HomeMy WebLinkAboutPermit Building 1987-12-17m
COI,IBI NATION APPLICATION/PERMIT 726-3753
Job Address
Legal Description -OZ$o.aa.
Hea t
EIIERGY SOURCES:
llater Heater
Ranqe
Va l ue of l,lork :
/Zao.4
Sq. Ftg. Access._
Sq. Ftc. 0ther_
_!,lew_Add___1A1 te r_Re p .
_Fence_Demo Change/Use
0ther
n_
owner Cnr a,F -f,%*zz,.va,D .e., Build Single
22>Arrdress22€ /./9, Sb9.
/,ysrr*zc 2 xA hz*rz> k/*z-
Construction Lender /4t.?, Z'7zr'/z Daap ,/* ?l ,lzr-
oF *z;;2, Dortn i 6.Address Phone
\
\
\\0
N
IJLSIGN ILAI,I name address exo t res (phone no-
EI ectri cai
Structura I
Prima
Hechani cal
CONTRACTORS name addres s exDl res (ohonp nn
El I
PLUHBING ELECTRI CAL MECHANICAL
N0.FEE CHARGE NN FFF THAACF NO FFF CHARGF
Each single fixture Residence of
FTSQ
furnace/burner to
BTU' s
Relocated bui ldinq
(new fix. additioial )
New circuits alts.
or extensions
Floor furnace
and vent
S. F. Residence(l bath)SERV ICES Recessed wal I
SDace heater and vent
Duplex (l bath) each
Additional bath Temporary Construction Apol iance vent
seDa rat-e
Ilater service e in existing
ence
Chang
resi d
Stationary evap.
cool er
Sewer muitifamily, cornm
I ndustri a i
0r Vent fan with
sinole duct
Storm Sewer 0f amps.Vent systern apart from
heatino or A.C.
COMI.I./IND. FEEDERS Mechanical exhaust
hood and duct
I n sta j I /a I ter/ re1 ocate
di stri h fcpdprc lrlood stove/heater
0f ampr
ISSUANCF OF PFRI,IIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAtl REQUIRES that the Electrical woshalI not be vali,l unti] the ]abel has been signed
rk be done by
by an Electri
' an Electrical Contractor, the electrical portion of t,his permit
cal Supervisor and returned to the Building Division
iHAvEcAREFULLYExAI\{INEDthe.completedapp1icationforpermit,anddohereb.vcertit@"iStrue
and correct, and I further certify that any and al'l work periormed shall be done in accordance with the Ordinances of the Cityof Springfield and the Laws of the State oi Oregon oertaining to the work described herein, and that NC 0CCUPANCY will be madeof any structure without the-permission of the Building Oiviiion. I further certify it,it r.v reqistration vrith the Builder,sBoard is in full force.and effect as required by ORS 701.055, that if exempt the baiii ior lxemption is noted hereon, and thatonly subcontractors and ernployees who are in comcliance with ORS 701.055 vrill be used on this oroject.
l,lAtlE ( pl ease pri nt S IGNATURE DA
Load Sq. Ftg. Access x Valuee"oup@sq. Ft;. n n"" @u ^rt"-ts*. --
llpFtg. l,la i x Valtone_;Vr{. lype/const. 5*.ts
Flood Plain Stories
Fire Zone Bedrooms.
Plan Ck. Conrn/Ind
65%/81dq Per Fee
Svsterns Deve'
Charqe ('1.5l'opmentBUILDING PERNIT
Charges and
Surcharges
&e-fea
PIan Ck. Res
30%/B1dq Per Fee
FencePLUI4BING PERMIT
Charges and
Surcha rges Dgmo
Sidewa l kELECTRICAL PERIlIT
Charges and
Surcha rges A/C Paving Total Comb. Permit
Curb Cut
HECHANICAL PERMIT
Charges and
Surcharges
at Zt
I,TAL i%q/E<r /o,@
{ l irc n^
ToTAL VALUATI0N_---
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot I00, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lender0. Energy Sources
l. exampl e-2. exampl e-
Square footag
l. example-.
2. exampie-
check add
heat/electrical cei I in forced airgas
wa ea e ec or solar
E e or valuat on
1250 sqif new
foot ,500s q. foot garage
proj ect,check-nEw if addition,, etcF. Bui)ding permit information:l. example - construct singie family house with an
attached garage
2. example - remodel existing garage into family room3. examp'le - convert single family residence into
iEsTiuFant (change of-use)G. Va'lue of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid desigr
Division Staff
n or construction delays, Building
must be able to contact a ppro
' job
pri ate
sitepersons regarding design information or
corrections, etc.II.Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and E'lectrical Schedules
are avai Iable at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label.must be dllivered{to the $
electrical contractor for signature by his electricalsupervisor. The general contractor is.not authorizedto sign the electrical label
Applicant to sign and date
I'lhenever possible, the initial applicat.ion will be used as
a worksheet only. l^lhere possible, Building Division Staffwiil prepare a type written copy and return it to theapplicant at the time the actuai permit is issued for his
s i gnature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due and
payable when the permit is issued.
