HomeMy WebLinkAboutPermit Building 1987-03-31Heee'-3" RESIL ,lTlAL"
22s North rr^ ironnorPPLrcA,r,N
/PERMrr
Springfield, )r'egon 97477
Buildtng Diuision
7 26-37 53
Job [ncaticn:
AssessorsMap# l7O 73
Subditsision:
Otmer:
Address: -',Phone:
cL
Desctibe Notk:
SPFIINGFIEI.D
o
ar{o(78 t,22',P-o-""'iy
u66
(U
,L
raMadditian
RemoCel
L
Date of App Lieaticn 3-29-?7 Date
Value
GeneraL
Plwnbing
ELectricaL
Mechanieal
i Conslruction_Lg@g!_
It io the respans'ibility oi tle pentrit holdet to aee that aLL inspeetions ote nade at the p?ope? tine, that each adltess is ten)nbie
froat the at?eet, and that the*Building Diuicion appro"^ed p
26-3769 (reeoyder) state you? City Cesignated job ntnrber,, job aCitess, type of inspec=icn
'inspection, Contraeto?s or omets nane and pione nw,tber. Requests teceixed befcre 7:00 staftet 7:00 on trLLL be nnde tTte ne.ct 'atking dag.
rout, Citu Desisrated. rob Nunbet rs;-- BfD I qf
ac. #
petmit eazd is Located at the frcat of the propez,ty.
Lan sltc.LL remain on the Building Site at aLL t[nes.
PP)CSDUPE FoR INSPEC?I)\| RIQ.WST:CALL 7
"equested and uhen gou uiLL be ready forILLL be nade the sane dcg, r'equests ncd.e
Tc,s Iot #ZO
lO4 SITE INSPEC:I)N: To be nade after fvlItA I eseattation. but pt toz, tc set uD of L/1
- i.ozne. Fh lA<4 QycS
INSULATION/VAPOR BARRIER II|SPECTION :
?o be made after aLL insulaticn ed
requi,red uapor ba'rie?s @e i.n place
but before ory 1,ath, Wpsun baatC ot,
tnLL cooering is applied, cnd before
oty insulation is concealed.
DEI.IOLI?TO!] OR !.:OW) BUILDIi]CS
M roortnG & F)UNDATT1N: To be naCeV\ I Afi er 6;nat;i-ar e-Zccao ated and.
forns ane erected, but prior to
Wuring ccncret€,I
il I U?IDEPFLOOR PLUI,IBTNG & MECHANTCAL:'of
floor insul,ction or decking,
POST AND BEAM: To be nade prLor toinstallation of floot, insulation ot
decking.
BQ.A4! -p rw.ra r il c @r@ a w c u=
ANILAIJ: IUO UOrk LS tO be CODered
,ffiiTthese inspections hanse been
nade arui approoed..
FTP.EPLACE: PtLor to plaeirg facingmaterials and before franrtng inspee-tion.
FRA.I.IING: ltust be requested afte?
approoal of rough plwrbi,ng, electri-cal & neclnnieal. ALL roofing
btacing & ehiltmeys, etc. rrust be
. eotnpleted. lto ucrk i,s to be eon-. eealed until this inspectton lns'been made anC approoed.
K
ANDERSLAB PLUMBING, ELECTRTCAL &
WCHAi|ICAL: ?o be made before any
.uotk is cooered.
UNDIRGPCUIID PLTJMETNC. S9WP, WATER,
DRAIIIAGE: To be nade pt'iot to fil-Lirq trenchee.
FTNAL PLUI4BITIG
FINAL I4ECHANICAL
ETNAL ELECTRTCAL
fTn DRYwALL INSPECTION: Ic
lK I ;rraZn-4""tf.i." .i"
-
but prior to any taping.
be nade
p'lnce,
a
MAS2NRI: Steel Loeation, bond
beons, grouting or uerticcls in
aceotdanee LtLth U,B.C. Section
2415.
WOODSTOVE:
ccmpT;T;A.
After installation is
CURB e APPRCACH APP)N: Aftet forms
@"e e;;;t;Anutnio" to poumng
coto"ete.
SfDEWALK & DRf"TIAI: Eor aLL con-;Ct;nau@Gffi street risht-
of-teA, to be naCe aftez, aLL erca-
oating canplete & for,t r,tork & sub-
base nwterLal in plaee.
?ENCE: Wen conplete -- fuooiCe
gates o? norsable seetions through
P.U.E.
