HomeMy WebLinkAboutPermit Building 2001-05-22SPEINGFIELD
Job# 01-00403-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 5
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 3630 Osprey Dr Spr
AssessorsMap#: 17021943
Lot:167 Block: Addition
Job Number: 01-00403-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot #: 09900
Subdivision : Ambleside
clTY oF sPRrNcFtELD, OREoON
Owner: Dukes & Dukes Construction Co
Address: Po Box 71095
Scope Of Work: Single Family Residence
Phone Number:
City/State/Zip:
New
541461-5477
Eugene, OR 97401
Vatue: $121'151
Same as 3562 Osprey Dr (00-01353-01)
Contractor Type
GeneralContr
ElectricalContr
MechanicalContr
Plumbing Contr
Gontractor Registration #
Dukes & Dukes Construction Co 65060
Po Box 71095, Eugene, OR 97401
Eastside Electric lnc 117770
38253 Boscage Ln, Springfield, OR 97478
Harvey & Son Heating & Air Conditioning I 55682
4680 Main St, Springfield, OR
97478-6054
Don Lewis Plumbing 33076
500 Greenfield Street, Eugene, OR 97404
Expiration Date
311612005
10t412001
4t412003
611012001
541-741-1499
541-746-7677
541 -688-1 931
[-set tortn
952'001-
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
3RNC
,l
(VN) Wood Frame
Gas
Office Use
-
Land Use: Single FamilY Dwelling Buildings: 1
Zoning Code: LDR
Bedrooms: 3
Range:Electric
Ger
To request an inspection callthe 24 hour recording a1726-3769. All inspectio ns req uested before 7:00
a.m. will be made the same
working day.
working day, inspections requested after 7:00 a.m.will be made the following
sbYl€
IF
u
t!
Site
Verify Ground Rod
Footing
Foundation
Post and Beam
Floor lnsulation
Ceiling Insulation
Shear Wall Nailing
-Prior to decking.
- Prior to cover.
-Before covering sheathing with finish materials.
Phone
541-461-5477
lles are
Framing
Walllnsulation
Drywall
Hold Downs lnstalled
FinalBuilding
Temporary Power
Verify Ground Rod
Rough Electrical
Electrical Service
Final Electrical
Underfloor Plumbing
Underfloor Drain
Rough Plumbing
Shower Pan
Water Line
Sanitary Sewer Line
Storm Sewer Line
Perimeter Foundation
Drains
FinalPlumbing
Underfloor Mechanical
Rough Gas
Rough Mechanical
Gas Service
FinalGas
FinalMechanical
Job# 01-0 Page 2 of 5
Required lnspections
Buitdins I
-Prior to cover.
-Prior to Cover
-Prior to taping.
-When all required inspections have been approved and the building is complete
Electricat I
-Approval required prior to SUB energizing pole.
- lnstall ground rod at footing, and call for inspection in conjuction with footing and/or foundation i
-Prior to cover.
-Must be approved to obtain permanent power.
-When all electricalwork is complete.
-Prior to insulation or decking.
- Prior to cover or placement of concrete.
-Prior to cover.
- Prior to filling trench.
-Prior to filling trench.
-Prior to filling trench.
-After gravel and filter cloth is installed, but prior to backfill
-When allplumbing work is complete'
Mechanical
-Prior to insulation or decking.
-Prior to cover.
-After line is installed and line has been connected to a minimum of one appliance. Pressure tet
-When allgas work is comPlete.
-When all mechanicalwork is complete'
Public Works
SW-Curbside
CC-Standard
Street lmprovement: Fully lmproved
Curb Cut?f lmProvement Agr'?
San Sewer DePth (Ft): 6 ' 4
Storm Sewer Available? f
SpecialReq.:
Security Required:
Bond Begin DateTime:
Special lnstructions:
Other Utilities:
Project SuPervisor:
,_After forms are erected but prior to placement of concrete
-After forms are erected but prior to placement of concrete
Sidewalk TYPe:
AdditionalROW?