FOR OFFICE USE ONLY
III
IV.
v
PERMIT VALIDATION
Permit CIerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit appl'icant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name ign ature ate /2-/2'*
t
SITE PLAN REVIEI.I DEVELOPI1ENT AGREEI,IENT
THIS DEVELOPT'IENT AGREEI,IENT, HeneINAFTER ,,AGREEMENT,,, IS ENTERED INTo THISBth DAy oF Mav , 1987 (TnE "EFFEcTIVE DATE") By AnD BETwEEN rHe CITYffi SPRINGFIELD, HEREINAFTER,,CITY,,, AND THE SITE PLAN REVIE}{ APPLICANT
HEREINAFTER "AppLIcANT", IN AccoRDANcE tvrrH Srcrton 31.090, Al.rD Secrlom
3.070G), 3.080(3), 3.090(3), AND 3.100(3).
REC ITALS
SIre Punru
A rrto sroRy cLASS Roo,r ADDrrroN To SpRtruerrem Frne SrnrtoN illj
LocATED et 1225 NonrH 28rn SrneET, SpRrr'rGFrELD, 0neoon.
hIHEREAS, IN coNSIDERATToN FoR Stre Pum AppRovAL, THE ISSUANcE oF A
Butlotrue PeRMtt, AI.ID THE ISSUANCE oF Ar'r 0ccupnrucy PeRmtt, AS spEctFIED IN THE
Spntnertelo Deveropmem Cooe SecrroN 31.090, Appltcnnr AGREEs ro cctr,lpLy wrrH
ALL THE STANDARDS oF THE Spnrmerrem DEvelopMENT Cooe nno SpRrruepreuo l'luurcrpRr-
Cooe hlFtIcH MAy BE AppLIcABLE To rHIS DEVELopMENT pRoJEcr, INcLUDING BUT r\llr
LIMITED TO, THE FOLLOWING:
1. A puBLIc STREET LIGHT sHALL BE TNSTALLED oN l'bnrn 28ru SrnEer.
THC FUNDING FOR THIS STREET LIGHT wILL BE THE oBLIGATIoN oF THE
cITY oF Spntruerreuo.
2. l,rlHet,t CenrerurutRu BourcvRno IS ExrEr\DED To rHE EAsr eruo/on
IMPROVEI4ENTS ARE REQUIRED AS A RESULT OF DEVELOPMENT TO THE SOUTH
THE CITY OF SPNTruETTEto SHALL PARTICIPATE IN ImPRoVEMENTS To
CErurerururRu Boulevnno.
WHEREAS, IN coNSIDERATIoN ron Srre Pueru RppnovAL, THE rssuAllcE oF A'Butlotne PenmIT, AND THE ISSUANCE oF AN 0ccupRrucy PeRMtr, As spEcIFIED IN THE
Spnlruertep DeveuopMENT Cooe SEcrroru 31.090, rHe Crw AGREES To cotvlpLy wrrH THE
FOLLOWING SPECIFIC CONDITIONS AS PART OF THE STTE PUru RPPROVAL:
WHEREAS, oN rHE 2ruo
AppltcRrroN SUBIVTITTED By rHE
1. FINAL SITE PLAN.
AccoRDANcE wrrH Secuoru 31
wrrH THrs Aeneemerr.
DAY oF APRTL, L987, rne Crw APPRovED
ApplrcRt.tr FoR THE puRposE oF ALL0wING:
1. TNE TRAINING TRAILER EXIsTING oN THE PRoPERTY SHALL BE REMoVEDpRIoR ro Ftt'rRr- 0ccupaucv oF THE cLAss Roo[ FAcILITy.
..,^--NAl.l I|:|EBEEOBE_-IN_ EOIISIDERATION OF THE FOREGOING RECITALS I.IHICH ARE
EXPRESSLY I-IADE A PART OF THIS AGnETTffi,-THE'CITy AcREES As TO[TowSi
AGREEI'IENT
_THe npplrcAllr AcREES To suEmrr e Frruer- Srre Pl-Rn lu.080 or rne SpnlruGFrELD Deveuopmerur Cooe cor.rcunneruruv
Stre Puru Deveuopmrur Aeneerqerur
1
2. STANDARIS. THC APPLICA{T AGREEs To FULFILL ALL APPLIcABLE STANDARDs
SPEC-IEIED IN THE Spntnerteu DeveloptvrENT Cooe nruo rHE spEcrFrc sTANDARDS LTsTEDIN RECITALS PRIOR TO OCCUPANCY, UNLESs cERTAIN sTANDARDs HAVE BEEN DEFERRED To4 LATER DATE IN AccoRDAt{cE wrrH Secrroru 31.110 oF THE SpRlnerrem DevelopMENT
Cone.
