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Home My WebLink AboutPermit Building 1993-11-24ELE}RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 JOB NUMBER ?7/ "<a, 225 Fifth Street Spri ngfield, Oregon 97 477 LOCATION OF PROPOSED WORK; LOT:BLOCK;SUBDIVISION A nnoEcc. PHONE: ztPSTATE:CITY: OWNER NEW - FIEMODEL ADDITION DEMOLISH OTHER ,€DESCRIBE WORK: ADDRESS EXPIRES PHONEeCONTRACTOR'S NAME MECHANICAL: ELECTRICAL: PLUMBING: G EN ERAL: CONST. CONTRACTOR # RANGE: # OF BDRMS: - OFFICE USE _ ZONING CODE: FLOOD PLAIN: WATER HEATER: SECONDARY HEAT SQUARE FOOTAGE: QUAD AREA: # OF BLDGS CONSTR. TYPEI HEAT SOURCE: LAND USE: # OF UNITS OCCY GROUP: * OF STORIES: To request an inspection, you must call 726-3769. This ls a24hour recording. All inspections requested before 7:00 a.m. will be made the same working day, lnspectlons requested after 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS fl Temporary Eleclric L_-_l Rough Mechanical - Prior to cover. f-A Final Plumbino - When allK plumbing *orli is complete. Site lnspection - To be made after excavation, but prior to setting forms. [-7| Rough Electrical - Prior toL4J cover. Final Electrical - When all electrical work is complete. Underslab Plumbing/ Eleclrical / Mechanical - Prior to cover. Electrical Service - Must be approved to obtain permanent electrical power. Final Mechanical - When all mechanical work is complete. Footing - After trenches are excavated.Flreplace - Prior to facing materials and framlng lnsp. n Final Building - When all required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting.w w w Framing - Prior to cover. Other Foundation - After forms are erected but prior to concrete placement.Wall/Ceiling lnsulation - Prior to cover. Underground Plumbing - Prior to filling trench.Drywall - Prior to taping. MOBILE HOME INSPECTIONS Underf loor Plumbing/ Mechanical - Prior to insulation or decking.Wood Stove - After installation. Post and Beam - Prior to floor insulation or decking.lnserl - After fireplace approval and lnstallation of unlt. Blocking and Set-Up - When all blocking is complete. Floor lnsulation - Prior to decking.Curbcut &Approach - After forms are erected but Prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanilary Sewer - Prior to filling trench.Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. Storm Sewer - Prior to filling trench. Sidewalk & Driveway - After excavation is complete, forms and sub-base material in place. Water Line - Prior to filling trench.f-_l Fence - When completed Rough Plumbing - Prior to cover. Street Trees - When all requlred trees are planted. Final - After all required inspectlons are approved and porches, skirting, decks, and venting have been installed. ASSESSoRS viap, ,/7e7-74-ZB rAX Lor: Aile a E tl tl E r tl E E tl r Lot faces Lot sq. ftg. Lot coverage TopographY Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac Set P.L.HSE GAR ACC N S E i YS THE PROPOSED WORK lN THE. HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be signed and approved bY the Historical Coordinator prior to permit issuance. APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinance adopted by the City of Springfield, including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances' Plan Check ree, ,4/. ?- G Date Paid: //'?/ ^?2 P d Receipt Numbe Received Date .< BUILDING PERMIT VALUE / 7?,av(A) o-77 SQ. FT, X $/SQ. FT,ITEM Main Garage Carport Total Value Building Permit Fee State Surcharge Total Fee tu1 /2d5e- Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B) /y* ' ADDITIONAL COMMENTS ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE (c) N0 FT. FT. FT. PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge Wood Stove/ lnsert/ Fireplace Unit Dryer Vent (D) N0Vent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rnace Exhaust Hood By signature, I state and agree, that I have caref ully examined the completed application and do hereby certify that all information hereon is true and correct, and I f urther 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 Building Safety Division. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I f urther agree to ensure that all required inspections are requested at the proper time, that each address is readable Signatu re Date 2- is located at the frontfrom the street, that the of the property, and set of plans will remain ctionon the site at all MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition Total Miscellaneous Permits (E) 4e-+_t- State Surc TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) 2/2 e3 VALIDATION: REcErPr NUMBER // ee 7DATE PAID BECEIVED BY AMOUNT RECEIVED a? (/ RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 JOB NUMBER 225 Fifth Street Springfield, Oregon 97 477 LOCATION OF PROPOSED WOFK: ASSESSORS MAP:^o z TAX LOT: BLOCK: SUBDIVISION os LOT: PHON E ZIP:STATE: OWNER ADDR CITY: NEW - REMODEL ADDITION DEMOLISH OTHER DESCRIBE WORK: ADDRESS EXPIRES PHONECONTRACTOR'S NAME MECHANICAL: ELECTRICAL CONST. CONTRACTOR # G EN ERAL: PLU M B ING RANGE: * OF BDRMS: _ OFFICE USE _ LAND USE: ZONING CODE: FLOOD PLAIN WATER HEATER: * OF UNITS: SECONDABY HEAT: SQUARE FOOTAGE: QUAD AREA: * OF BLDGS: OCCY GROUP: * OF STORIES: CONSTR. TYPE: HEAT SOURCE: To request an inspection, you must call 726-3769. This is a24hovr recording. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. REOUIRED INSPECTIONS Temporary Electric w Rough Mechanical - Prior to cover. Final Plumbing - When all plumbing work is complete. Site Inspection - To be made af ter excavation, but prior to setting forms. Rough Electrical - Prior to Final Eleclrical - When all electrical work is complete.cover. Underslab Plumbing/ Electrical / Mechanical - Prior to cover. Electrical Service - Must be approved to obtain permanent electrical power. W Final Mechanical - When all mechanical work is complete. Footing - After trenches are excavated.Fireplace - Prior to facing materials and framing lnsp. Final Building - When all required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting. OtherFoundation - After forms are erected but prior to concrete placement.Wall/Ceiling lnsulation - Prior to cover. Underground Plumbing - Prior to filling trench.Drywall - Prior to taping MOBILE HOME INSPE TIONS Underlloor Plumbing/ Mechanical - Prior to insulation or decking.Wood Stove - After installation. Post and Beam - Prior to floor insulation or decking.lnsert - After fireplace approval and installation of unit. Blocking and Set-Up - When all blocking is complete. Floor lnsulation - Prior to decki ng.Curbcut &Approach - After forms are erected but prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to filling trench.Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. Storm Sewer - Prior to filling trench. Sidewalk & Driveway - After excavation is complete, forms and sub-base material in place. Water Line - Prior to filling trench. Fence - When completed Rough Plumbing - Prior to cover. Street Trees - When all required trees are planted. Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed. E E tl E E tl E tl E E r I--l Framing - Prior to cover. E tl r E E E E Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type. - lnterior - Corner - Panhandle - Cul-de-sac Se IS THE PROPOSED WORK IN THE HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be signed and approved by the Historical Coordinator prior to permit issuance. APPROVED: P.L.HSE GAR ACC N S E BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinance adopted by the City of Springfield, including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Recei pt Number:- Plans Reviewed By Date Plan Check Fee: Date Paid Received By VALU E (A) X $/SQ. FT. Main Carport Garage Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SQ. FT. Systems Development Charge is due on al I undeveloped properties within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ADDITIONAL COMMENTS ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE (c) N0 FT. FT. FT. PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge Wood Stove/ lnsert/ Fireplace Unit Dryer Vent _2- /,:;> (D) N0 7. n-' Vent Fan ,/"/ry //+.-- ./a -eMechanical Permit I ssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rnace Exhaust Hood By signature, I state and agree, that I have caref ully examined the completed application and do hereby certify that all iniormation hereon is true and correct, and I f urther certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springf ield, 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 Building Safety Division. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I f urther 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 plans will remain ure q Date at all tiothe sit ring construction. MlSCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, q D, and E Combined) DATE PAID AMOUNT RECEIVED VALIDATION: RECEIPT NUMBE C'TY OF OREGO'U 535..U. //e 47zzo<-=-:, SPRIN 1 OP Permits are non-transferable and expire if vork is not started vithin 180 days of lssuance or if vork ls suspended for 180 days., 2. CONTRACTOR INSTALINTION ONLY Electrical Contractor Addre Ci ty /</ Phone -72 Etbcrnrcar, Pgru{rr APPLTcATToN city Job Number 93 Z / 2 Q, 3. COHPIJTE FEE SCEEDT'LE BELOS ldential-Single or HuIti-FamlIy per dvelling unit. Service Included: ?ilxa$*il:"-ll:225 FI,Z SI?BEf, SPRINGTTEID, oRBGoN 9 INSPECTION REQIIBST: 0PPICE: 726-3759 Zon\ _ .f I ro\q "{ Supervisor License Nurnber 262a-5 Explration Date Constr Contr. Nunrber / z>?*z Expiration O^t" Slgnature of sing Electrician s Name Atidress 4vt Ci ty Phone OVNER ON The installation is beirig made on property I own vhlch is not intended for sale, lease or rent. Onners Signature: DATE: c. D. Branch Circuits Nev, Alteration or Extension Per Panel Items 1000 sq.f t. or less -j-Each additional 500 ' sq. ft or portion thereof Each Hanuf'd Home or -Hodular Dvelling Servlce or Feeder Services or FeedersInstaIIation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps -401 amps to 600 amps -601 amps to 1000 amps Over 1000 amps/volts -Reconnect 0nIy One Circui t Each Addi tional Circui t or r.ri th Service or Feeder Permi t STIBTOTAL OF ABOVB 5Z State Surcharge TOTAL Temporary Services or'Feeders Installation, Alteration or Relocation 200 amps or less S 40.00 Over 401 to 600 amps $ 80.00 0ver 600 amps or 1000 voTis see rtgtt "[f,!f- Cos t $ 8s.00 $ 1s.00 s 40.00 $ s0.00 $ 60.00 $100.00 $130.00 s300.00 $ 40.00 s 35.00 $ 2.00 .yt- Sum B. E Hiscellaneous (Service/ feeder -Each installation Pump or irrigation SSign/outline Lighting- SLimited Energy/Res - SLimited Energy/Comm $ not included) 40.00 40.00 20. 00 ff- RBCEIVED 5 o SPRTNGFIELE, RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 Zfr, JOB NUMBER a?^ 225 Fifth Street Springf ield, Oregon 97 477 LOCATION OF PROPOSED WORK: LOI BLOCK:SUBDIVISION TAX LOT: PHON E: STATE:ztP vDzz-azsGs ,b:7*,u-OWNER CITY: ADDRESSI NEW - FIEMODEL ADDITION DEMOLISH OTHER - DESCRIBE WORK: ELECTRICAL: - ADDRESS EXPIRES PHONECONTRACTOR'S NAME CONST. CONTRACTOR # G EN ERAL: PLUMBING RANGE: * OF BDHMS: _ OFFICE USE _ LAND USE: WATER HEATER: ZONING CODE:* OF UNITS: QUAD AREA: * OF BLDGS: SECONDARY HEAT SOUARE FOOTAGE: OCCY GROUP: * OF STORIES: CONSTB. TYPE: HEAT SOURCE: To request an inspection, you must call 726-3769. This is a24hour recording. All inspections requested before 7:00 a.m. wiil be made the same working day, inspections requested after 7:00 a.m. wlll be made the following work day. REOUIRED INSPECTIONS Temporary Electric Rough Mechanical - Prior to cover.w Final Plumbing - When all plumbing work is complete. Site lnspection - To be made after excavation, but prior to setting forms. Rough Electrical - Prior to cover. Underslab Plumbing/ Electrical / Mechanical - Prior to cover.Electrical Service - Must be approved to obtain permanent electrical power. Final Mechanical - When all mechanical work is complete. Footing - After trenches are excavated.Fireplace - Prior to iacing materials and framing lnsp. Final Building - When all required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting.Framing - Prior to cover. Foundation - After forms are erected but prior to concrete placement.Wall/Ceiling lnsulation - Prior to cover. Underground Plumbing - Prior to filling trench.[-_l Drywall - Prior to taping MOBILE HOME INSPE TIONS Underlloor Plumbing/ Mechanical - Prior to insulatlon or decking.Wood Stove - After installation Post and Beam - Prior to floor insulation or decking.lnsert - After fireplace approval and lnstallation of unit. Blocking and Set.Up - When all blocking is complete. Floor lnsulation - Prior to decki ng.Curbcut & Approach - After forms are erected but prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to filling trench.Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. Storm Sewer - Prior to filling trench. Water Line - Prior to filling trench. Street Trees - When all required trees are planted. Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed.E Rough Plumbing - Prior to cover. ASSESSoRS M^P: - / 2 -aV-?€-zi> ?,4' -^ ^rtr.rI-l 6t\llaAl' FLOOD PLAIN: r n E E tl fl l--l SiOewalk & Driveway - AftertJ excavation is complete, forms and sub-base material in place. I-_-l Fence - When completed.tt E Final Electrical - When all electrical work is complete. tf E [-_-l other Lot faces Lot sq. ftg. Lot coverage TopograPhY Total height Lot Type -+. - lnterior - Corner - Panhandle - Cul'de-sac Setbacks P.L.HSE GAR ACC N S E i - THE PHOPOSED WORK IN THE HISTORICAL DISTHICT, OR ON THE HISTORICAL REGISTER? -=--lf yes, this application must be signed and approved bY the Historical Coordinator prior to permit issuance. APPROVED BUILDING VALU E, PLAN CH ECK AND BUILDING PERMIT This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinance adopted by the City of Springfield, including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Receipt Number:- Plans Reviewed By Date Plan Check Fee: Date Paid Received By: VALUE (A) BUILDING PERM!T Total Value Building Permit Fee State Surcharge Total Fee SQ. FT. X $/SO. FT.ITEM Main Garage Carport Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ADDITIONAL COMMENTS 22-- L: 2/,-o(c) --L No FT. FT. FT. Fixtu res Residential Bath(s) Plumbing Permit State Surcharge Total Charge FEE zld PLUMBING PERMIT ITEM Sanitary Sewer Water Storm Sewer Mobile Home Wood Stove/ lnsert/ Fireplace Unit Dryer Vent MECHANICAL PERMIT (D) No Mechanical Permit lssuance State Surcharge Total Permit Fu rnace Exhaust Hood Vent Fan By signature, I state and agree, that I have caref ully 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 Springf ield, 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 Building Safety Division. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I f urther 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 plans will remain Signat Date ^/?Z -/,/ - on the site at all times struction. MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) //z/e- .*+C DATE PAID AMOUNT RECEIVED RECEIVED BY VALIDATION: FIECEIPT NUMBER TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) 2-/ ?/ 'effY oF OFEGO'V 225 PTYTE Sl3EEf,approval" 77SPRINGPIBIJ), oRBGoN 974 376f""iINSPECf,ION BEQIIBST: 726- 0PFICB: 726-3759 o*u-12-^&G -Q3 :iPtlT]{O- lLO as submitted has the following require specific land use EI.ECTT,ICAL PEruIIT APPLICATION City Job lluober qj\ \?_b 3 COHPI.ETB PEE SCEBDI'I:B BEI.OS Nev Resldential-Single or l,lultl-Famlly per dvelling uni r. Service Included:Items Cost 1000 sq.ft. or less Each additional 500 sQ. ft or portlon thereof Each Hanuf,d Home or -Hodular Dwelling Servlce or Feeder $ 8s.00 $ 1s.00 $ 40,00 Services or FeedersInstallation, Alteratlonsor Relocation: The loll zoning, owing proiecl and does not 1 *H.Ti,o'til*ttrx- Permits are non-transferable and expireif vork ls not started vithln 180 daysof lssuance or lf vork ls suspended for 180 days., 2. COTITRACTOR INSf,ALIATION ONLY B Electrlcal Contrac ,* @rfrrZ/ fu/rC Address J 7fZ 1a,**f Exp tration Date ,/ory7 Constr Contr. Number / ")-S Z- Explratlon oate / O-?3 Slgnature of Superv Electrlcian Name Address 5A\ n.f$F t\,.' Phone AJr 0tUrne I;EGAL JOB ct OITNBR TNSTALIATION The. installatioir is beirig made onproperty I own vhlch is not intendedfor sale, Iease or rent. ovners Slgnature: DATB: C. Temporary Servlces or'FeedersInstallatlon, Alteratlon or Relocation 200 amps or less 201 amps to 400 amps -401 amps to 600 amps -601 amps to 1000 amps- over 1000 amps/volts -Reconnect 0nly 200 amps or less \ S 40.00 201 amps to.400 amps - $ 55.00over 401 to 600 amps - S 80.00 0ver 600 amps or 1000ETts see t,8,, a[_ A Sum cf,rv 6rfzl shon"SE 2?7 Supervisor Llcense Number )52A-S $ 50.00 $ 60.00 $100.00 $130.00 s300.00 $ 40.00 aE6iE D. Branch Clrcuits Nev, Alteratlon or Extension