Size Of Line (in):
Downspouts/Drains:
Enchroachment Permit:
San Sewer Tee (in):
Bond End DateTime:
Curbside - 5'
B
To Curb and Gutter
6
00/00/0000 00:00 AM
00/00/0000 00:00 AM
Types Of Warning Devices Reqd'
Zoning: LDR
FloodPlain? [ Wetlands? [
Journal numbers
1:2001-04-0090 2:
Comments:LDAP in Progress
2
3
Additional Requirements:
Required Attachments:
Source Locn:
Material:
Flood Plain FEMA:
Job# 01-00403-01 Page 3 of 5
Land Use: Single Family Dwelling
Pave Driveway? Z
Overlay District:
# of Street Trees
Planner: Liz Miller
Urban Growth Boundary?! Gtenwood Area?
Quantity Of Fil!:
Supplier:
Drainage:
Floodway FEMA:
Construction Types(VN) Wood Frame
Occupancy Groups: Dwelling
# Of Buildings: 1
# Of Bedrooms: 3
Handicap Access? [
Area (Sq.
Main: 1607 AccessorySO0
Accessory Structure
# Of Stories: 2 Height (feet): 29
Current Units: Proposed Units:1
Census Code: New SF - detached
TotalZ107
Fee Paid On Receipt# Value/Quantity Fee Amount
Plan Check
0412312001 5027 2Hourly Plan Review
Total Plan Check
$80.00
$80.00
Buildins
Building Permit
Garage/Carport
State Surcharge For Building Permit
Building Administrative Fee
Total Building
05t22t2001
05t2212001
05t22t2001
05t22t2001
5485
5485
5485
5485
111,981
9,170
$460.00
$80.50
$37.84
$16.22
$594.s6
Electrica!
Wiring Footage 1,000 Sq Ft or Less
Wiring Footage Each Add'l 500 Sq Ft
State Surcharge - Electrical
Administrative Fee - Electrical
Total Electrical
05t22t2001
05t22t2001
0512212001
0512212001
5485
5485
5485
5485
1
3
$85.00
$45.00
$9.10
$3.e0
$143.00
Plumbing
Minimum Plumbing Permit Fee
Three Bathrooms
State Surcharge - Plumbing
Administrative Fee - Plumbing
Total Plumbing
05t2212001
0512212001
05t2212001
05t22t2001
5485
5485
5485
5485
1
$.00
$192.50
$13.48
$5.78
$211.76
Hood and Exhaust
Minimum Mechanical Permit
Administrative Fee - Mechanical
Less than 100,000 BTU
Vent Fan to One Duct
Mechanical lssuance
Mechanica!
05t2212001
0512212001
0512212001
0512212001
0512212001
0512212001
5485
5485
5485
5485
5485
5485
1 $4.s0
s.00
$.68
$6.00
$12.00
$10.00
1
4
Job# 01-00403-01 Page 4 of 5
Fee Paid On Receipt# Value/Quantity Fee Amount
State Surcharge - Mechanical
Total Mechanical
Mechanical
0512212001 5485 s1.58
$34.76
Public Works
New Sidewalk
New Curbcut
Multiple Permit Discount - 2nd Permit
Tota! Public Works
05t22t2001
05t22t2001
05t22t2001
5485
5485
5485
60
1
1
$65.00
$65.00
$-30.00
$100.00
Develo
Residential- Single Family - Storm
Sanitary Sewer
Residential Transportation
Residential Sanitary MWMC
Residential lmprovement MWMC
MWMC Administrative Fee
Sanitary Sewer SDC Reimbursement
SDC Administrative Fee
Transportation SDC Reimbursement
Total System Development
05t22t2001
0512212001
05t22t2001
05t22t2001
0512212001
05t2212001
0512212001
05t22t2001
0512212001
5485
5485
5485
5485
5485
5485
5485
5485
5485
1,984 $537.66
$371.45
$656.02
$285.91
$24.33
$10.00
$488.75
$126.42
$154.27
$2,654.81
23
1
1
1
1
23
1
S.F. Residence - Willamalane
TotalWillamalane SDC
Willamalane SDC
0512212001 5485 1 $1,000.00
$1,000.00
Grand Total
Plan Check Type
lnitial Review-Res
Engineering-Res
Planning-Res
Planning-Res
Structural-Res
Checked By
Lisa Hopper
Steve Templin
Liz Miller
Liz Miller
Bob Barnhart
Date Completed
04t2412001
04t26t2001
ost09t2001
05t01t2001
$4,818.89
Comment
Additional note on solar check. The rear of the
structures high point is 24'. Slope on this
property according to the plans, slopes to the
south where the house measures 29' at the
highest point. The 29' measurement is approx
54'from the north property line, meeting the
required solar setback. The 24' highest point
on the rear of the structure is approx 6' from
the rear of the structure. Adding the 6' to the
setback shown on the drawings = 38'setback
from that point to the north property line, also
meeting the solar requirements for this lot.