3. C0NDITI0NS. Tue Appt-tcANT AGREES To FULFTLL ALL spEcrFrc coNDrrroNs0F APPRovAL REoUIRED By rHE Ctw lrsrED rN RECITALS pRroR To occupANcy, uNLESS
CERTAIN CONDITIONS HAVE BEEN EFERRED TO A LATER DATE IN ACCORDANCE WITH
Secrroru 31.110 oF THE SpRrruerreu DrvelopMENT Cooe.
- 4: I'IODIFICATI0NS. THe AppLIcANT AGREES Nor ro r,toDrFy rHE AppRoveo Frruar-llre Plnn wITHour FIRST NorrFyrNG rHe Crry. wloolrlcArroNs io rne rir'rnr- SirE
Plnru sHALL BE REVIEu,ED IN AccoRDANcE wrrH Secrroru 31.100 or ue-spnirueriir-o
DEveuopmem Com.
5. I{AINTAINING THE USE. THe nppltcANr AGREES ro rHE FoLLowrNG:
(R) THe sutt-olNc AND sITE sHALL BE I,IRTNTATNED IN AccoRDANcE wITH THE
PRovISIoNS oF THE Spntruertem DeveuopMENT Cooe tn oRDER To coNTTNUE THE usE.
(s) Ir sHALL BE THE coNTINUING oBLIGATToN oF THE pRopERTy owNER To
I'IAINTAIN THE pLANTING REoUIRED By Secrtoru 31.140 oF THE SpRrruerrelo DevelopmENTCooe IN AN ATTRAcTIVE IIANNER FREE oF wEEDs AND orHER rrwADrNG vEeeinrioN. -iN
ADDITION, PLANTINGS IN TI{E VISION CLEARAT.ICE AREA SHALL BE TRIIVIV1ED TO MEET ME 2L/2 Foor HEIGHT sTAIIDARD rN AccoRDAucE t,trrH Secrroru 32.070 oi rHe SCniruoriEuo
Developmrrur Cope.
(c) PRnrlruo Lors sHALL BE IVIAINTAINED By rHE pRopERTy owNER oR TENAftrIN A CONDITION FREE OF LITTER OR DUST, AND DETERIORATED PAVEMENT CONDITIONS
SHALL BE IMPROVED TO f"IAINTAIN CONFORMANCE WITH THESE STANDARDS.
(o) UnoevelopED LAND wITHIN THE DEvELopMENT AREA sHALL BE MATNTATNED
FREE 0F TRASH Al,lD STORED MATERIALS Il'.1 A I'lOy{ED p0,lD ATTRACTIVE I'lAl'tNER.
UruoevelopED LAIID sHALL Nor BE usED FoR pARKTNG.
6. Iru ADDITION TO ALL OTHER REMEDIES I,{TIICH MAY BE PROVIDED BY LAW OR
EOUITY ( TruCIUOTI'IG BUT NOT LIMITED TO PENALTIES PROVIDED BY APPLICABLE STATE ljwoR cITY oRotrueHces) Appt-lcRnt AGREES THAT Ctry MAy ENFoRcE Appr-lcnr,rf's
RESPONSIBILITIES BY WITHHOLDING OR TERI4INATING AppI-TcRnT,S OccupANcy PeRmIT.
- 7. Due ro THE uNcERTAINTy oF FUNDING FoR THrs pRoposAL, rHe FtruRl Strc
PUAN SHALL REMAIN VALID UNTIL SUCH TII'IE ns STaToRRDS IN EFFECT AT THE TII,IE oF
THIS AGREEMENT cHANGE. Ir SrerupRnos oF DEVELopMENT cHANGE A NEt^t sITE pLAN wrLL
BE SUMITTED WHICH REFLECTS SUCH CHANGES.
Srre Puru DevelopmeNr Aeneemet'lr
2
IN IdITNESS }'IHEREOF, THE APPLIcANT AND THE CITY HAVE EXECUTED THIS AONCEMEHT RS
OF THE DATE FIRST HEREINABOVE WRITTEN.
APPLICANT
May 8, l9B7
DnrE
STATE 0F OREGON, Couruw or Lane
Ma v I 198 7
Ronald P. LeBlanc
DonaId Herschel
BE THEIR VOLUNTARY ACT. BETONE ME:
FOR
I'Iy ComTssIoN EXPIRES / ?8?
CITY
BYMay B, L9B7 NISTRATOR
nArE
STATE 0F OREG0N, CourlrY or Lane
It{a 8 198:_: Pensoueu-y AppEARED THE ABovE NAI4ED
Gregory Winterowd WHO ACKNOWLEDGED THE FOREGOING INSTRUMENT TO
BE THEIR VOLUNTARY ACT. BCTORE ME:
FOR
lilv Col'tmrssroN ExPI
Srre Pmn DevruopmeNT AcREET4ENT
3
BY:
BY:
PERsor,rRr-ly AppEARED THE ABovE NRtqED
WHO ACKNOWLEDGED THE FOREGOING INSTRUMENT TO
€
p)5 N'2b
?
