HomeMy WebLinkAboutOccupancy Correspondence 1992-10-22
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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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D:~:~----------- ------------------------------ - .---JOB-NUMBER:-~ -
ADDRESS OF INSPECTION:
471 Main Street. Sorinqfield. Oreqon 97477
OIINER:
PHONE NUMBER:
OIINER' S ADDRESS:
APPLICANT:
Doris E Powell
APPLICANT'S ADDRESS: POBox P, Springfield, Oregon 97477
FOR ACCESS TO PROPERTY -. TELEPHONE NUMBER: 747-6080
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PROPOSED USE: . Insurance Aqencv and related classrooms
~SPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OYNER OF THE PROPERTY TO BE
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,r::., Sf~[TtfRnF L PROPER~ O\INE~. -\' .
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FOR OFFICE USE ONLY
DATE PAID:
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/7) .Af) .q cQ RECEIPT NUMBER: \J) s1{l
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DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
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CITY OF SPRINGFIELD
DEVELOPMENT SERVICES DEPARTMENT
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
PHONE: (503) 726-3759
MINIMUM DEVELOrl~'! STANDARDS (Ref. SDC Section 31.010)
LOCATION OF PROPERTY
741 Main St, Springfield, Oregon 97477
~XISTING USE OF PROPERTY
Insurance Offices
DESCRIPTION OF PROPOSAL
We hope to have classes for Contractor's
instruction in the future. We would use the South end of the
building for that purpose.
.~PPLICANT NAME
Doris E powell/ Powell Insurance Associates, Inc.
ADDRESS
741 Main St. (P 0 Box P) Springfield, Or 97477
747-3381
PHONE Afh'r 10 Q.&./92 747-6080
OIlNER NAME
Vic Alfonso
ADDRESS
PHONE
THE UNDERSIGNED ACKNOIILEDGES THAT THE~N~9R ATION IN THIS APPLICATION
ACCURATE. .
APPLICANT SIGNATURE dM/~ ji;- ?f::ib/, / j1 ,
IS CORRECT AND
IF THE APPLICANT IS
APPLICANT TO ACT IN
OTHER THAN THE OIlNER,
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m:;;;;ERE" G~:SSION
FOR THE
OIlNER SIGNATURE
STAFF ONLY
ACCEPTED BY
DATE ACCEPTED
FILE NO.
ZONING
REF. PLAN
METRO PLAN
ASSESSOR'S MAP NO.
TAX LOT NO.
OVER
SCHEDULE OF IMPROVEMENTS
TYPE OF IMPROVEMENT
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1. CONNECTION TO SANITARY AND STORM SEVER LINES
COMPLETION DATE:
2. STORAGE/TRASH SCREENING
COMPLETION DATE:
3. PARKING/DRIVEVAYS
COMPLETION DATE:
[I BOND [] LETTER OF CREDIT [] CASH DEPOSIT [I OTHER
4. SIDEVALKS
COMPLETION DATE:
[] BOND [I LETTER OF CREDIT [J CASH DEPOSIT [] OTH~R
5. LANDSCAPING
COMPLETION DATE:
[I BOND [] LETTER OF CREDIT [] CASH DEPOSIT [I OTHER
6. STREET TREES/LIGHTS
COMPLETION DATE: -
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[I BOND [I LETTER-OF CREDIT [] CASH DEPOSIT [] OTHER
OiINER SIGNATURE
STAFF SIGNATURE
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DATE
DATE