HomeMy WebLinkAboutPermit Building 1999-09-13CITY OF
!5PRINGFIELD
22s HsFPtBstsAYFffiGtSpringfield, OR 97477
Location of Proposed Work: 3469 WATERMARK DR
Assessors tvlap #: 1-7021-943
Lot: 79 Bfock:
NOTICE: REsrp-ENEraD pERI{rr Appr.rcArroN
TH1S pERMtT SHALL EXP IRE tF TffiqqJBF s pnrNeF r Er,D
o,liHo*,zgD UNDER TH t s PERlfififfidrol s ERvr cE s D rvr s r oN
Con nren cED oR Is ABANDoNED FoPFLDrNG SAFETY
a
Page 1-
ilob Number: 99LL91-
Office:
Inspection Line:
726 -37 59
7 26 -37 59
Tax Lot #: 07900
Subdivision:
OwneT: GREY LARKIN
Address : P. O. BOX 2041
Describe Work: S.F.RESIDENCE
Phone #: 740-4370
city/state/ zj-p: GoRVALLES oR, 97339
NEW
General:
Plumbing:
Mechanical-:
Electrical-:
Contractor
RIVER VALLEY BU 0082854
27402 GREENBERRY RD CORVALLIS OR 97
MIDWAY PLUMBING OOO4587
2428 SE THREE LAKES RD ALBANY OR 97
MIDWAY HEATING 0004687
2428 SE THREE LAKES RD ALBANY OR 97
G&E ELECTRIC 0054458
PO BOX 1585 ALBANT OR 973210000
Const.
Contractor #Expires
04/L2/oo
07 /2s / oo
o7 /25/OO
oe /ls / ee
Phone
140-4370
928 -7 927
928 -2L23
967 -7 045
QUAD AREA: 3RNC
OCCY GROUP: R3
HEAT SOURCE: FG
OFFICE USE - -
LAND USE: 1111
CONSTR. TYPE: VN
INSUL PATH: P1
# OF UNITS
# OF BDRMS
SQ FOOTAGE
1
3
2069
To requesE an inspecEion, call the 24 hour recordj-ng at 726-3769.
A11 inspections requested before
inspections requested afLer 7:00
a.m. will be made the same working day,
will be made the following work day.
7:00
a.m.
--- REQUTRED TNSPECTIONS ---
SITE - To be made after excavatj-on but prior to setting forms.
FOOTING - After trenches are excavated.
FOITNDATION - After forms a{e erected but prior to concrete placement.
ITNDERFLOOR PIJITMBING - Priof' totr ihsulation o6 decking.
ITNDERFLOOR DRA,IN - Prior io .orbr or placement of clncrete.
IINDERFLOOR MECHAI{ICAL - Prior'to kisulation or decking.
POST A}.ID BEAM - Prior to f'loor"insu-l-ation or decking.
INSULATION - Floor; prior t8,'diicking Wa11/Ceiling; nrior to cover
WATER LrNE - Prior to fif-1?i{{li-t,rench.
sAr{rrARy sEwER LrNE - prior to filling trench. i rii-;i.ii,
STORM SEWER LINE - Prj-or to filling trench.
ROUGH PLITUBING - Pri-or to cover.
ROUGH cAs - after line is installed and capped if not attached Lo an
appliance
ROUGH MECHANICAL - Prior t.o cover.
ROUGH ELECTRICAL - Prior Lo cover.
SHEAR WALL NAILING - Before covering sheathing with finish materials.
FRAI{ING - Prior to cover.
rNsuLATroN - Floor; prior to decking wa11/Ceiling; prior to cover
DRYWAIJL - Prior to taping.
GAS sERvrCE - After line is instal-l-ed and Ii-ne has been connected to a
mi-nimum of one appli-ance. pressure test done at this point.
SPRINGFIELD
Job Number: 991191
ctTv a
Page 2
ELECTRICAL SERVICE - Must be approved to obtain permanent power.
CURBCUT - After forms are erecLed but prior to placement of concrete.
SIDEWALK - After excavation is complete, forms and sub-base material
in p1ace.
FINAL PLITMBING - When all plumbing work is complete.
