HomeMy WebLinkAboutPermit Building 1989-1-24
I INSPECTION LINE . CITY UF SPRINGFIELO
726-3769 CDriBIIIATION APPLICATION/PERMIT
b E!lERGY SOURCES:
Job Address ~ -<"'0 #..4"z;>~ -"._ /1 Z'> Heat
!'Iater Heater
,
INFORlIATION LINE
726-3753
SQ. Ftg. "'ain
~CJ. Ftg. Access.
SQ. Ftg. Other
Ilel< Add Alter Pep.
--Fence Demo Change/Use
Other- -
()~
I~
\J\
legal De5cription
/7-..-7 '3 - =<< -~'\ ~"2 /~?\
Address
DES I GN TEAl.'
(na&X!)
Phone
(address)
Range
ValuE of Hark.:
/r /<........... . c:>o
Bulld;neJ Permit Info: Describe Work.(Le. t Build Single
F~rnilv ~esidence With Attached Garaae}
l1E~~:r~=7 ?/Y9/'
JLA-P cb~--': J:b,/~
~~~~~. reXnir:S) (nhone no. I
Owner' ~ ?/.YNr~ L~/'-
Address C~6 ~c.e:sk.> ~
-%(~;..... ./"'",-~
~
Construction lender
'_4.....:.-.~..'.-"_0l\
Phone
Primary
Structural
Electrical
Mechanical
CONTRACTORS Inanel
General ~y<",~ ~A/~,;.
Plumbina
(address)
(1 ics. no.)
(pxnirps)
(ohnop M_)
p~ &y7:?S"/E-~,C ,~7"'O.?/
7-~-8'5, ?~~~3'~
, -
Electrical
~1echanical
Pl\lllllIIlG
ELECTRICAL
MECHANICAL
NO.
FFF CHARGE-HD
...EE..L. J:JiA.RG.E. NO.
'~J:'I= J:1.i8.RG.E..
Each siRgle fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated ~ilding
(new fix. ~dd;t;onal)
New circuits a1t5.
l/ or extensions ~.L"
~~~r>--
SERVICES
~5'1>
Floor furnace
and vent
S.F. Resident;e
(] bath)
Duplex (1 bath) each
Additional bath
Recessed wall
~n~~p hp~tpr ~nrl vpnt
Storm Sewer
Of
amps,
Appliance vent
S.P'D.il ra te
Stationary evap,
cooler
Vent fan wi th
sinole duct
Vent system apart from
heating or A.C,
Mechanical exhaust
hood <lnd dUr't
Sewer
Temporary Construction
Change in existing
res i d-.e.nce
multifamily, corrm. or
Industrii'll
Wa ter servi<:e
CO~1./IND. FEEDERS
Install/alter/relocate
dic;trih. fppdprc;
Hood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE l,~i REQUIRES
shall not be vali1 until the
TOTAL CHARGES
ISSUANCf OF PFRIIIT
--:<~ .S'c> TOTAL CHARGES
that the Electrical work be done by an. Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREfULLY EXM1INED the completed application for permit, and do hereby certify that all information hereon is true
and correct~ and I further certify that any and all wor~ oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore(]on pertaining to the work described herein, and that rw OCCUPA[~CY will be made
of any structure without the permission of the Building Division. 1 further certify that my registration with the Builder's
Board is in full fnrce and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project,
Zone
Fi re Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
0~Units
Occy load
/ Occ,Y Group
SIGIIATUREf1L ~,;7
FO~ OFF I CE USE OIll y
Sn. Ftg. liain
Sq. Ftl). Access
/n~LSq. Ftg. Othor
DATE /..2 v-6''1
NAf.1E(please print) ,t.../,/'IV,1't ;oQ.v_lh"G.t,.,~ Co
Rk'/
x Value
x Value
x Value
TOTAL VALUATION
/a
.~
BUilDING PERNIT ~55? Plan Ck. Conm/l nd ~~/Y~ ~~temsDevelopment
Charges and -----_..! ---- 65%/Blda P,.E'r Fpp W'--~ , ~rQe (I.5~)
Surcharges ~..?? Plan Ck. Res ~~'H<Jf~>-"'"
30%/BldQ Per Fee ~ <=
PlUi1BING PERMIT Fence I I
Charges and ------------
Surcharges DUmo I I
ELECTRICAL PERlm -::?7-5= .Sidewalk I I
Cha rges and ------------ I ITotal
Surcharges /./"3 A/C Paving Comb. rermi t
MECHANICAL PERMIT Curb Cut I I
Charges and ------------ I I TOTAL
Surcharges
##
/&:'8. /6
,.