Steve Templin to review LDAP when returning
from vacation. Will need to obtain before
building permit issued.
Needs to pick up and pay for LDAP permit
REQUIRES REVISED PLANS FOR ROOM
ABOVE GARAGE IF USED FOR HABITABLE
SPACE, NOT APPROVED BUT FOR
STORAGE AT THIS TIME
Job# 01-00403-01 Page 5 of 5
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 701.055 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, that the permit card is located at the front of the property, and the
approved set of will remain on the site at all ring construction.
SF ,JGFIELD
1000 sq.ft. or less
Each additional 500sq. ft or portion
thereof
Each Manuf,d Home or
Hodular Dvelling
Service or Feeder
STDTOTAL OF ABOVE
7%, State Surcharge
3Z Administrative Fee
TOTAL
225 FIFTH STREET
SPRINGFIELD, OR g7477
(541) 726_375s
FAX o41) 726_368s
OFFICE: 726-3759
1.
JOB dl
Permi ts are ransfer and expiretarted vithin 180 daysof issuance or if vork is sus pended for
180 days.
2. CONTRACTOR INSTAII^A:ITON ONLY
Electrical Contractor EASTS/D€ €LeC,
Address 38).53 BoScAGC LAN €
city SPTLO Phone 1y /^ ( Y71
COI{PIJTE EEE SCEEDTILE BELOS
Nev Residential-Single orMulti-Family per dvelling unit.Service Included:
BIECIRICAI. PERITT APPLTCATTON
City Job Number
f tems Cos t
$ 8s.00
,.i..'b\+ 3
A.
Sum
I &
4s-
Supe rvisor License Number tJ 71 7 S
Expiration Date /o- o l^ ol
Constr Contr. Number I f177O
Expiration Date )0- ov-ol
Signature of Supervising Blectrician
Ovners Name
Addres
$ 1s.00
$ 40.00
Services or FeedersInstallation, Alterationsor Relocation:
200 amps or less
20L amps to 400 amps
-401- amps to 600 amps _601 amps to 1000 amps_
0ver 1000 amps/vo1ts
Reeonneet Only
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 4OO amps
-Over 401 to 600 amps
Over 600 amps or fbOO voTTs
Branch Circuits
ee'Br aEovil
h\-J
B
C
D.
$ s0.00
$ 60.00
$100. 00
s130.00
$300.00
s 40.00
$
$
$
s
40.00
55.O0
80.00
Ci ty
OVNER
The installation is being made on
property I ovn vhich is.not intended
for sale, lease or rent.
0vners Signature:
DATE:
Nev, Alteration or Extension Per Panel
one Circuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E. Miscellaneous (Service/feeder not included)
Phon"l13i1,iil3D
-Each installation
Pump or irrigation $
sign/outline Lighting- $
L:.mited Energy/Res
-
$
40.00
40.00
20.00
36.00
RECEIVED BY:
5 cr)
if vork is not
CITY OF
DEVEL CIL .}E TNAME OR COMPANY:
LOCATION:
TAX LOT NUMBER:
DEVELOPMENT TYPE:
SF
0l -00403_01
DUKES &
RESIDENCESINGLEFAMILY
3630
17-02-1
OSF LOT SIZE: 0
OR JOB
NEWDWELLING UNITS I BUILDING SIZE:
TMPERVIOUS S.F COST PER S.F DISCOUNTRATE
0.00 $0.271 s0%$0.00
S .F
1984.00
COST PER S.F
$537.66
x
x x
DRYWELL
TODIRECTRI.INOFF
RUNOFF ROI.ITED TO
CITY STORM SYSTEM
DESIGNEDAND CONS TRUCTED TO CITY STANDARDS
IITEM TOTAL STORM DRAINAGE SDC
$s37.66
NUMBEROFDFUK COST PERDFU
23 $ 1 6.15
$371.4s
NUMBER OF DFt-.t's
23
COST PERDFU
$488.75
x
x
COST:A.