FINAL MECHAIiIICAL - When all mechanical work is complete.
FINAL ELECTRICAL - When all electrical work is complete.
FINAL BUILDING - When all required inspections have been approved and
the building is complete.
Lot Faces: N
Topography: 2
House
Garage
Lot Sq. Ft.:
Total Height
513 0
18
Lot Coverage: 40 %
Lot T)pe: INTERIOR
E
5
N
Setbackssw
165
18
Item
Main
Garage
Tota] Value
Building Permit Fee
Surcharge/admin
TOTAL FEE
--- BUII.DING PERMIT ---
Square Feet x
L627
440
$/Square Feet
69 .54
18.34
(A)
Value
113,304.00
B, 070.00
L2L ,37 4 .0O
482 .50
48.26
530.75
--- PLI'MBING PERMIT --.
Item
Residentlal Bath(s)
Plumbing Permit
surcharge/edmi-n
TOTAL CHARGE
2
Fee
160.00
160.00
15.00
(c)175.00
--- MECHANICAL PERMIT ---
Furnace
Exhaust Hood
Vent Fan
Wood Stove / lnsert /Fireplace Unit
Dryer Vent
GAS PIPE W/H
Mechanical Permi-t
Issuance
Surcharge/admin
TOTAL PERMIT
3
5.00
4.50
9.00
4.50
3.00
5.00
32.00
10.00
3.20
(D)45.20
--- MISCELLANEOUS PERMITS
surcharge/admin
Sidewalk
Curb Cut
CIITY SDC
WILLAIW\LAI{E
PLAN REVIEW
0.00
50.00
60.00
2 , 445 .41
1, 000 . 00
80.00
TOTAL MISCEI,LANEOUS PERMITS (E)3 , 646 .4L
SPRINGFIELD
ilob Nurnber: 99lL91
SPTNGF1ELq a
Page 3
(Excluding Electsrical)
unless oEherwise noted
--- TOTAL A.MOI'NT DUE ---
(A, B, C, D, and E combined)r,Iffi
L{ Tqg'.3L
--- BUITDTNG VALUE, PLA.}I CHECK AND BUILDING PERMIT ---
This permit is grant.ed on the express condition that the said construction
shalI, in all respecLs, conform to the ordinance adopted by the City of
Springfield, including t.he Devel-opment Code, regulatj-ng the construction and
use of buildings, and may be suspended or revoked at any time upon violation
of any provisions of said ordj-nances.
Received By:
Plans Reviewed By: AL WARD Date: 09/1,3/99
Building Site Reviewed By: BOB BARNIIART
--- ADDITIONAI, COMMENTS
A SEPERATE ELECTRICAL PERMIT IS REQUIRED
DRIVEWAY REQUIRED TO BE PAVED
2 STREET TREES REQUIRED
By signature, I Etate 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 Ordlnances 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 Divisi-on, Building Safety. I further certify that only
contractors and employees who are in compliance with ORS 701.055 will be
used on this project.
f further agree Eo 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 fron of the property, and the approved set of plans
wil-1 r on the site ri s during construction
?-r/-?
Signature Date
--- VALIDATION ---
03s{ L7
Receipt Number:
Date Paid:
Amount Received:
Received By:
,t qq
ktlt'tr,
al Ntuq
f1
JOURNAL 'OB NO. ?? / I? I
ATTACHMENT A
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME OR COMPANY Gaea I ,a2 t{tx)
LOCATION:3+6q b)a7€e- ,:,a,rlL Fa
DEVELOPMENT TYPE: 6. [E R.. ,
BUILDING SVE: LOT SIZE SQ. Ft.