,.--
ect conditione, such as the installation of street trees, conoletion of the
Landsccpirg, etc., mtst be satisfied before the BUILDING FilIAL can be requested.f
lx
_l
ALL proj,
required
f,A FINAL BUILDINC: Ihe Final Building Inspection nilst be t,equested. after the Final Plunbing
Y:-/ Electrical, otC l,lechariccl Inspections ltaue been nade and approueC.
Scnitaty seaez, capped ct property Lite
Septi,c totk p;nlped ann filled rrith gra;;el
Final - I{hen obcue itens ate ecnpleted
and uhen d*tclt-tion is conplete o" st"uc-
tuye noued otC g,ewises cleaneC up.
Le Hcmes
Blocking od. Set-up
Plunbing connectiats -- sate? otC. uatet
Electticcl Ccmnecti.on - Blocking, set-u,
and plutnbing connections rn;st be apprcx-ed
before requesting el.ectrtcal inspeelion
Aeeessory BuilCnng
pct,ches, ski,rting, decks,
Leled.
Piral - After
etc. a?e eonp
*ALL I|ANHCLES AND CLEANOUTS t'tUST BE ACC\SSJBLE, ADJUSTllEill ?O BE L|!\DE Ll lto COST ?O efy Page 1 of 2
4
tr
T
!f
JOB NO
Zone
ResiderttiaL (1 bath)
Sazi Saser
Ila,t/Ectend Cit cuits
Total
I?!M
i Vent Fat
llcodstoite
Permlt fssuanee
Meclnnicel Permit
State
-- ENCROACHWN? --
SOLAR ACCESS REQ.-
Grou,
L-co *
Beiroons
Electricol Permit
Were State Las requires t1",4t the electrical uork be done by an Eleetrieal
Contraetor, the electrical portion of this permit slwll not be ztali.C. until
the Label tns been signed by the Electrical Contt'actov'.
Mechqnicol Permit
7::P-*>
s*3)3)
I HAW CAREFULLy EXAI4INED the eontpleted application for pennit' and do
hereby eertify t?nt aLL infotrnation het'eon is true atd correet, artC f
futthbr eertify that any ar:d aLL aork perforrned slwll be done in aecot'
dance trith the 1rdinancbs of the CitA of Springfield' and the Laas of the
state of oregcn pe?taini.ng to the wrk cescribcd herein, end t|nt No occu-
pANCy trtLL bb nade of any structute uithout permission of the Building Di-
tision, I futther iertiiE that only contracto"s crd enplcyees uho are in
eonpLiance dith oRS 701.055 uiLL be used on this proiect
Maintenance
TotaL
Cutbcut
Si.da,taLk
Mobile Hane 0
\
Signgd
Lot Faces -
lleat
Df House AccessZ of Lct Cooerage_
# of Stories
LOT TWE
_ Interior
_ Cormer
_ Panhand.Le
CUL-de-sac
Total lleight
Topogrcphy
I-t Sq. FtS.
ITEII SQ. FTG x Value
Main
A
TOTAL VALUE
S.D.C. 7.5 c
Check Fee
3-L',ate Paad.:
Reeeipt #I blrOIeA:
Building Vtllue & Permit
This permlt is granted on the espress cottdition tlnt the said-eonsttaction
slnll-, in all nespects, confonn to the Ordirwnce edopted Liy the City 9fSpringfield, including the Zoning CYdinanee, regulcting the ccnsttueticn
and use of buildings, cnd mag be suspend.ed oz'reookeC at cny tine upon oic-
Lation of otA prcoisions of said ovdirnnces.
Building PerrrLt
?otal Cltangea
State
FEENO.CHARGE
Ftbtuves Plumbing Permit
No pe?eon slnl.L canstract, instal!, altet' or clnnge any neu cr eristing
pltnbLng or drainage sAsten in uhole or in patt, unless sueh person is the
legal pbssessor of a oali.d plwtber's License, eseept th,at a pe?son nag Qopltntlig uork to prope"tA uhieh is ouned, Leased ot operated by the apPli-
cant.
Plunbing PerftLt
State Surehange
Seruice
. t/b
FEE
bllanst Hoo,L
TO?AL ATIOUII? DUE: */7".d8 Date
I
TTEM
l,latet
N0.
..]-.:
I T LL C.IARGE I
Rep^ Sa- fl:o-
2a.?t*G 25D
2?.Ea
.Aa
hrna.ce P?U'S
zz5 No*th rrt rrou.ArPPLrcArroN/PERI'ff?