COST:B.IMPROVEMENT
$860.20
ITEM2 TOTAL. CITY SANITARY SEWER SDC
ADT TRIP RATE NUMBER OF LINITS COST PER TRIP NEWTRIP FACTOR
9.s7 I $68.ss 1.00 $656.02
ADT TRIP RATE
9.57
NUMBEROFUNITS
I
COST PER TRIP
$ 16. l2
NE!I/ TRIP FACTOR
1.00 154.27
x x x
x x x
A.REIMBURSEMENT COST:
B.IMPROVEMENT COST:
10.29ITEM3 TOTAL - TRANSPORTATION SDC
$10.00
NUMBEROFFEU's
I
COST PER FEU
$28s.91 $28s.91
NUMBEROFFEU's
I
COST PER FEU
$24.33 $24.33
s0.00
SUBTOTAL OF MWMC REIMBURSEMENT, IMPROVEMENT & CREDIT
MWMC ADMIMSTRATIVE FEE
$310.24
B.IMPROVEMENT COST:
x
x
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
4. SAMTARY SEWER - MWMC
A. REIMBURSEMENTCOST:
$320.24ITEM 4 TOTAL. MWMC SANITARY SEWER SDC
.39SITBTOTAL (ADD ITEMS 1,2,3, & 4)
SUBTOTAL ADM. FEE RNTE
t26.425%.39
5. ADMIMSTRATIVE FEE:
x
$2,654.81
1073
109
1092
I
I
(r)
rI]aoU
&r!Fa
Or!g,
1056
l0s
4/26/01 TOTAL SDC CTIARGES91w\,N/b
SDC COORDINATOR DATE
$0.rrJ-
$21.2s
DRAINAGE URE UNIT C ABLE
NrWMC CREDIT CALCULATION TABLE: BASED ON COT]NTY ASSESSED VALUE
EQUIVALENT
ONLYCALCULATE
I..INITSFIXTUREDRAINAGEI.JNITxFIXTURESNEWOFNUMBER
NETTHEFOR
NO OF FIXTURES DRAINAGE
FIXTURE
I.]NITS)
UNIT
(#NEW . #OLD x
FXTURE TYPE I 0 )x J J
BATHTUB
(
0(0 0 )x
x
x
x
x
I
DRINKING J 0(0 0
FLOORDRAIN
SoLIDS IETC. (0 0 )J 0
FOR GREASE IOTLI
6 0
FORSAND / AUTO WASH / ETC.(0 0 )
(0 )2 0
LAUNDRY TUB
(1 )x
x
x
x
x
x
J J
CLOTHESWASHER/MOP SINK
6 0
WASHER- 3 OR MORE (EA)(0 0 )CLOTHES 0 t2 0
MOBILE HOME PARK TRAP (l PER TRAILER)(0
/ WATER STATION IETC.(0 0 )0
RECEPTORFOR REFRIG
3 0
FORCOM. SINK/DTSHWASHER/ ETC. (0 0 )
(1 0
,)2
SHOWER, SINGLE STALI-
)2 0
SHOWER,GANG (NUMBEROF HEADS)(0 0 x
x
x
x
x
x
x
x
x
KITCHEN (I 0 )J J
SINK:2 0
SINK:COMMERCIAL BAR (0 0 )
(0 0 I 0
SINK:DOMESTIC BAR
0WASH BASIN 0 0 )2
(3 0 )JLAVATORY0URINAL, STALL/WALL (0 0 )5
TOILET PUBLIC INSTALLATION (0 0 6 0
TOILET PRIVATE INSTALLATION J 0 )J 9
MISCELLANEOUS DFU TYPE NLIMBER OF EDI.],S*
( 0 - 0 )x 20 0
TOTAL DRAINAGE FIXTTTRE t.lNITS :23
*EDU (Equivalent Dwelling Unit)is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day
$0.00
YEAR
ANNEXED
CREDIT RATE PER $I,OOO
ASSESSED VALUE
YEAR
ANNEXED
1979 OR BEFORE $4.74 1990 $r.96
1980 $4.65 l99l s r.ss
198 l $4.59 r992 $1.36
1982 s4.46 I 993 $ 1.23
1983 $4.30 r994 s l.0s
1984 $4.14 I 995 s0.90
I 985 $3.93 1996 $0.75
I 986 $3.63 t997 $0.s7
1987 $3.26 I 998 $0.35
I 988 $2.8s 1999 $0. l5
l 989 $2.40
$0.00
$0.00
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
CREDIT FOR LAND (IF APPLICABLE)x
$0.