',.....,
.'
.'
J
I
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, lane County Map Reference
II uj 43
2. examole- Lot I. Block 3. 2nd Addition to
. ::>pr1l1gf"ield Estates
C. Name, etc. of owner a'nd construction lender
O. Energy Sources
1'. examl?le- heat/electrical ceiling/o'r forced air ,:
2. example- waterheater/electrical/or solar
E. Square footage or valuation. etc. -
I. examele- 1250 sq. foot house. 500 sq. foot gara'
2. examplew if new project. check new - if additiol
cneck. add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garllge
2. example - remodel existing garage into family rc
3. examl?le - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. 80xes adjace
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedul
have been abbreviated
2. If the item(s) to be installed are not covered 0
the abbreviated schedules you should consult the
full schedules
C. 8UILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to '
electrical contractor for signature by his electrica
supervisor. The general contractor is.not authorize!
to sign the electrical label. ---
Ill. Applicant to sign and date
Whenever possible. the initial application will be used as
a worksheet only. Where possible. Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application. and no plans will be processed until these
.fees are paid. All other fees and charges are due and
payable when the permit is issued.
V.. FOR OFFICE USE ONLY
CITY OF SPRINGFIELD
\,
\
City Hall r
Springfield, Oregon I
Office 01 Community and Economic Development
OFFICIAL RECEIPT
13077
Date ,JA-# "< s-I 19$'7
.. /
Rec'd From ,/,1;;..> vo-"T" .c---- ~
R<::>-I:5'&<K7$'1f1 .
Address ;C;-:-~~:--~:.<'I)rl;, 97<,16/
,
Received For:
1p,tr~89~'2~~A'.
-;:f?
~
E.7:'
r-~
7'6/4<-
&C'_ ~O
4/. O;r
22.~O
/,/,:;i"
/.58, /&:;
U'K#/23;?
'~
Amount Re=d ~/ C:;8~ /(C,
~=of:G~~
!!L
r
r ,. , . 'BUSIN~SSfORj,I!i.INC. 150031,.2.".'
".n
Permit Clerk
,~,.-". ,..-
,..,......,_.'.
; !
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
: ,
: !
I
Additional Project Information:
';\',
.'.
PLANS REVIEWED BY:
name 1~;?ffiS: ~.CVTSignature ~~;..,.?~ date / "':<7'-8"':>
I .c L-/ /"" I ~.... .
"
I
,
I
I
Owner ~ .:z;>~~?,,~ ~_1:t("~~_"!2."'r' '...-=.....,.s.
r
Address h5"6 ~('~L > ~ . Phone
% .f,<~ -" 4'"~" ;:'':-,-''
Construction lender
I
,
INSPECTION LINE
726-3769
INFORllATlON LINE .'
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
lIew Add Alter Pep.
-Fence Demo Change/Use
Other - -
.
CITY ilr'SiRINGF'iELD
COflBIIIATlON APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
t~ater Heater
Ran!le
.
Job Address ?; ~O #--4.,>;>~ ""I-.... ~2:)
Legal Description /.7'.b3-~<-q'~ /.7~/~r'\
, .
Address
UI:~J(jN II:JV1
'name)
Primary
Structural
Electrical
Mechanical
CONTRACTORS Inane)
General . (1__yC'!'.Z? ~../~ .