(""r.THIS DEVELOPT'IENT8th DAY OF
OF SPRINGFI
SITE PLAN REVIE}I DEVELOPI'IENT AGREEI.IENT
HEREINAFTER
,,AGREEMENT,,,
VE DATE,,) gY(*te "Errectt
IS ENTERED INTO
AND BETWEEN THE
THIS
CITYMA
(,i
HEREINAFTER ,,CITy,,, AND THE SITE PLAN REVIEI,,I APPLICANT
HEREINAFTER "AppLIcANT", IN AccoRDANcE vttrH Secrton 31.090, Al,lD SEcrton
3.070(3), 3.080(3), 3.090(3), eno 3.100(3).
REC ITALS
I,IHEREAS, oN THE 2no DAy oF ApRrL, 1987, rHe Crw AppRovED Stre Puen
ApplrcertoN suBt'lrrrED By rxe ApputcANT FoR THE puRposE oF ALLOWING:
A rt,lo sroRy cLASS Rofi ADDrrror{ To Spntruerrem Frne Srarton #3
LocATED N L225 Nonrn 28rH Srnerr, SpRII'TGFIELD, 0neeon.
hIHEREAS, rN coNsrDERATroN FoR Srrr Pun AppRovAL, THE ISSUANcE oF A
Butr-otne PeRmtr, Ar.rD THE ISSUANcE oF AI'r 0ccupRttcv PeRmtr, AS spEcrFIED IN THE
SpRrr{srreLD Developmem Cooe Secrroru 31.090, Appurcnnr AGREES To cgvlpLy wrrH
ALL THE STANDARDS oF THE Spnrnorrem IEveuop[,rENT Cooe nno Spnrnerreuo l'lunrctpRr-
Com h[llcH MAy BE AppLIcABLE To rHIS DEVELopMENT pRoJEcr, INcLUDING BUT Nror
LIMITED TO, THE FOLLOWING:
1. A puBLrc STREET LrGHT sHALL BE TNSTALLED oN l'bnrH 28rH Srneer.
THe FUNDING FoR THIS STREET LIGHT wILL BE THE oBLIGATIoN oF THE
cITY oF SpRtruorteup.
2. l,'lHeu Cerurcrururer- Bourcvnno rs ExTENDED To THE EAsr eno/on
IfVIPROVET4ENTS ARE REQUIRED AS A RESULT OF DEVELOPMENT TO THE SOUTH
THE ctry oF Spntruertem sHALL pARTIcTpATE IN IMpRovEmENTS To
CerurelrN rnu BoulevRno.
WHEREAS, IN coNSIDERATToN ron Stre Puru RppnovAL, THE rssuAncE oF A'
ButuorNe PeRmtr, AND THE ISSUANcE oF Alq 0ccupnrucy PeRMIt, AS spEcIFIED IN THE
SpnrNorteup DevzuopmENT Cooe Secrron 31.090, rne Crry AGREES To cotvlpLy wrrH THE
FoLLowrNG spEcIFIc coNDrrroNs As pART oF THE Stre Pueru RppnovAL:
1. TnC TRAINING TRAILER ExISTING oN THE PRoPERTY SHALL BE RE,'lovED
pRroR ro Frntr 0ccuperucv oF THE cLASS Roq{ FAcILITv.
NOI'I THEREFORE IN CONSIDERATION OF THE FOREGOING RECITALS I,IHICH ARE
EXPRESSLY I'IADE A PART OF THIS AGREE''IENT, THE CITY AGREES AS FOLLOWS:
AGREEr'lENT
1- FINAL SITE PLAN. THe AppLICANT AGREES To suEirvrrr a Frruru- Srre Punm rr,r
ACcoRDANCE wITH Secrrou 31.080 oF THE Spnrruorrem DevruopMENT Cooe corucuRRENTLy
wITH THrs AoneefieNT.
Srre Punru Devzuopmetlr AoReemrnr
1
,
C
e
(.,,
2. STANDXRDS:-. INC APPLJgruI AGREE. To FULFILL ALL APPLI.ABLE STANDARDS
ii','{Eii?^l$ Ilirl'+i'35J5r?-3ivefleNr-co# nru9-*rE-siEErirb'srnruoaRDs LrsTED
8.,!a;ui"iirE"r* eccononvbl..';iir'i!ffi.f iiiiio'#-ifiE'8#fl5 #il"BE EISFil.i?
3' c0NDITIoNs' Tne App.t.ANT AGREE' ro-E..,lFrLL ALL spEcrFrc coNDrrroNSOF APPROVAL RESUIRED AY TiE CITY I-TSTCO iI'r-NECITALS PNrON-TO OCCUPNruCY, UNLESSCERTAIN CONDITIONS I-4VE BEEN EFERRED TO A LATER DATE IN ACCORDANCE WITHSecnoru 31.110 oF THE SpnrrueFiero-DeveloFmeni cboe.