IF IMPROVEMENTS OCCLIRRED AFTER ANNEXATION DATE, CALCULATE CREDIT SEPARATELY
TOTAL MWMC CREDIT
VALT.IE /LOOO
0.000
CREDITRATE
$0.00
0.000 x
FOUNTAIN
INTERCEPTORS
0
0
I
RECEPTOR
1
CREDIT RATE PER $I,OOO
ASSESSED VALUE
Communily Services D;- nuilding SafetyqnY oF sPRIN6l _ _r-D, OREGON225 5'h Srrcer, Springfield, oR glqllinliia_ltSg
Job o 3L3o
City Job *
AMBLESIDE MEADO WS SUBDIVISI ON-IS, ADDITION
requrements - new structures on
This form may be used as a temporary verilication to allow construction to continue
on the job site until the consultant's stamped aflidavit 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 his/her 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 approved for construction.
Owner and/or Contractor
1. Date of the design professional's site evaluation?s/rt /-r
2. Has the design professional reviewed a copy of the geotechnical information
for the subdivision that was provided with the building permit? YesXNo-
If not, please contact this ffice for a copy of the report. The design professional
must be familiar with the geotechnical information before completing this fonn.
3. What was the size and depth of the excavation and /or fill?
ELD
ConsultingInSiteforQuestionnairevestigation ProfessionalsDesign
Was existing non-Structural filt or expansive soil encountered on the lot?
Yes-NoX H "yes", what types, depths and locations?
-7-
,VFA D /aSf tt 7'Zt AC Frstlj <k -'<I LT</.ru
h
R( -
What measures were taken to remedy the
engineered fill used to stabilize the soil)?
soil condition (include tYPe of
1
(
,J 6- ..n tS'A t; t l)t)t
Community Services Dr- --uildi ng Safety Job Address----1-,(:' oCITY OF SPRINGI -LD, OREGON City Job #225 5'h Strect, Spri ngfield, OR 97477 ph.726_3759 3.
Is the site as prepared adequate 8 inadequate a to maintain constant moisturecontent in the sub grade?
-Note: Verificatiin of moisture iioitrzotron in the subgrade is a requirement of the geotechnical report, ona *i,ii oe ffirmed beforeconstruction can continue.
If inadequate,
the sub grade?
what measures are needed to provide constant moisture content in
Is the site as prepared adequate S inadequate to support the proposedstructure? An affirmative answer is requisite to p roce edin g w ith c on struction.If inadequate, what additional work is needed to provide adequatefoundation
4. Did the design professional witness placement and compaction of the
engineered fill, or is there a special inspection report foithcoming from aqualified agency? I witnessed Placement I Special Insp/compactiin report IT"farue Lpb,f {o (s^rC rNl=t{i*,r Pt t-t-5. The design professional intends to use the following method for installationof perforated perimeter footing drains:
The design on the attached drawing provided by the design professional ...... tr
The method shown on the original construction drawings . ........ n
The typical 'Foundation Drain' drawing attached to permit tr
Perforated perimeter drains are not required n
Comments:A)oTe ,, u tv D tjt a 7't=D 1-.r €aJ( d ct ttt rcR@
k)
Note: City inspectors will inspect installed drains prior to cover upon request...
Call: 726-3769 to schedule inspection.