, . - ,
Plumbina
Electrical
~lechani ca I
PLlJIIlIIIG
NO.
FE
Each single fixture
Phone
(addres~)
Il (Y (J
-~ I-I.) I
I ^I,
V" 'I
1\1 ;-
I
(address) (lies. no.l (pxnirpo;.\ (OllMP nn 1_
.~ ZbY.7"3''Y/L:2 ~~~, ,~YO.?? 7-~~_?~~"")..3'~'
SIf,IIATURE(?L ~/
rlfrf(jfF I CE USE OIll Y "
So. Ftg. liain
Sq. Ft~. Access ~ /
.J77-LSq. Ftg. Other
IlAI-1E(please print) ;...t,~.;.." r<'''''''.~''G+'.':' Co
ELECTRICAL
MECHANICAL
-/ Relocated building
(new fix, add;tional)
-ls.F. Resideoce I I
(1 bathl
-I Duplex {I bath) each I ,
IAdditional bath I I
I Wa ter service .1 I
I Sewer I I
IStorm Se_' I I
-I I I
I I I
-I ~\ If I t:-f) ,.- "'
-, u e>'i . Ie, I I I
I I I I
_I LI LJ ,_] I ISSUANCE OF PFRlllT
TOTAL CHARGES J TOTAL CHARGES --=<:::? -~C>, TOTAL CHARGES
\/HERE STATE L\ll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical ~ortion of this pemit
shall not be valjj until the label has been signed by an Electrical Supervisor and returned to the Building Division
Residence of
.1
I ,
I
I
I
I
I
I
I
I
I
I
I
I HAVE CAREfUlLY EXNfINED the completed aprl;cation for permit. and do hereby certify that all information hereon is true
and correct. and J further certify that any and all work oerformed 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 rID OCCUPArKV will be made
of any structure without the permission of the Building Division, I further certify that my registration with the Builder's
Board 1s in full farce and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
Zone
Fi re Zone
Flood Plain
.<::'- N .
Tvpe/Cons t.
Bedrooms
Stories
I
BUILDING PERMIT
Charges and ~
Surcharges ;
SQ. FT.
furnace/burner to
BTU's
New circuits alts.
v or extensions .
~..:orr /??C>~
-, SERVICES
-,
I Floor furnace
and vent
I I Recessed wall
~nArp hp~tpr ~~d vent
-I
ITemporary Construction
IChange in existing
rp~.jrly""'''P
Imultifamily, COIl1ll. or
lnrill"f',r;;tl
I Appl iance vent
seoaratp
I Stationary evap.
r.noler
I Vent fan wi th
sinale duct
I Vent system apart from I
heatinn or A.C,
I Mechanical exhaust
hood and du,.t.
I Hood s tove/hea ter
jOf
I COHl.I./ I NO. FEEDERS
I~sta~l/alter~~;locate I
Of amps.1
amps,l
.DATE 1-,.2 v-8'1
Units
Occy Load
Occy Group
,
,
x
Value
Value /a----eoe
Value
TOTAL VALUATION
-__e~2?__ :~;~B~~~ ~~~'!~d
Plan Ck. Res
30%/Bldq Per Fee
I Fence
I DDllXl
L___3::?=~-' Sidewalk
[' /. /'3 I A/C Paving
r-----------I Curb Cut
$",0;3
.