^ 4: I'I0DIFICATIONS. Tne nppltcANT AGREEs Nor ro r,toDrFy rHE AppRoveo Frruelltre Plm wlrHour FIRsr ruorrrvilra inr'ciry: "fiooiirCiiibms'fi iHt FiNAL'S;rE
Puqru sHALL BE REVIEu,ED IN AccoRDAr'rCe wiri SediioH-ji:ioij-oi-rxe-spnii,rEriiip
DEvelopmerur Cox.
5' IIAINTAINING THE USE. Tne nppltcANr AGREEs ro rHE FoLLowrNG:
(R) THe^gull-oING AruD sITE sHALL BE I'IRTNTATNED rN AccoRDAr\cE wrrH THEPROVISI0NS 0F THE SpRtruertelo DevelopMENT Cooe rru oRDER To coNTTNUE THE usE.
(g) Ir sHALL BE THE coNTINUTNE oBLTGATIoN oF THE pRopERTy owNER To
{AINTAIN THE PLANTING REQUIRED BY SECTIOn 31.140 oF THE SpRlruerler-o UeveloFmerIiCoue IN AN ATTRAcTIvE MNNER FREE oF wEEDs AND orHER rrwADrNG vEeeinrior,r. -i;
AD.DITIoN, PLANTINGS IN THE VISION CLEARATICE AREA SHALL BE TRIIVIVIED TO MeET THe 2ll2 Foor HEIGHT sTAruDARD rN AccoRDANCE wilr Seciior,r-li:oitj-bC rHi-spdNGiiEL;
UEVELOPMENT UODE.
(c) PRnxtrue Lors sHALL BE I'TAINTAINED By rHE pRopERTy owNER oR TENANTIN A CONDITION FREE OF LITTER OR DUST, AND DETERIORATED PAVEMENT CONDITIONS
SHALL BE IMPROVED TO MAINTAIN CONFORMANCE WITH THESE STANDARDS.
(o) UruoevelopED LAnD wITHIN THE DEvELopt'rENT AREA SHALL BE TVTAINTAINEDFREE OF TRASH AIIID STORED MATERIALS I].,I A Irct,{ED AT.ID ATTRACTIVE IVIAI{NER.UruoevelopED LAI{D sHALL Nor BE usED FoR pARKING.
6. Iru ADDITIoN To ALL orHER REMEDIES h,r-rlcH MAy BE pRovrDED By LAr^r oREQUITY ( tttct-uolttc BUT Nor LIMITED To pENALTIEs pRovIDED By AppLIcABLE srATE t-At,t0R ctrY oRolNRruces) Appt-tcRnr AGREES THAT Crry MAt eilroncr-Apiir'inrui,'s
RESPONSIBILITIES BY WITHHOLDING oR TERIVIINATIno AppI.TcANT,S OccupRlIcy PeRMIT.
^ 7. Due ro rHE uNcERTAINTy oF FUNDING FoR THrs pRoposAL, rHe Frual StrePlRru sHALL REMAIN vALID uNTIL su+r rrme-ed-srnruoARDs IN EFFECT AT THE TrME oFTHIS AGREEMENT CHANGE. IT STEruORROS OF DEVELoPMENT cHANGE A NEw SITE PLAN WILLBE SUBMITTED WHICH REFLECTS SUCH CHANGES.
Srre PueN DevElopmerur Aoneemerur
2
('t'
(
l'
l .i:rt..; ::
\-:,:/
(^..1
IN UIITNESS \^IHEREOF, THE APPUTCRTIT A}.ID THE CITV HRVE EXECUTED THIS AGREE}'IENT AS
OF THE DATE FIRST HEREINABOVE WRITTEN.
APPLICANT
May 8, 1,987
Dere
STATE 0F 0REG0N, Couruw or Lane
Ma B 198 r_.
Ronald P. LeBIancDonald Herschel
BE THEIR VOLUNTARY ACT. BETORE ME:
BY:
BY:
PensouRlly AppEARED THE ABovE NArvlED
WHO ACKNOWLEDGED THE FOREGOING INSTRUMENT TO
--
ARY
IVIy CoruIsSIoN ExPIRES / ?8?
C ITY
May 8, 7987 BY:
INISTRATOR
Dnre
STATE 0F 0REG0N, CoullrY or Lane
Ma B 198 j_. Pensoruru-y AppEARED THE ABovE NAvtED
Gre Winterowd WHO ACKNOWLEDGED THE FOREGOING INSTRUI',IENT TO
BE THEIR VOLUNTARY ACT. BETORC ME:
FOR
Ilv Cot+lrssroN ExPIRE
Srre PlRru DEveuopmeNT AGREET'IENT
3
FOR
(
?