SprtngfieLd, )negon 97477
Buildi.ng Ditsision
7 26-37 53
" RES,JENTIAL"SPTI1{GFIELD
Ic,s Iot #I -)23
Job Ioeaticn:
Svbdittision:
Aasessots Map #
bb
n'Otmer:
TrOf ^), S,rJAddtess:Phone
zip:Ci ty:
DescrLbe Notk:*'/, furtyil*n
4-L-rI
ft Neu
ValueDate of App Lication
Aiwitian
RenoCeL
Itobi
'. Gqneral
i Ptt*lng '
I t -\t/rtl,,t/ I AD
DEMOLnIO!] 0R
Sanitaty saser capped at Woperfui Line
Septic tutk punped a'nn fiLled tttth grauel
Pinal - Ilhen abcue itens aye ccrnoleted
and uhen dq.plition is complete'or styac-ture motsed od. ptenrises cleaneC up.
Itobile Hcnes
Bloeking otd. Set-up
Pltnbing conneetions -- aate? otd. aatet
Electrical Ccmnection - Blocking, set-up
and plunbing eonnections tnist be apprct;ed
before z,equesting electrical inspeclio;t
Accessory BuilCnng
skirting, decks,pct ckes,
1 ^t^)
Fital - After
etc. are eomp,
Page 1 of 2
#
ry"Cr/ -o/<-
t\ r \
qq^
I
q.v
&
r: i8 llu rcepono'ibi-lila of -ttc petwit holt* to aee that all inspectiotta ee nade at the ploper tine, that ecch addrees is renCahief|n tlw at"eet, and ttnt the petmit eud is Located at the ftotti of the orooettu.*Buiuing Nuiciot agproxed plbt slwll remain on tle Bunlding site at all'i{mee."
PR)jEDUPE,Fon=IysPEcrr2N,E9=QIEST:CALL726-3769(recorder) state your City designated job ntonbet,, job aCCress, type of i,nspec;i,cntequested and uhen gou uiLL be ieady fot inspection, contraetao" oio a,tners nane Lnd ptoie nunber. biquists rcLeiiZd tZfcri z:00 c,tL\LL be nade the sane day' ?equeets nade afte.t 7:00 ant ttLLL be np.de tlze neot aorki$ dag.
Conatructton Lede?
?TilAL PLUMBINC
^A,{. \
PINAL MECHANICAL
?INAL ELEC?RICAL
Date
8?r tlL
SfiE fNSPEC?T0N: To be rrude aftet,
eccansation, but priar tc set up of
forne.
ANDERSLAB PLAMBING. ELECTRICAL &
MECHA.ilICAL: ?o be made befoz,e ang
.wtk i.s eotsered.
LO)LIN1 & F)UNDATfCN: ?o be naCe
M t"ffi;; ate;icauated and.
forns ate erected, but ptiot, to
potu"tng ecncrete.
ANDERGROAIID PLT]METNG. SIWEP,. WATER,
DRAIIIAGE: To be naCe pr"Lor to fil-litq trenehee.
UIIDERFLOOR PLUI,ETNG & MECILANICAL :
?o be mad.e prion to installation of
floor ineulation or decking,
POS? AND BEAM: ?o be nade prior toinstallatian of floon insulation or
decki,ng.
LOLIGII}LIX,IB I IIG, ELECTR TCAL & MECE-
ANfCAL: No uotk is to be cotset,ed
.ffiiT-these itnpections haue been
made and. approoeC.
FIP.EPL!. C!: Prior to plaeirg facingnaterials and. before fronLng inepeb-tion.
FRA.|.,!TNG:_ tutust be requested after
approual of rough plwrbing, electrt-cal & neclwnieal. AL! toofing
braeing & chinmeys, ete. rruet be
; cotnpleted. lto uoyk is to be con-. cealed until this inspection lastbee.n made anC approtted.
Iottr City Desi,gnated Job Nutnber Is
TNSULA?TON/VAPOR BARRTER IIISPEC?TON:
?o be nade after aLL insulaticn ed
required oapor bavie?a @e in place
but before ory la.th, Wpswn boayC oy
tnLL couering is applied, and. beforeay irculation is concealed.
DRWALL LNSPEC?f)N: Ic be made
-.,
after aLL dtyuall is in plaee,
but ptior to ang tapitrg.
I,\ASONRI: Steel Location, bond
beons, grouting or oerticals in
accordance dth U.B.C. Section
241 5.