PLUllBING PERMIT
Cha rges and
Surcharges
------------
ELECTRICAL PERI~IT
Cha rges and \.\
Surcharges V
11ECHANlCAL PERMIT
Charges and
Surcharges
N.c>/y.e r~
~.q/'~ ~
~~'I'fi'I"f1:!' y
?! -'.-. '"
stems Development I
_rqe (1.5~)
1
I
I
I
I
I
/~t? /6
#-;#-
I
I
I
/Total
I TOTAL
Comb. rermi t
I
I
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
8. Legal Description
. 1. example- Tax Lot 100. lane County Map Reference
11 OJ 43
2. exam~le- lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1'. example- heat/electrical ceilinq/or forced air .~
2. example- waterheater{electrlcalJor solar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq. foot house, 500 sq. foot gara,
2. examp'le- if new project, check new - if additiol
check add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examp'le - remodel existing garage into family rl
3. exam~le - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM ANO CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules'
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical -Schedules,
the applicant need fill-in only the No. Boxes adjace
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building ~ivision
1. To conserve space on the permit form the schedul
have been abbreviated
2. If the item(s) to be installed are not covered 0
the abbreviated schedules you should consult the
full. schedules
C. 8UILDING OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
O. As noted on the CAP, the label must be delivered to
electrical contractor. for signature by his electrica
supervisor. The general contractor is .not authorizet
to sign the electrical label. ---
Ill. Applicant to sign and date
Whenever possible. the initial application will be used as
a worksheet only. Where.possible, 8uilding Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
CITY OF SPRINGFIELD
\
,\
.
Clly Hell
Springfield, Or8llon
Office 01 Community and Economic Development
OFFICIAL RECEIPT
13077
Dale ,)/1-/-/ ":2.y '9g~
.1 / ,
Rec'd Fmm ~ V~ L'6~7:"
P'6-~"""K~:f1
Address ;<?( -/ .~'7n6i?=:.""~, 9'7Y:~ /
,
Received For:
IVP~89~'Z~<,,~;rlt:
ff-p
~
E. J:'"
r-~
7'674<-
~C/. ~O
4-"- c> ~
Z;Z.5"'0
/,/7
1.58, /&:;
U(;f #/23;;:
Amounl Received . / .?>8... / (j;,
~ - // 97 -; -/~.7"'C>
-#~HORI;EO s.GNATURE /'. r
frontier BUSINESS' OMMS, INe I!>OJI~"''''
Permit clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
, ,
. '
I
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
.',
PLANS REVIEWED BY:
"'"" I M'-lf-,,",'T'igo,,",:o~~
da te 1 ., ':<"--8"'=3
CITY Uf SPRINGfIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Hark:
/O~. c:oo
Bu;(riina Permit Info: Describe Work(i.e.. Build Single
Familv Residence With Attached Garaoe)
l1E~ ~rA'=7" -:;:> / .:v 9/'
'~L#"t!? c:;:;;~ ---.::- U:,nk-'':::'>
Phone ;Z ~ r::/ ~d-:- .
(address) (lics. no.)
.~
I INSPECTION LINE
726-3769
.
,
Job Address ~.("'O #~~,A>.2) .
Legal Description / 7",b '3. ~< -~"\ .4~ /""......
Owner'~ ?,6/N7'€' ~~.......--""-'~"
Address -:::5"6 ~~~ ~ , Phone
'%A~ ~...'?~
Construction lender
Address
UtS1GN WIM
(name)
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
General . f _
I......'
_ 'Y<'"''''<'? ~..u'~
r
(addres~:;)
(lic:<;._ nn_ \
P.L!>. ?by 7"3S"/&--
L- _')$0;>,/ 7-3<:>;!!i"5, ?~~'")..3'~'
; -
I
I
I
I
I
I
I
I
I
I
I I
TOTAL CHARGES TOTAL CHARGES --:;::=? -SD TOTAL CHARGES
WHERE SIATE L\N REQUIRES that the Electrical work be done by an'Electrical Contractor, the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
,
Plumbina
Electrical
~1echanical
PLUIlllIlIIi
ELECTRICAL
ND.
fEf r.HARr.F Nn
~~~ r~QQr.~ NO,
Each single f;xture
Residence of
SQ. FT.
Relocated bo;lding
(new fix. additional)
INew circu~ts alts.