C
-t t,ATTACHMENT F
SPRINGFIELD
CITY OF SPRINGFIELD
A}IEUIJNCE VEHICLE INSPECTIOII REPONT
VEH ICLE HOUSII'IG ANO CRE/ QUA RTER,S STi.IIOAROS
DATE: 3'%-*'n
A}'!sULAIICE CCI4PA\Y:
Business Name:SPRINGFIELD FIRE & LIFE.SAFETY DEPARTMEHTONE : 726-3737
Hail ing Add:-ess:225 NORTH sTH STREET
( 5 t reer/Ap r.# )
SPRI NGF I ELD 0R 97477 7?6-3737
I vEi{ICl_E t{ousI}tc
Any ambulance
I ts amcu'l ance
lnrornaiion iby f i'li ing ou
Ly/ Sia,-et P)Phone
service licensed with the City of Springfield is required to housevehicles in a heaied anc secu:'e gf,rage. ptease cc:::ciete then sec:icns A-0 ano inc:cgte ccnpiiancc wi-th tha requiremen:: sec--i on E ( DEC i S iCl{) .
A. LO:;iICII OF GARAGi:
1225 NORTH 28TH STREET
(ScreerT'Api;)
SPRINGFIELD, OR 97477 726-3737
(CltyzS tareZZi p)P(hone )
B. NUI4sE,]. OF AM BULINC= VE:iI CLES HOUSEO 'AT THIS LOCATICI{:
c.E}ITITY OF AHSUIj}IC VEI-IICLES HOUSED AT THIS LCCATIO}{:
I. I'IAKE/MODEVYEAR OF VEi{ICLE:
LICE}{SE PI-{TE NUMSER.:
2. I'{AKE/MODEL/YEAR OF VEHiCLE:
LICE}ISE PI-ATE }IUI48ER,:
3. HAKE/MOOSL/YEAR OF VEHICLE:
LICANSE PI-ATE NUMBER:
3/86 . Pagelof3
t
CITY OF SPRINGFIELD
AI'I8UI-ANCE VEHICLE INSPECTION REPORT
DATE: 9 2C-a
SPRINGFIELD DEPARTMENT OF FIRE & LIFE SAFETYAI,IBU [.{NC E CO.\IPAIIY :
4. HAKE,/i'|0DEVYEr\R 0F VEHiCLE:
LICENSE PI.ATE NU|,IBE.? :
5. I'IAKE/MODEVYEAR OF VEI.{ICLE:
LICENSE PI.AIE NUiIBER,:
c. cOlaP'- IAilC3:
HruT ap/oE
fiEtTere,
VEi.iICLE HOUSING YE5 NO CC;,:HENT
i re the amou i ancs yen c es houseo
ln a heated garage?
z Are the amouiance ventcies rrousecln a secure garage?
D. OECISIOII:
Acceprabl e.
Acceptable, wlth minor discrepancies to be corrected anci
lnspec-,ed by this date:r Not acceptable, with discrepancies to be cor:^ected and
lnspected by this date: .
ADDITIOIIAL CC|4MENTS :
n sPectl onerononoucil n e n sPect I on teo
3/86 Paqe 2 of 3
$,:26-8o
a
II.RFi UAR
CITY OF SPRINGFIELD
AiqEUI-ANCE VEHICLE INsPECTION REPORT
OATE g-za -8C
AI'IBUL\NCE Coi,lPANY. SPRINGFIELD FIRE & LIFE SAFETY DEPARTMENT
STAi{OAROS:
service licensed by the.'City of Springfield is required to pro-rters that conforn to the standarde set forth in the current'ing Code for resiCentf al occupanc: es (Cwei l ings). PI ease
information in section A and indic:te cc;roliance wlth they fi'l1ing out sec',ion B (DECISI0II). Please attach ccpies'.ion forns used by the Bui idi ng 0i vi si on to determine com-
A. LOCATiCiI OF CRN/OUARIEP.S:
Any ambu I anc'e
Yide crew qua
Uni form Bui ld
conplete the
requi rement bof any inspec
pl iance
Streec
(c i'"y /S taiez Z'i p )(Phone)
B. DECISiCI,I:
Acceptabl e.
Acceptable, with minor dlscrepancies to be corrected anC
lnspected by this date: .
Not acceptab'le, with di sc:'epanc: es to be corrected and
lnspecteci by this date: -
AOC ITIO}IAL CCIA!!EIITS :
ft'%-gCffir5no:ductt n lne nspectl on
3/86 Page 3 of 3
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/ATTACHMENT F --. -. i
SPRINGFIELD
CITY OF SPRINGFIELD
AfiBULTNCE VEHICLE INSPECTION REPOI1T
v EHICLE HOUSIIIG ANO CRE/ OU ARTEiS ST/..I'IOARDS
DATE:
AI4gU LANC: CCi,IO,.1 I{Y
Eusiness llane: Sorinqfield Dept of Fire & Life Safety Phone: 726-3737
#ga7v?
