HomeMy WebLinkAboutPermit Field Test & Inspection Report 2003-2-12
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Community Services DIV, BUIlding Safety
CITY OF SPRINGFIELD) OREGON
225 5th Street. Springfield, OR 97477 Ph. 726-3759
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Job Address Lor ~IC( zrql/l 31 ::if
City Job # SHe. 'l.o03 - tJrt70 z.. S
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A:MBLESIDE :MEADOWS SUBDIVISION~l~T ADDITION- ,;..
I Site Investigation Qde~ti~nnaire for Consulting Design Prof~~ionals' '
. foundation requirements - new structures on residential lots
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This form may be used as a temporary verification to allow construction to continue
on the job site until the consultant's stamped affidavit on the site soil compaction
and stabilization is submitted to the City. This form must be completed by a
licensed design professional (engineer or architect) or hislher authorized employee,
and submitted to the building inspector prior to requesting City inspections or
placing foundation concrete. It is important that all questions be answered
completely for the foundation site to be ~pproVed for construction. ) -
Owner and/or Contractor --ro IN\l ':- ~~ 'I .~(~" ~ :~-I,t''''''''''-
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1. Date of the design professional's site evaluation? / I 0
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2. Has the.deSign" p'(ofessional reviewed a~copy of the. geotechnical information
'fo~ t1~( siI~diviston lha~ was provi!ied with the buijding. J?ennit? Yes~ No_
If not, please contact this office for a copy of the report. The design professional
must be familiar with the geotechnical information before completing this form.
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3. What was the size and depth of the excavation and lor fill?
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Was existing non-structural fill or expansive soil encountered on the lot?
Yes)(.No_ If "yes", what ,o/Pes) depths and locations?
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What measures were taken to remedy the soil condition (include type of '
engineered fill used to stabilize the soil)? 5 VaC:ln:4-r?~ Vw\<; ~ll0:J.sO
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Note: City inspectors will inspect installed drains prior to cover upon request...
Call: 726-3769 to schedule inspection.
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Community Services Div, Buildmg Safety
CITY OF SPRINGFIELD, OREGON
225 5th Street, Springfield, OR 97477 Ph. 726-3759
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Job Address IV..J J
City Job # 5t-1t<..... c-<mZ'3 - (f)@@7.c)
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Affidavit
For Site Investigation Questionnaire
Foundation Sub-Grade Approval for
Residential Building Site in Ambleside Meadows - 1 st Addition
Subdivision
The undersigned hereby affIrms that the excavation, structural fIll and moisture
stabilization methods for the building site at the address shown above was observed by
me or an authorized employee of my fIrm and that the following is true:
1. The foundation sub-grade is capable of supporting a minimum of 1500 psf) and is
adequate to support the building proposed for this site.
2. The moisture content of the excavation was adequately maintained during the site
preparation process and was adequately covered to stabilized moisture content
prior to any signifIcant change in moisture content of the sub-grade.
3. The site is adequately graded and drained to prevent the collection of water in the
excavated area during construction.
4. The accompanying report titled "Site Investigation Questionnaire for Consulting
Desi,gn Professionals" containing fIeld observations and instructions made on
z/rz.. - 2./18 (date) for the building site was completed either by
myself or by an employee of my fIrm under my supervision. To the best of my
knowledge, the information contained in that report is complete and accurate.
Name of Licensed Professional (print)
OWE:N L qew~R- J~
Signature
Date 71%3
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