per panel One Circult Each Additional Circuit or r,rith Serviceor Feeder Permi t s 35.00 $ 2.00 E.Hiscellaneous (Serviee/feeder not included) -Each installation s 40.00 s 40.00 $ 20.00 $ 36.00 Pump or irrigation Sign/0utIine Light tng- Limited Energy/Res -Llmi ted Energy/Comm STIBTOTAL OP ABOVB 5Z State Surcharge TOTAL: L\SARBCBIVED 5 DO OREGO'VC'TY OF SPR SPFlINGFIELD D E V ELO P M ENT S ERV I CES D E PART M E NT CERTIFIED LETTER December 2, 1993 Linda Steele P.O. Box 221 Klamath Falls, OR 97601 Subject: Housing Tnspection at 535 N. 14th Street, Springfield, Oregon. Dear Ms,Steele: At your request, the Community Services Division/Building Safety conducted a Housing Inspection at the above address. The inspection revealed items which do not meet the minimum City Housing Code requirements and must be corrected. They consist of the following: Structural Cracks in the south exterior wall indicate a possible structural failure. Corsult a certified engineer for corrective action to be taken, and submit a copy of the engineers report to this department. Submit two complete sets of working plans, and two copies of the plot plan for plan check, if the garage is to be reconstructed. If you need any further inforrnation or have any questions regarding the above requirements, please contact the me between the hours of 8:00-9:00 a.m., 1:00-2:00 p.m., or 4:00-4:30 p.m. at 726-3759. Tom Marx Building Inspector Dave Puent, Community Services Manager Spectra Systerns 587 Shelley Street Springfield, OR 97477 h,225 FIFTH STREET SPRINGFIELD, OR 97477 (503) 726 375s FAX (503) 726-s689 1 2 cc: Sinceryply,J; t1*/ ID-16 .t\ * q\tq)t SPRINGFIEL} FIRE DEPAi],TMENT FIRE DAI4A.GE REPORT OR ELECTRICAL HAZARD X",u X.t * l') D33tJ3 -D5iDL.. DATE: TO: FROI4: SUBJECT: Buil ding Department Springfield Fire Department Structural Damage to Bu'i1 di ng Address or location of building 5 1< N,, lq si Name of o!,ner A-Pr7 11\-1)-rr-YJ-&t o n. Type of bu i 1d'i ng 0 (1 1 i ng, Store, l,larehouse, etc. ) 55 oron .ooEstjmated val ue of bui 1 di n9 Estimated I oss to bu'ilding Date of fire Q-rr-q1> $ $ ]o ooo oo Location of damaoe i n bui'ldi nq lr [.k,-* non{,^ta lt( Structural weakness as a resu'lt of the fire Yoo-\i t, trl oft \o (Burned rafters, Beams , .loi sts , etc. ) Addjtional pertinent information Electrical Hazard (1,1i rinq , 0ut] ets , etc . ) ICC + S i qned sLq oi, etc. ) HOUSTNG INSPECTION APPTICATION CITY OF SPRINGFIELD BTIILDINq DI\ISION DATE: ADDRE 0 3 SS OF INSPECTION:fll O\,INER:/roo, fzaa JoB NUMBER: ?3Zz/2.4 PHONE NUMBER: OVNER'S ADDRESS:zz/ APPLICANT: APPLICANT'S ADDRESS: FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: A S35.OO INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION .fr THIS APPLICATION FORM MUST BE SIGNED BY THE INSPECTED. OVNER OF THE PROPERTY TO BE Turs lc r?m V*?ztn 'fu2 ftzc,,mZ4 c*-7€'2.- 4'A ,*a --€i'z+*.-' fia-7zm=a 0 FOR OFFICE USE ONLY DATE OF INSPECTION: RECEIPT NUMBER: DATE OF REPORT: DATE OF CERTIFICATE OF COMPLIANCE: COMMENTS: DArE PAID z //-/'?3 _/a--r7.4? t. SENDER: i. Complete items 1 L 2 for additional services.. Complete items 3, and 4a & b.. Print your name and address on the reverse oJ this form so that we can return this card to you.. Attach this form to the front of the mailpiece, or on the back if space does not permit. . Write "Return F6ceipt Requested" on the mailpiece below the afticle number. The Return Receipt will show to whom the article was delivered and the date delivered. 3. Article Addressed to Linda Steele P.0. Box 221 .Klamath Falls, 0R 97601 I al{ yish to receive the following services (for an extra fee): 1. dtr Addressee's Address 2. E Restricted Delivery Consult aster for fee. Article NumberP. 866 797 944 o;o oo o. o(,o E, c (, G oco) o o .!co3F 4b. Service TypefI Registered SCertified E Express Mail - E lnsureo n coo Return Receipt for 7. Date of D 8. Add and fee 5. Signature (Addressee) Form DOMESTIC RETURN RECEIPT, December 1991 lr 6.893 ttt, UNITED STATES POS r xL lillll a SERVICE Oflicial Business PENALW FOR PRIVATE USE TO AVOID PAYMENT OF POSTAGE, $3OO Print your name, address and ZIP Code here a a DEVELOPMENT SERVICES 225 FIfiH STREET SPRINGFIELD, OR 97477 * U.S.MAIL (