Lr or extenslons ~Ar
~~~r..--
ISERVICES
I
-z:t-5 >
S. f. Resideoce
(1 bathl
Duplex (I bath) each
Additional bath
ITempOrary Construction
IChange in existing
r~s j d..e}lc~
Irnultifamily, comm, or
Industrial
I Water serv;~e
I Sewer
I Storm Sewer
I
I
I
I
I
I
10f amps.1
ICOMM./IND. fEEDERS I
IInstall/a1ter/relocate I
r1ic:t.ritL fpl'lrlprc:
10f amp~1
I
I
I
INfORllATION LlNo
726-3753
Sq. ftg. 1.lain
~q. Ftg, Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
-Fence Demo Change/Use
-Other- -
~
~.
'"
,
lexniresl
(ohane no.
(pl(oirp~)
(nhnnp nn \
MECHANICAL
H~ r~dQr.~
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
Sn~~p hp~tpr ~nrl vpnt
Appliance vent
seoaratp
Stationary evap,
cooler
Vent fan with
s;nole duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood and durt
Wood stove/heater
ISSUANCE OF PFRlllT
I HAVE CAREfUllY EXM1INED the completed application for permit, 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 UO OCCUPArlCY will be made
of any structure without the permission of the Building Oivision. I further certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7Ql.055 will be used on this project.
~ ~IY~ ~~.~~terns Development
i'~~"....,.. arQe (1. 5~) .
'~<f'HC ,d":" ~
i'3'~ ~Cir
I
I
Total Comb. rermit.
I~Ar'lE(please print} d,,,,,,M'.. f'J44/_,kwG+'u~ Co
SIGrlATUREf7L 7'/~?
Zone
Fire Zone
Flood Plain
FO~ OFFICE USE OIlLY
Type/Canst. .:v-~Units Sq. Ftg. riain
Bedrooms Occy Load Sq. Ftg. Access ~/
Stories / Occy Graup .1'77 - / Sq. Ftg. Other
BUILDING PERflIT
Charges and
Surcharges
~ ~ Plan Ck.
______~...__=__ 65%/Blda
Plan Ck.
30%lBlda
I Fence
I Demo
-;;?7_SC> IS1dewa1k
- -----;.-;3---, AlC Pavin9
I Curb Cut
------------
I
I
I TOTAL
Y'- 0;3
Conm/lnd
PF!r FF!F!
Res
Per Fee
PLUt1BING PERMIT
Charges and
Surcharges
I
I
I
I
ELECTRICAL PERIHI
Cha rges and
Surcharges.
MECMANICAL PERMIT
Charges and
Surcharges
DATE 1-.2'1'-6'9
x
Value
Value /a,~eoe
Value
x
x
TOTAL VALUATION
//#-
/tfJ'&.16
.
r----
,
.
'.
, .
,.., "'J
," j
COMBINATION APPLICATION/PERMIT (CAP)
, ,
PERMIT VALIDATION
, .
III.
I. Applicant to furnish
A. Job Address
B. legal Description . .'<
1. examole- Tax Lot 100, Lane Cou~ty Map Reference~'
II oj 43
2. example- lot 1. Block 3, 2nd Addition to
.. "', . ,Sprlngfield Estates :...' "
C. Name, etc: of owner and 'construction-lender
0, Energy Sources . ....
,..' 'f. example. heat/electridil' ceilinoior. forced air Qas
2. examole- waterheater/electr.ica(/or'sohr'
E. Square footage or valuation, etc: -----
1. exam~le- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check new - if addition,
check add, etc.
F. Building permit information:
1. exam~le - construct Single family house with an
attached garage
2. examele - remodel existing garage into family room
3, example - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (aj of the
" Structural Specialty Code:'
'H. DESIGN TERM ANO CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
8. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult.the
full schedules
C. 8UIlDING OIVISION STAFF WIll FIll OUT All FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is ,not authorized
to sign the electrical label. ---
Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only, Where possible. Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application. and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
~'. '
\0 '-"
"
,~ .... ..\', ...:
'i
..' "".'.~
"
"
....." '..
. '.' -
"
... ~. ,",
.'
"..... .
V. FOR ,OFFICE USE ONLY
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Additional Project Inform~tion:
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