Ha i 'l i ng AdCres s :Street
q c:-eer,zApi.#
field 0R 97477 726-3737
hon e,)t t'1t S La ."e./i p)
I vtr:.I ? nr 3 unt tc;rs- i rv!v -r l\::
A. Loc;iicll oF L:,1d.,\ria:
Any ambu'lance senrice 'ticensed ';i'.h the City of Springf ield is required to houseIt: amcujance ven:cles in a hea:ec and sec'r:-e g3raqe. Piease cc;cjeae theln;or;aiion in sec:ions A-'-r anc inc:c:re ccncii"n.i wi-th ihe ;.equireren-,by filling ou: sec--.:on E (DEC:Sicti).
reet
t, i'e e c./ Ao; .
fi R 97477
'.y / S:.ate/ip
I 726-3737
(ne)
B. NUl4 9=p. 0F AMgULr.l,lc:VEii I CI-=S HOU S ED AT TH ! S LOC.."TICII :
C. IDE}IIITY OF AMgULAIIC = VEI]ICLES HOUSE.] AT THIS LCCATIC}{:
1- MAKE/I'40DEVY9{R 0F VEi{ICLE: Ford-Econot ine XL 1981 #839
LICEIISE PI,AIE NUt",lsER,: E1 4gOZg
2. I'IAKE/MODEL/YEAR OF VEHICLE:
LICENSE PTJTE IIU|,IBER:
3. HAKE/},,IODEL/YENR OF VEHICLE:
LICENSE PIJ.,TE }{UHBER:
3/86
Page 1 of 3
1
CITY OF SPRINGFIELD
A.'VIBUI.ANCE VEHICLE INSPECTION REPORT
DAIE:
AIIBULANCE C0}IPANY: Sorinqfield Department of Fire & Life Safetv
4. MAKE,/i'l0DEL/YE/lR 0F VEi-lICl-E:
LIC:NSE PIIIE NUII9SP. :
5. HAKE/I4ODEVYENR CF VEi{ICLE:
LICEIISE PI.AIE NUI,I9EP. :
C. CCIAP'-IAIICS:
VEiiICLE HOUSi}JG YE5 NO ^^tarr-rr-L\,,tr',,'ltrt I I
Are
ln a
the arncu iance vent c
heatec garage?
es nouSeo E/4ffi
Heqrxx
2 re the afii:ou tance vena secure garage?
e5 nousec
ln L'/
O. OECISICi'I:
Acceprabi e.
Acceotable, with minor di sc:'epancies to be correct.ed anolnspec:ed by rhi s date: *pltL ^t /?or
Not acceptable, with di
lnspec.,ed by thi s date:
sc:'epanc*es to be-csrrected and -- ---
ADDITIO}IAL CCIAYE}JIS :
o
2, RfurytmzuD 670l alrW tD'
3
peccl oner50nono!'t ng rhe n spect I on ate ot i
3/86 Page 2 of 3
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--/
:a'/CITY OF SPRINGFIELD
AJ'IEULAIiCE VEi"IiCLE INSPECTION REPORI
OATE:
AI'I8UL\NCE C0MPANY: Springfield Department of Fire & Life Safety
I I . CRt'' CUAaf ERS STrtilD.{R0S :
Any ar:rbulance service licen:ed by the.City of Sprtngfield is requtred to pro-
vide crew quar+.ers that conforn to the standard: set for',h in the current
Uniform Building Code for residential occupanc;es (C.rellings). Please
comp jete the infor;rat'ion in section A and indicate ccmol iance wlth the
requirement by filling ou: sec:ion B (DECISIOil). Please attach ccpiesof any inspec'-ion forns used by the Buiiding 0ivision to deternine ccn-
pl i ance
A. LOCATICIJ OF CP.3.i OUiRTIP.S:
( S ire et,zAp -..; )
(Ci'-yr StarezZi p)(Phone,l
B. DECJSiC}{:
Acceptab) e.
Acceptable, with minor discrepancies to be corrected anC
I nspec'ued by thi s date :
Not acc=ptabje, !/ith disc:-epancies to be ccrrec:ed and
{nspecteo by this date: _
AOD ITIONAL CCI''IYE}{TS :
S/za /Er-0ate'of iispe-cronerson Co:3 t,1 ng the nsp on
3/86 Page 3 of 3
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CITY OF SPRINGFIELD
AI'IBUIJNCE VEHICLE INSPECTIOI{ REPORT
vEr-{ICLE HOUSIIIG ANO CRE/ OUARTERS STANDAROS r'
OATE:6
gf ield Fire &'Life Safety phone: (503) 726-3737
{D
AI,ISUI-qNC: CC:4PANY
Business Name: Sprin
Hai'l ing Address:225 North 5th Street
(S r:'eec/A Pr.#)
Springfield, 0regon 97477 7 26 -37 37
(c i ty t SLz-v?/L iP)( Phon e )
I. VEIIICLE HOUS I}IG:
A. LOCATICX OF (:r\r(AL:C:
1225 No rth 28th Street
Any ambuiance service Iicensed wfth the City of Springfield is required to houseIts ambulance vehicles ln a heated and s.cur" g3rage. prease cc::ioiete thelnfornation in sec:ions A-0 and indicate ccmpiian." with the requirementby fllling out sec:ion E (DECiSICN).
treet./Apt.
