurnIsh proof 01 Willamalane Credit approval. See SOC Credit Worksheet. $ 3; TOTAL WILLAMALANE NET SDC ASSESSED (If soe reduced for Credit) $ ='"" (000 .~ ~\).)~!}~. . De~pment Services Department City of Springfield ~I L(,O\.J\.. Date . . CITY 'OF SPRINGFIELD SYSTEMS DEVELOPMEIvORKSHEET JOURNAL OR JOB NUMBER: co012004-00552 NAME OR COMPANY: Dennis Nowak LOCATION: 6867 Hollv Street TAX LOT NUMBER: 18020223 tl 10100 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS I BUILDING SIZE (SF' 0 LOT SIZE (SF): 1. STORM DRAINAGE 6534 CIl >tl CI o U ~ ~ I~ DIRECf RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. I CHARGE I I 2650.25 I $0.290 = I. $768.57 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCfED TO CITY STANDARDS I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I I DISCOUNT I 0.00 I $0.290 I 50% = I $0.00 ITEM 1 TOTAL - STORM DRAINAGE SDC $768.57 ~ 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I COST PER DFU I 27 I $22.64 B. IMPROVEMENT COST: I NUMBER OF DFU's I x COST PER DFU I 27 $17.21 ITEM 2 TOTAL - CITY SANITARY SEWER SDC ~, $1,075.95 $768.57 $611.28 $464.67 1070 11091 I 11092 I ,~ ~ , DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW F1XTIJRES x UNIT EQUN ALENT - DRAINAGE F1XTIJRE UNITS (NOTE, FOR REMODELS. CALCULATE ONLY TIlE NET ADDmONAL F1XTIJRES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS IBATIlTUB 2 0 3 = 1 6 IDRINKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 IINTERCEPTORS FOR GREASE I OIL I SOLIDS I ETC. 0 0 3 = 0 I INTERCEPTORS FOR SAND I AUTO WASH I ETC. 0 0 6 = 0 I LAUNDRY TUB 0 0 2 = 0 !CLOTHESW ASHER I MOP SINK 1 0 3 = 3 ICLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0 IMOBILE HOME PARK TRAP/I PER TRAILER) 0 0 12 = 0 IRECEPTOR FOR REFRlG I WATER STATION I ETC. 0 0 1 = 0 IRECEPTOR FOR COM. SINK I DISHWASHER I ETC. 0 0 3 = 0 ISHOWER. SINGLE STALL 1 0 2 = 2 ISHOWER. GANG (l'!UMBER OF HEADS).. 0 0 2 = 0 ISINK: COMMERCIAURESIDENTIAL KITCHEN 1 0 3 = 3 ISINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASINIDOUBLE LA V A TORY 1 0 2 = 2 ISINK: SINGLE LA V A TORY /RESIDENTIAL BAR 2 0 1 = 2 IURINAL. STALL I WALL 0 0 5 = 0 ITOILET. PUBLIC INSTALLATION 0 0 6 = 0 ITOILET. PRIVATE INST ALLA TION 3 0 3 = 9 , MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 27 .EDU (Equivalent Dwellinp; Unit) is a discha.nte equivalent to a sinJde family dwellinp; unit (20 DRJ's) set al 167 Jt8.I...!?ns per day MWMC CREDIT CALCULA nON TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$I,OOO ASSESSED VALUE S5.04 55.04 54.95 54.88 54.75 54.58 54.41 54.20 S3.88 S3.50 $3.07 S2.6O $2.14 $1.71 $1.52 $1.38 $1.\9 $1.03 $0.87 SO.68 $0.46 SO.27 SO.09 SO.04 ~, IS LAND ELGlBLE FOR ANNEXATION CREDIT! (Enter I for Yes. 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT! (Enler I for Yes, 2 for No) BASE YEAR o 1994 CREDIT FOR LAND (IF APPLICABLE) V AWE I 1000 CREDIT RATE $27.32 x $1.19 = , $32.51 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) V AWE I 1000 CREDIT RATE $0.00 x $1.19 o TOTAL MWMC CREDIT $32.51 = 225 FIFfH STREET' SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTR1CAIn~~~k1P~,..rr,pN City Job Number m1Yt1X A .( ~bte l.lg1:'~I8~l1tt~~f:!) M?..^!: :>:S~~TION tt \V~ lO\DO . . JOB DESCRIPTIONl' ~ ~~n-tra s erab:e~~:.nCG not started within 18 days of issuance or if work is Suspended for 180 days. 2 ~~:l~~eToRWST~TI..~'~oNrO.:;NE/y.,,~ . ~~"~~.;:':-n.~~~~;j!i.'''''''''''''<>I'1lfJt~' ~'. ...... ' Electrical Contractor GLEN NEAL ELECTRIC 4715 rox 1I0LLO"" RB EUGENE, OR 97405 Address City Phone .l(5?.{"" :JL(7 Z. Expiration Date 5c;7~S / /J -tJ I - C) t.{ 93 '? 53 ItP ~;ZZ-CJ ~ v Supervisor License Number Constr. Contr. Number Expiration Date l~\U LO.t.LA \!\. ~,,",(~';'W'l'~~~___~ ~,.>-,...,-,__' "_"~""'>"'F"'''\'~4'~f<''i:~.:a''''4''',Jl~~lJjj;e1!..'''