WOODSTOVE:
enATetA.
Aftet, installation is
CURB & APPRCACH APRON: After fornsee evecteC but ptiot, to pow.ing
eonerete.
SIDEIALK & DRIVWAI: For aLL con-c"A; pafrffi street right-
pf-,';oA, to be made after aLL erea-
oating conplete & fonn uork & sub-
base nateytal in place.
PE!!E: Wen cotnplete -- Prottide
gates ot mouable sectians through
P, U, E.
?TNAL BATLDING: The Final
Eleetz,ical, otd Meelwnical
ALL p.roject conditions, such aa the i.nstallation of street trees, conpletion of therequired Landsccpitg' atc.' tmtst be satisfied befote the BUTLDINb rfNAL canbe requested.
Building. Inspeetion mtst be requested after the Final Plunbingfnspectians hate been nade ard approueC.
*ALL I4ANHCLES AND CLEANOUTS MUS? BE ACCESSTBLE, ADJUSTTTEN? rO BE I,L4DE A? ilO CCST TO Crty
e
trr
ur
tr
;1
#JOB NO.soLAR ACCt : REQ.-L-CO
Bedroons
Access.
Ileat
DT House
[,ot Faees -Iot Sq. Ftg.
% of Lot Couerage
# of Stortes
Total Eeight
Topogrqhg
LCT TWE
_ Interior
_ Corne?
_ Panhand.Le
CUL-de-sac
-- Eees --
Building Volue & Permit
This permLt is granted on the erpress eondition tlwt the sciid_eonsttwction
slnll', in a|-L tZspects, confonn to the 0r'dirwnce adopted 6iy the City o.f
Sprin4field, including- the Zoning Crdinance, r'eguLating the ecnstmteticn
*rn ,-nb of buildings, cnd may be suspended oz' r'euokeC at cny time upon oic-
Lation of dtA prcr.tisione of said Otdinances.
?OTAL VALUE
ttu Value
*
Signed:
S.D.C. 7.5 r
ruEM
lbin
Building Permit
?otal Clanges
State Date Paid:
{.
Plumbing Perrnit
No person s?nZL consttact, install,- alter ot clurqe -any ne?'-c? eristing
ptti*1rq or dr.ainage syetan in uho1e o_r in patt, unlesg such person is tlp
iegal piosses"o, o7-o u'-olid plr b"r's Lic-ens-b, eteept that a P??son natl Qo^ptiitrhg uotk to property ihi"h i" ot)ned, Leased or operated by the apPl1-
cant.
FEE CEARGEN0.
,t
Ftbtut'es
Reeidenti,al (1 bath)
Sa'ter
PLumblng verfrLt
State
Electricql Permit
h*w,e State La requires ttlat the electy'i.cal uo?k be done by _an Electrieal
Cittactor, the elietricaL portion of this permit slnll not be oaliC until
the Label has been sig:ned by the Electrical Conttacton'
lotaL *
Na,s/Ertend. Circuits
Set uiee
NC FEE
O,O v
Mecho nicol Permit
lJcodstooe
Vent Fdt
Erhalet Eood
BTU, S
Permit fssucnca
Meehanieal Permtt
-- ENCROACHMENT --
Secarity Deposit
Sto?age
Maintenantce
Perwit
Clttbcut
Sidasalk
Fense
Electrical Label
IMgb(te Hong /)
1oS. *
Ut/
PLan EidnLnel'uaxe
(/-
I IIAW CAREFULLy EXAILfNED the eompleted appli-cation for pennit, cnd do
ieietu iertifa that aLL inforrnation hereoi is t,ue and. co,r'eet, anC f
fut tk"e* centl-fy that any i"a aU ao.r,k perfotmed slnll be do'ne in aecot-
dance vLth th'e'Otdinanc"es of the Ci.ta bf Sp,ingfield, artd th_e Ldns of the
state of o"egcn pertaininq to the tprk cesctibed hetein, cnd, tlnt No occa'
pLiCi ,itt b"e rnaZe of any'structure uithout pernissi_on of the Building N-
ttision. I further certi."fu tLnt otly eontractors and. _ettplcyees r,tho are 'tn
eonpliance'ultt oas 701.-055 uiLL be used on this pt'oject
totaL
TOTAL A]fiOUNT DUE: *7o,too
{<
Date
?.ceeict t" RESIDtrNTlAL"
zzs North stlr streeAPPLrcArr,N/PERIITT
Springfield, )regon 97477
Buildtng Ditsiston
7 26-37 53
Job Locaticn:rrl
Aesessore lVap I 170 3 -2 2.
svbdiuision:
A.sner:
Addz.ess: /1 Phone:
SPFIINGFIEI-D
o
L
ll,t,L qol t
1
Additicn
RenoCeL
Le
Date of Apo Lication
General
ELectrical
, tlechdrical
Desey,Lbe hroz,k:
/8 " 22' !r.i,i, ro,.,"\
.2
Si
a"4a(
tr'
OL
Value
Ias Iat #20
Constuuction_L.ndg?