B.-op iz/+6 =2z v t* c3tvzZ-=to-t{i
c >fb = 2-l-
1. STORM DRAINAGE
IMPERVIOUS SQ.FT. z,<"*xs0.232 PER SQ. FT.S sa8,ro
2. SAMTARY SEWER-CITY
NO. OF PFU'S z<.)X548.27 PER PFU $ ?c{.+o
(See Reverse Side)
3. TRANSPORTATION
NO OF LINITS X TRIP RATE X COST PER PM PEAK HOUR TRIP
I X I,o( X5486.73PERTRIP $ 4q I ,6c)
X 5486.73 PER TRIP s
4. SANITARY SEWER-MWMC
A. REIMBURSEMENT COST:
NO. OF FEU'S I X 24I,7a.PER FEU s z'Q-,76
B. IMPROVEMENT COST:
NO. OF FEU'S I X zz.oi PER FEU S z,o{
o/u l?vzo = ?te
x
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMIMSTRATTVE FEE
5. ADMINISTRATIVE FEES:
BASE CHARGE TOTAL ABOVE) X .05
SDC Coordinator
ATTACH'A.WPD
$ 10.00
TOTAL-MWMC SDC $ z7+, 8l
suBTorAL (ADD ITEMS 1,2,3 & 4) $ 2,34,4/
s //L, f,o
Date: q-< 4q
-
TOTAL SpC S Zr++e.+t
FIXTURE UNIT CALCULATION TABLEI Numberof Nerv Fixtr,--s X Unit Equivalent = Fixrure Units
(NOTE: For remodels, calculate only the - ' dditional fixtures)
FIXTURE ryPE
Drinking Fountain..
Floor Drain.
Interceptors For Grease/OiUSolids/Etc
Interceptors For Sand/Auto Wash/Etc.
Laundry Tub/Clotheswasher/Ivlop Sink..................
Clotheswasher - 3 Or More......................
Mobile Home Park Trap (1 Per Trailer)..
Receptor For Refri gerator/VVater S tation/Etc...........
Receptor For C ommerc ial S ink/D ishwasher/Etc......
Shorver, Single Stall..
Shower, Gang.
Sink: Bar, Commercial, Residential Kitchen............
Urinal, StallAYaU.....
Wash Basin/Lavatory, Single..
Toilet, Public Installation..
Toilet, Private.........
Miscellaneous:
NUMBER OF
NEW FIXTURES
LTNIT
EQUIVALENT
FIXTURE
LINITS
2
I
2
J
6
2
6
6
I
3
2
I
2
2
I
6
4
?-
z--
z
------:-6
/Head
I
4z--
?-
TOTAL FIXTURE LINITS A()
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table, calculate
credits
(Rate X Assessed Value)
Improvement (if after annexation date)x s_
(Rate X Assessed Value)
CREDIT TOTAL : $
Year
Annexed
Rate per $ 1,000
Assessed Value
Year
Annexed
Rate per $ 1,000
Assessed Value
1979 or before
1980
l98l
t982
l 983
1984
1985
1986
1987
1988
$4.47
4.38
4.32
4.20
4.03
3.88
3.68
3.38
3.03
2.62
I 989
1990
1991
1992
I 993
1994
1995
1996
1997
I 998
2.18
1.75
1.35
t.t7
1.03
o.so
0.7 t
0.57
0.39
0. l8
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
(For Estimating Purposes Only)
Residential..
Commerical...
0.4
0.9
0.5
0.5
FIXUNTT.WPD IMPERVIOUS AREA: TOTAL LOT SIZE X RUNOFF COEFFICIENT
Credit for Parcel or Land Only If Applicable X $ _
+
Willamalane
Park & Recreation District
SYSTEM DEVELOPMENT CHARGE
WORKSHEET
NAME:
ADDREST' PC. k rv Socrl tr.'t r{rtti^
LOCATION OF PROPOSED BUILDING SITE:
.loo- uo- lt -.:iI
.L0-tt o37PHONE:
STATE: i ztP: 91-(Kl
Street Address:
Ptat Name: \1ClU\9 qe Tax Lot Number:5 ln Ul
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC calculations and dwetfing t
lpe definitions are on the baclc)
A Single-Family Detachecf
K Single Family homd
NO. OF UNITS I
Manufactured home not in a park
(")
(jo
X $1,000 per unit = $\ crtir\ :
B. Single-Family Attached
NO. OF UNITS X $924 per unit $
C. Multi-Family Apartment
NO. OF UNITS X $692 per unit
D. Manufactured Home Pafk
NO. OF UNiTS X $699 perunlt
WLLAMALANE SDC
)2. SDC CREDff (r appncabte) SDCaayormust (unlsh proof of
Willamalane Credit approval. See SOC Credit Wotl<shoeL
3. TOTAL WILLAMALANE NET SDC ASSESSED
(lf SDC reduced for Credit)
$
$
E
$
$
$
\N
De0elopment Se rvices Department
City of Sprihgfield
-L ,!-\-t-
Date
7
OREGONCITY OF
225 FIFTB STRXET
SPRINGFIEI.,D, OREGON 97477
INSPECTION REQTEST| 726-3769
oFFICE: 726-3759
1 rNST ON
DESCRTPTION
JOB SCRIPTION
Permits are non-transfera b1e and expire
if vork is not started vithin 1B0 days
of issuance or if vork is suspended for
180 days.