?:~' "'" , 3. ~jCOMPnETE'FEE~SCHED(iLEiBELOW,:~~~;,.iO!f"ii':" . ~'~">"-~~"'lL~~~'ft:,:,-"'~~iN;;.l~t;,...'i~"iit~~..&.~&~kw1~~1:;";' . ~'ff~11:'f""iJil'~:'!ll~m!1!:~1V.">;-",,')~~~:;~,,..t~<:~ A. ~~~~_~!\~~J!~~J!X~~t,~~'ffJ"i~rtU~B~~~i!~~ Service Included $106.00 J cx.o .ex:> ~ \ 4 $ 19.00 1000 sq, ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 ~-*~~i:;~~~~~1\.)!~~~~"PJk1:iJ.~."-~~~~;i'.~;r.~,~~~ B. ~~~~~~.;;t;=~~~~~p~~!gtr~~ 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/V 0115 Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 ~~.~:m::"~:S5f'V''''ll~:~;.:'lli. ;,-'.'~~,")M..fy,,~~~~.~_..~~ - ."1m c. . l"em!l?rarY.i~_er.Vlc.~~~~~~~~~ Installation, Alteration or Relocation to 200 Amps or less On laIN !e~ul!es Y~'j","'I $ 50.00 ~~t~Pllt\i liH6';~ tne o!e\:lv,,_..,~ fN\M9.00 10~,~\5S~~~&? Amp.~se !\lIes ~'; ':';:,,_n.oS~oo.OO ~ce01.'6!.-T \'l ol""'~- NC()~6 _ _f)\)l~~Wl\lg 'iJu\atibV'e.bY ~<ffBIi!iffi~Ii~:-;" ~m' 1~.t\l)r.B~"~~';\~ Mf-'feW ljU.' 'f . &. . 0 !iJa!\~ OQ, .... ('.Role,[.- '''hJ.I>JOlJ Ie Nc!l.\~.at.arr omMI'yp,ibllU'er 'PaIlel q~fWtufpl the. 1_800-332-2344). $ 43,00 Each Add~ffi~CWcuit or with Service or Feeder Permit ~ Signarure (j?l~sm;c;C? ~ _.oj :1,. I- Owners Name ~~ :f-t'i~i.~ f\Ylli\\<' ,il 0 ..J\- C'L l!l~_"'J\~=,'=",,,.~~""-"""jN'.,,,,,,,""->;;"""~~_"""" Address -1J ()(). "1 '&~n... ~D....!- E, ~~~~~=(~~iCi[~~!r~J.1!!~;~~,;!~~~~~~~,tJl",!l,ti2~ City ~cL Phone -A\~.~S\ $ 3,00 Pump or irrigation $ 50.00 SignlOutlme Lighting $ 50.00 OWNER INSTALLATION Limited EnergylResidential jl;', $ 25.00 The installation is bemg made on property I own WhiC~01\C~,!-imited EnL't~~pww.e\tilIr\E ~~iC1 $ 45,00 IS not tntended for sale, lease or rent. ir\\~ij\t.",1i&H\1~~R'EW\IfI Rli. J ~e is $45.00 + Surcharges '\lI~~tm~- 1~J~. .,. c? OD Owners Signarure: I"' 4~<< r~~ A~}fAB6VE : ,: - ;:;! '2.-,> COW.W\ '~~1Ui't"" '" . . · fl,~'{ "\ ~/R~ate Surcharge i b Z"" 10% Admmistrative F ee .~ "3:> z.o Inspection Request: 726-3769 TOTAL Z 7/ 4<f Shared Drive(T:}1Building Forms/Electrical Permit Application 1..()3.doc communiIYSerVIC~S~MS1~ .lgSafCIy/BUildlnogCCdes ~PFlINGa _~~"AlfJjilf""1:J:IJ"'Jet;tI::tI1,jf{.m::l.~.lA'~~ IT' . DEVELOPMENT SERVICES DEPARTMENT .. . ~l . (541) 726.3753 FAX (541) 726.3576 Notice to Permit Applicant. Soils engineering or review required j)D Name of Owner 'bS-IINI"::,. dOlJ ,A- 'L- ;. Address of Project: . bzs 67 H0/l'7" / Tax Map: J 1562. C> 2... L ~ . Tax Lot: Permit: Colll1ZOU4 -()O S-Sz... ~.} ,~ /0/00 The building site at the above address is located on hillside property, and/or has soil characteristics that are prone to shrink-swell or other potential movement. Excavations and placement of fill materials on this site must be done under the direct supervision of a properly licensed Professional Engineer or Architect to verify the stability and compaction of the resulting building pad and the site. The owner, or the owners qualified agent, is responsible to obtain the services of the appropriate professional engineer or architect. The professional engineer or . architect shall be responsible for providing direction for the stabilization methods to be used for the building pad (and surrounding site, when site stabilization is necessary). An acceptable geotechnical report, which is prepared for the specific site, niay be utilized to provide appropriate guidance for the method of stabilization and required compaction. The engineer or architect shall prepare a report to be submitted to the City when . the necessary soil stabilization and compaction have been accomplished. A signed . and stamped report from the engineer or architect must be received and aooroved bv this office before insDection aDoro"al will be lITanted by the City Building Inspector for the placement of footing or foundation concrete.