B. NUI4SER OF AMBULqNCE VE}{ICLES HOUSED AT THiS LOCATICII:1
c OF AMBUI-ANCE ICLES }IOU AT THIS LOCATION
1. I'1AKE/MSDEVyEAR 0F VEHICLE: 1978 Ford Braun Type III
LICENSE pt-ATE NUMBER: E 149005
2. I'{AKE/MODEVYEAR OF VEHiCLE:
LICENSE PI.ATE NU|,IBER:
3. HAKVMOOEL/YEAR OF VEHICLE:
LICENSE PTATE NUMBER:
/85 Page 1 of 3
Springfield, Oregon 97477 726-3743
/qbs
CITY OF SPRINGFIELD
AI'IBUIJNCE VEHICLE INSPECTION REPORT
VEHiCLE HOUSING AND CRF,/UARTERS STr1N0,\R0S
OATE:
AHSULqNC: CCI4PANY
Eusiness Narne: Springfield Fire &'Life Safety phone: (503) 726-3737
Hai'l ing Address:225 North 5th Street
s*
( 5 r:'ee c/A ps.#)
Springfield, 0regon 97477 726-3737
(Ci tyt S catet Zip )(Phone,;
I vEi{ICi-E !.{0USi}tG:
Any ambuiance semice l icensed wf th the City of Springf ield is required to houseIts ambuiance vehicles in a heated and secu:-e g3rage. Please ccnoiete +-he
lnfornaiion in sec:ions A-C and 'indicate ccnpiiance with the requirementby flliing out sec'-ion E (DECISICN).
A. LOCATICX OF GARAG
1225 North 28th Street
( Streel/Ap r.#)
Springfield, 0regon 97477 7 26 -37 43
(Cl tylS tate/Zi p)
B. NUI,ISER OF AMBULqNCE VEi{iCLES I{OUSE D AT THIS L0CATICII: 1
C. IDENTITY OF AI4BUI-ANCE VEHI CLES HOUSED AT THIS LOCATION:
( Phone )
LICENSE PTATE NUHBER: E I49OO5
2. I'IAKE/MODEVYEAR OF VEHICLE:
LICENSE PI-ATE NU!4BER:
3. I'IAKVHODEL/YEAR OF VEHICLE:
LICENSE PLqTE NUMBER:
2/85 Page 1 of 3
\
1. HAKE/MSDEL/yEAR 0F VEHICLE: l978 Ford Braun - Type IIi
CITY OF SPRINGFIELD
AHEULANCE VEHICLE INSPECTION REPORT
DATE:
AJ'IBU I,-ANC E COiYPAIIY :
4. I',IAKE/I4ODEVYEAR OF VEi]ICLE:
LICENSE PI.ATE NUI4BE.?:
5. I'IAKE/MODEVYEAR OF VEi{ICLE:
LICE}ISE PI-AIE I{UTIBEP. :
c.CCI4P LIAI'ICE:
VEiiICLE HOUSIiiG YES NO CCi,iMENT
I Are the amouiancs venrcles houseoln a heated garage?ELea it,{d-'
te\76<.3
2 Are the amouiance venicies nouseoln a secure garage?
D. OECISION:
w
tr
tr
Acceptabl e.
Acceptable, w{th minor disc!'epancies to be corrected and
lnspected by this date:_
Not acceptable, with discrepancies to be corrected and
lnspected by th{s date: _
ADDITIONAL COMMENTS:
ffiPerson Conou-tt@n
2/85 Page 2 of 3
. CITY OF SPRINGFIELD
A}IBUI-ANCE VEHICLE INSPECTION REPORT
OATE:
AI'IBUI-ANCE COMPANY:
II. CIIF,{ CUARTERS STAIJDARDS:
Any ambulance service licensed by the.City of Springfield is required to pro-
vide crew quarters that conform to the standarCs set forth in the current
Un'iform Building Code for residential occupancies (dwellings). PIease
complete the inforrnation in section A and indicate compliance wlth the
requirement by fi 1 1 ing out section B (DECiSi0ll). P1 ease attach ccpies
of any inspect,ion forms used by the Bui'lding Divi sion to determine com-
pl i ance
A. LOCATIO|I OF CRF..I OUARTE.?.S:
(5treet./Apc.#)
( C i tyz Sta :.e/Zi p )( Phone )
B DECISION:
w Acceptab'le.
Acceptable, with minor dlscrepancies to be corrected and
lnspected by this date: .
u Not acceptable, with discrepancies to be corrected and
Inspected by this date: .
AOOITIONAL COMMENTS:
q/r-q/*,s
0atd/of Vnspectione rson uct )ect on
2/85 Page 3 of 3