It ia lhe responeibility of-the peorit ttoller to eee that aL! insoeetions ee nade at the p?ope? time, that. ecch adlress is ren;ai^ieiy--tly at?eet' anc tlwt the-pirmit_c-atd is Loeated. at the froni of the property.*9uiltiing Nuisiotz aoproxed plat shcll remain on thz nuildinlq- Site at aLL tines.
t?cgDUPq ro'1 r,"sP5,"rcil,|,909$?;CALL726-3769(recotd.er) state your City designated. job nto:tber, job aii:.ess, t.gpe of insoec=icn
::.*"il"i-1:a_l.1en'gou uiLL be reariy for inspection, contract"rs oi a*ters-naneZnd puie ni,rnbet,.' biq".ri" rcLei|'ed. bLicre'z:0c c:i,'LLL be maae the sane dcy, "equests ncde aftet, ?:00 on vLLL be nade the ncst aorki$ day.
Icur Ci\,Desigra.tedr,tqf Nutnber rs:_ _81D I qr
Peottinoi .n*(9
E trS::3 l.','-.Pli:lr,l.. ?o be naae after
"-""ueDlo". CuX DI.LC? tc sea uD or'jome.frfilg<q CTreS '
U:IDIRSLA3 ?LU:.3Ii:G. !L!C:PIC,"L P,
iEC4;.;;iC;.L: I,o be nacie beioz,e anyuork is ectsered.
i ; ; s L', L A? : 0 :t / VApo R 0.4 R pIEi? I i r S p! C! I 2 l1 :DEt.i)LrTic:i 0F B'' ILDI;:C.S
,n )
PCOTn|G I fCN: ?o be maCeaftertyencites are escatsated and.
forns are ereeted, but p?iol, to
pour-ing ccnerete.
7 u:lotncpcu::D pLunrtc. sqtllp. ,.t.lT!R.'j
Lirq xrenehes.
trfTn DRYilALL INSPIC?fiU: Tc be nade
W l;FA-;A@;;Tfts in plnce,
-
bui prion to cny taping.
To be naie after aLL insulattcn a-.d.
required oapor buriers @e in plaee
but before ory Lath, gUpslnn bcatC orunll eouering is cpplied, cnd. beforeoty insulation is concealed.
I4ASCNR!: SteeL Locatton, bond
beons, gz,outing or uerticcls in
aceond"orce Lrith U.B.C. Section
WOODS?OVE:
ecrnpleted.
Aftez, installation is
Scnitary seuer capped ct prooerig Lire
Septic tank pti::ceci and fnlled urith ;r*ei.
Pinal - klzen cbcte -.tens a-re cctaietei
anc uhen C*ol:-tion is conrplete o! st!u3-tute noued ard. ptetises cleanei up.
llcbile Hcnes
Blocking otd. Set-upI
n
robernaz.e@of
fLoot insulction or decking.
C
POS| AHD BEAI.|: To be nade orior toTiiiiTTilf,dn of floon insulLtion or
UI|DEPFLCOR PLU].ETNG & IIEC!]ANTCAL:
FTilAL PLUIIBIIIG
CURB & A?PRCACI| APPON:ue erecteC but pt'ior
Plutnbing connectians -- sarte! otl. uater
Electtical Ccnnection - Blockittg, set-ut
and plwnbing ecnnections rn;st be cpD?cv^ei
before requesting eleclrical insptec=iol
Aceessong BuilCing
Aftet fornsto pourtngdecking. y)
'm
--.
..w:til these inspectiot;s haue been
nade arui approued..
I FIpEplACt: prior to plccirq fceing| | mdterLals and. before franing inspee_tio4.V
.{ | FRiltIttC: I4ust be requested aftez,r I app,rotsal of rough plurbing, eiectyi_caL & neciunical. ALL roofing
bracing A chinmcys, ete. nrast" be
. conpleted. lto ucrk is to be con_- ceazed until this inspection lns'been macie anC appro-*ed-
cofi,cpete.