2. COMRACTOR INSTATLATION ONLY
EIe ctri I Contractor
SP. -:FIEL!,
ELECTRICAL PBRUTT APPLICATION
Ci ty Job Nunber ffirr
COUPLETE FEE SCMDULE BELOIT
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:Items Cost
L000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home. or
Modular DvelIing
Service or Feeder
Services or Feeders
$ 8s.00
$ 40.00
at ion
SHAIT EXPIRE IFTHE WORK
ISNOT
h,
3
A
6 Sum
B
s 1s.00
sr_00. 00
s130. 00
$300.00s 40.00
FOR-
5
0090" v
Address
Ci ty Phone
Supervisor Licen Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of SuPervising trician
owners y1^^.Gae .k;,1
eaaressPO, B aY Z.O4 I
cit U/q,0, pnon€4J:240-437d
c.Temporary Services or Feeders
Installation, Alteration or Relocation
2oo amps''or f ess -l-201 amps to 400 amPs
-
Over 401 to 600 amps
Over 600 amps or 1OOO voTts
Branch Circuits
fo
Nev, Alteration or Extension Per Panel
One Circuit $ 35.00
iach Additional-cii"uit or vith Service
or Feeder Permit
-
$ 2'00
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation S 40'00
l,iili ted Energy/Res
-
$ 20. oo
SUBTOTAL OF ABOVE
7% State Surcharge
32 Administrative Fee
TOTAL
200. amps
20L amps
401 amps
601 amps
Over 1000
t
t qtu
/vo tS
Reconnect 0n1Y
a6ove
s 40.00
$ ss.00
$ 80.00
see rrBrr
D
OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Ovners
DATE:
E
RECEIVED
gnature:
5
,fad0
Ins ta11at i
or
ne center' (Nol€
tortne i't
1ati.E'iS
cre
-1a't
st rr r rt{ (; f: I l- L u
CAL PERHIT
b Number
APPLICATIOIJ
m,
225 FIFTII STRI.:I.:'T
The lollr,rwing project as submltted has the following I
zu{rrrrg and does not require specific land use BLBCTRI
SPRINGFIELD, OITEGON elq\lT"l
INSPECTI0N REQUESTz 726 -37@eiT
L Dt1 .,ty Jo ?/t ?/c
0FPICE: 726-3759 Date
1 ON OI'
I tl -cr q
JOB DESCRITT'IONS*
Permits are non-transferable and expire
lf vork is no t s tar ted vi tlrin 180 days
of issttance or j.f vork is suspended for
180 days.
2. CONTRACTOR INSTALITI'ION ONLY
3. COHPI,ETE PBB SCTTEDULB BELOV
Nev Residential-Single or
Hulti-FamiIy per dvelling unit.
Service fncluded:
I tems Cos t
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Hanuf 'd Ilome or
Modular Dvelling
Service or Feeder
I s Bs.oo
s 40.00
B Services or Feeders
InstaIIation, Alterations or
Reloca t ion :
NOTICE:IFfiEWOHK
200 amps or IEJSPERMIT SHAII lSNOT
201 amps to 4
401 amps to
601 amps to 1
0ver 1000 amp
Reconnect 0nly
C Temporary Services or Feeders
Installatlon, Alteration or Relocatiort
200 amps or less S 40 ' ii
Over 40L to 600 amps _-- S B0.tt,,
Over 600 amps or 1000 vol ts see " li " :i i)o\'{l
D. Branch Circui ts
Nev,-11','urat lon or Ex tens i on l)e:.