,)
Community Services D; - --,ril ding Safety Job Address ?-c oCITY OF SPRING}^-LD, OREGON City Job #ao225 sth Strcet, Springfie ld, oR 9't477 Ph.726_3,759
Low'point crawl space drains are required to prevent the build-up of excessmoisture inside the foundations during (and aiter) construction. This drainmay be installed after foundation placiment
of the desisn orofessional.
a. The design professional has determined the following..
The crawl space drain is required when the foundation is installed..... tr
The low-point drain can be installed afierfoundation placement without a
si gnificant moisture build-up problem within the foundat;on.. .. . .. . .. . .. fl
(The low-point drain may be installed at the
of construction)Post etc.
b Has the design professional observed and approved the installation of the
required low point drain?...... yes, _N, y
d "yes", where is the low point drain located under the building and
where does it terminate at this time? (must be an approved location, i.e,
street gutter, storm sewer, sump pump and discharge line to the street,
etc.)
The design professional must determine whether the approved permit drawings have
adequate foundation steel. Is any additional foundation steel required that is not
shown on the foundation drawings for the building?
Yes _ lfo X-. If "yes", describe additional steel required (or provide drawing).
The foltowing statement must be signed by the individual doing the observations and
proutdtng diiection for the excavation and site preparation work on the Property'
J
o3 dt
Community Services D' - .uilding Safety
CITY OF SPRING},.JLD, ONPCbi,i
225 sth Strcct, Springfield, OR 9747j ph. 1116_3759
Job Address Z a
City Job #
C)C"t
fuO t't
Cl J
The undersigned design professional (or authorized employee) attests that helsheobserved required mois^ture stability procedures on this'site, and that such procedureswere accompltshed befor-e yny changes occurred in the moisture content oi ie sub-grade under and arounil the building (where expansive stoils were "n"oooiriio1, Theyn(-eyisned further attests that theiuih-grade,'as prepared, is adequate i support tnebuilding proposedfor this site.
Additional
/\ ,l.b
0
6
^
L
ll Lr
0,(J(Note): A copy of this report shall be kept on site with the approved plans at all
times.
This report shall be followed by an affidavit, signed and stamped by the design
professional under whose auspices this report was completed, affirming the information
herein. The signed/stamped affidavit together with a copy of this report shall be
submitted to this office prior to requesting framing inspection for the building.
Namdtul t Title F,u.+ rYffk
Company k*A C*; *-t ,,u4s1?- t\ t tY ( ]z).J'C'pnoni a's-{t-1>2? -
L, Ur
License #ex
The geotechnical report for the Ambteside Meadows - l't Addition Subdivision
recommends immediate moisture stabilization of exposed expansive sub-grades, and that
expansive soils be over-excavated and replaced with at least 12 inches of fill compacted
to at least 95Vo of ASTM D698 for foundation preparation, The report also recommends
that measures be taken to prevent water from collecting in or around the foundation areas
during and after the construction process, and that positive site drainage be provided to
reduce the infiltration of surface water into the expansive soils.
The geotechnical report further emphasizes that the finish grade of landscape soil
adjaCent to the foundation should be at least 24" above the expansive bearing soils, firmly
compacted to reduce the infiltration of water at the surface. The adequacy of fill soil
material around the building must be verified to the satisfaction of the design
professional.
/44,
4
Community Services Dir, -.rilding gs1s1,qlry oF spRrNGF _o, <jnriibN22s s'h Strccr, Sprinsfield, oR nqtfinliis_
Job Address Z<--_-G}
City Job #
3759
U
BINGFIELD
Affidavit
For Site Investigation euestionnaire
Foundation Sub-Grade Approval forResidential Building site in Ambleside Meadows - 1., Addition
Subdivision
The undersigned hereby affirms that the excavation, structural fill and moisturestabilization methods for_the building site at the address shown above was observed byme or an authorized employee of my firm and that the following is true:
l ' The foundation sub-grade is capable of supporting a minimum of 1500 psf, and is
adequate to support the building proposedfbr tniJsite.
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 lnvestigation euestionnaire for Consulting
Design " containing field observations and instructions made on
(date) for the building site was completed either by
myself by employee of my firm under my supervision. To the best of my
information contained in that report is complete and accurate.knowledge, the
Name of Licensed Professional (print)/4, Lh,.-* //d/
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