SIDEWALK & DRftEl,lAy: For aLL eon-
crete pantirq uithin street night-
of-txA, to be nade after aLL erea-
oating complete & fotn wt k & sub-
base nater"ial in place.
IENCE: h1ten conplete -- ProuiCe
gates ot mouable sections through
P. U.E.
Pirnl - After
etc. aPe ccnD
gct ckes, skitting, decks,
Le!ed.
llx
l
\q
ALL pnoject conditions, such as the installation of slreet trees, ectpletion of tierequired lanCsccpizg, ctc., nust be satisfied befone the BUILDIII1 FII|AL can be requested..
?INAL BUTLDINC: The Final Buildrng Inspeetion mtet be reouested cfter the Final plunbingElectrical, anC Neeimic,:L Inspections itatte been macie ard approuci.
FIIIAL I4ECHANICAL
'-lq
FINAL ELECTRICAL
?ace 1 of 2
IALL tl;:ti:CLES tiliD CLEA,:\CUTS IIUST BE ACCESSIBLE, ADJUSTltiitl lO BE |!.4D8 t! lt7 CSST TO CM
@
T
JOB NO soLAR r.-aEss REQ.-L-co c
Grouc:
LCT TWE
_ Intenict
_ Corile?
_ Paahand.Le
Cul-de-sac
EesJcot:s:
Iot Sq. FtE-
7 of Lct Cctserage_
t of Stories
iotal P.eight
Topography
Duildtno Perrtt
Iotal Clarges
Scurees
:;eat
Building Volue & Permit
This perntt is granted on the eap"ess condition tL@t the said.construction
slnll-, in all nespects, conforrn to the Ordinance adopte,T by the City of
Springfield, inclu.ding the Soning Crdinance, regulctitzg the ccnstr,rcticn
cnd use of buildings, otd may be suspended or reuokeC at cty tine upon oic-
Lation of dry prcoisions of said Ordir,anees.
bLaTiea:
/iccess
th
DT
D
Lot Faees -
-- Fees --
ITE!.1 X VaLue
4ovzdn 76 /fu*
TOTAL VALUE
S.D.C. 1.5 x
Chec Fee
-12 -aL)/a
.68
CHAP,C'FEEITE:.!
I, Fistures
Resil.znti-a.L (1 bath)
Sani Seuer
Plunbing Penrtt
State Suvch.avqe
Tcta7.
t llas/Eztend Circuits
| Tanpc"@ll Seniee
1'oXa L
Plumbing Permit
No person stwll constr'ttct, instal'!., altet' ot clunge -cny net-cr existing
pt;nitlng oz, dtainage syste"n in ttlale or in patt' unless such person is the
iegal pZsses"o, ol"a nolid pl*rb"rts L'Leense, eu-cept that a pe?son ^ay 4?pt"nalig aork to pvoperty ihich is otmed' Leased or operated by the dpPli-
cailt.
*
O^a Electricol Permit
h1tere State Las reouiyes that the electrical uo?k be done by an Eleetrical
Contraetor, the eleetrical portion of this permix s7nll not be uali-C. until
the Label lns been aigned by the Electrical ContTacto!.
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2?.tto.fo
2?" qb
r7:!.:
I bhanst HooC
Vent Fot
'ilcodsto:.te
Pennut fssucnee
Mechanical Petnrit
-- E;ICROACHMENT .-
Mechonicql Permit
Pentrit
Tatal Cnatoes
C'uabcui
Sida,talk
!,Lect?LcdL LcbeL
.vobile Hcne
I HAW CAREFULLY lXil4fNED tle cornpleted application for permit, and' do
L.iety iertify that aLL infotmati'on hereoi^ is true and correct, ond f
funtk"e? certi,-fy that any ard aLL uo?k penfoz.ned shall be done in aeeor'-
'danee ,,rith thb- Ordinancbs of the City of Springfield, anC the Laas of the
state of oregcn pertaining to the uoy,k cescribed hetein, cnd titan llo )cc".l-
pANCy ;LL bZ nade of any structute uithott pertnission of_ the Building Di-
oision. f fut'ther c'ertilfy tha.t otly eontTaetors a':d enplcyees uho are in
conpliance uith cRS 701.05s uiLL be used on this proiect
nIJli
s-; j -,r)
F!E atJ,1 Da;
n.n.f A,.^1,^,G ^1,c. ^/?",06 Signe<i
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