one circuit $ 35'ttl;
Eaclr Acldi t ional
Circuit or vith Servi.ce
or Feeder Permi t s ll' i;rr
E. Miscellaneous (Service/feeder not irrclircl r:d)
-Each installation
Pqmp or irrigation $
Sign/Outline Liglrting_ S
Limi ted Energy/Res S
Limi ted Energy/Comrn _ S
Signature
A
LEGAL
t7a
DESCRIPTION
zt 1 ts !?1tt
3 $ 1s.00
Sum
gs_.to
?9A0
EIec t ri cal con t rac rr, -{!E,tfu!.-
Addr:css ?o boY lbgb
{#,lgtfulrtozzCi ty
Ovners Name
Add rcss
a??ee 3 0
0
0
00
00
00
Supervisor License Number
Expiration Date
Constr Contr. Number e t9A
Expiration Date t5 o
Signature of SupervisinlJ Electrician
Z
'//1/
/o brr ?!
Ci ty (nruJh lhone 7fo^(17a
OVNI]R INSTALLATION
The installation is being nrade on
property I ovn vhiclr is not intended
for sa1e, lease or rent.
0vners Signa trrre:
30
4$
0. 00
0.
0.
6.
4
4
)
3
00
00
00
SIIBTOTAL OP ABOVE'ilZ State Surcharge
TorLL-t3 A .firul
/30
DATE:
RECEIPT
RIICEIVID I]Y:
/t tl l<
5
l4?.0'o
A(ba nV
This Slde To Be Filled Out by Applicant ,i i' ""'141ttr) .'-,i1,
This permit is required for any site activity in the flood plain and everywhere site atteration consists of
fifry (5O) cubic yards of material or more and/or if a drainageway is affected, within City limits and
:. *. ..
l{*d ity of Sprirrgfield"ir ///{t
TI.
Property Owner
Date of Appl ication
1 -bkl
pqBn
Phone:
Permit Expiration Date
Springfiold, Oregon
7a
Sito Address:
Address :
Journal number applicable Land Use Application
Tax Lot:tr UGB Tax Map No
' u , ProjoctSupervisor
tr
tr
RADIG NG,
Supplier fut\Dv
Phone
Destination:
,M
D LkL\ , Source Locationts FILL, euantity
Supplier:
Address
EXCAVATTO N, Ouantity_[Q_gpl2__
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DRAINAGE, POLLUTION AND EBOSION CONTROL PLAN
E[,and
nd
CROSS SECTIONS,
SOILS & GEOLOGY PLAN,
ADDITIONAL INFORMATION,
REPLANTING PLAN
COMPAMY NAME: , PHONE
PROJECT SUPERVISOR:
COMPANY NAME: , PHONE
STATE
STATE
CITY
CITY
ADDRESS:
PROJECT SUPERVISOR:
ADDRESS:
MOBILE PHONE:EMERGENCY PHONE
FAXq1aSTATEYl oFFtcE PHoNE
PROJECT SUPERVISOR
?D Bx ?-oAl
CONTRACTOR NAME:
Registration Number:
ADDRESS:
PHONE
Expiration Date:
, CITY:
I understand that I. or my succo8sors may have future plans for my property which may bc antlcipated or unanticipated at
this tim6. I undergtand that such futuro plans may requiro permits and developement approvals from the City of Springfield.
I understand that notwithetanding any approval of this Land and Drainagc Alteratlon Permh (LDAPI, that rt the time of
applicatiop of future permite or approvals th6 City may reviow and roconsider all actlonr whlch lor.my 8uccolsors have
undenakqn porsuant to this LDAP. I understand that tho City may as a condition of any futurc approval, require the
undoing, changing, or modificatlon of any actions which I have undonaken as r rosult of the Cf'e approvai of this LDAP.
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By signature., I state and agree, that I have c-arefully examined th6 completod application and do hereby c€rtify that all
information herein is truo and correct, and I furthar cenify that any and all work performed chall be done [n aicordance
with th€ Ordinancos of the City of Springfield, applicable City Standard specifications and Drbwinga, and the laws of theStato.of Oregon p^olt!i![rg to_the work doscribed herein. I funh€r cortify ihat only contrastors andehployees who are in
compliance with ORS 7O1 .O55 will be used on this projecl
The City may inspect the work site described in this permit at any time during a ono yoar pcrlod following the receipt bytho City of notice of completion of the described work and specify, at the City'a sole'doaicrrtion, 8ny adiitional roitordtionwork requirod to raturn the site_to a standard acceptable to the City. The perrilttee will be notlfieh in'writing of any workrequired and will have thifY (3Ol days from the date of the notice io comilete the work. Work not completid atln'e eno otthg thirty days will be porformed bv tho City and the costs will be billed t6 the permittee.
l.funher agro€ to.onsuro thlt all required inspoctions are roquested at the proper tlm6, thrt proiea address is readable fromtho street, and the approved set of plans will romain on thi sito at all tim6s riuang ctn6tru&'io'n,
- --
t -r/;.lqql^08'iDal . g-n-qq
DatoSignature
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DRAINAGE, O Storm, El Ditch, O Culvert, E Natural
Date:
WETLANDS, Description
FLOODWAY, FEMA Community panet No
FLOOD PLAIN, Zone FEMA Community panel No.:
s20.00
s30.00
$40.00
f1O.OO For the first 1O,0OO cubic yards, ptus
$20.00 for each additional IO.OOO cubic yards or fraction thereof$220,00 For the first l0O,OO1 cubic yards, plus
$20.00 for each additional 1O,OOO cutic yards or fraction thereof$340 For rhe first 20O.OO1 cubic yards, jtus
96.O0 for each additional 1 O,OOO cubic yards or fraction thereof.
$30.00
S30.OO For the first 1 O0 cubic yards, plus
$14.0O for oach additional IOO cubic yards or fraction ther6of.
$ 1 56.00 For the first I,OOO cubic yards, ptus
$12.00 for each additional 1,000 cubic yards or fraction theroof.$264.00 For the first 1O,0OO cubic yards, ptus
$54.00 for each additional 1O,OOO cubic yards or fraction theroof.$750.00 For the first 10O,OO1 cubic yards, plus
$30.00 for each additional 10,000 cubic yards or fraction thereof.
Date
Date:
r\ l'e*J//,,/,
G rading Permit fee:
5
100,001 To 200,000
2OO,OO1 CUBIC YARDS OR MORE
1,001 TO 1O,OOO CUBIC YARDS
10,000 To 100,000 cuBtc YARDS
100,001 To 2oo,ooo
Estimated Volume:
Dato:
.oo
Received by:
PLAN CHECK FEES:
UP TO 1OO CUBIC YARDS
101 TO 1,000 cuBlc YAROS
1,001 TO 10,000 cuBtc YABOS
10,000 To 100,000 cuBtc YAROS
GRADING PERMIT FEES:
UP TO l OO CUBIC YARDS
101 TO l,OOO CUBIC YARDS
Receipt No:
Date:
Plan Check Fee: 2O,'2
neceireO ay:
AMI]LESIDE MEADOWS SUT]D.
11lis property is located in an area of hcavy clay
soils (expansive clays). A liccnscd enginccr slrall
vcrily thc slability olthc soils in the proposcd
building arca arrd ntake any rcconrnrendations
ncccssary lo assurc thc contirrucd stability ofthc
soil. A copy ofthc cnginccr's rcport shall bc
subrnittcd to thc Building OITicial prior to
bcginning construclion of thc structurc.
,*/riatlzzt Nb,, ra q fiq-i/ep
Plannin q 1Date:
DateGI-- Engineering V-t-4/
Date:
Datetr Maintenance
tr Buitdins:
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Maintonance Date:
Pormit Number lssued by Date
Date
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Land and Drainaoe rglY1ry,3. outlined in this permit has been completed in accordance withtho provisions ofthis perririt.
hfiiho,?ildp?53[A9r"r%?ti$lJfj,S$],"ed in this permit has not been compteted in accordance
Land and Drainage activity was performed prior to application for this permit.
Accepted by Date
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1/6/1998
Receipt No: 3;7 ( 7
is Side To Be Fil ut By City Staff
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