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Home My WebLink AboutPermit Demolition 2004-02-23Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-00211ISSUED: 0212312004 APPLIEDz 0212312004 EXPIRES: 0812312004 VALUE: SITE ADDRESS: 980 28TH ST ASSESSOR'S PARCEL NO.: 1703361100800 PROJECT DESCRIPTION: Demolish existing residential building Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Demolition Residential License Expiration Date Phone Owner: Address: LIVING STONES CHURCH 942 28TH ST SPRINGFIELD OR 97477 Contractor Type Contractor TION )RMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: %o oflot Coverage: N:Oreg on iaw requtres you tu Sidewalk Type: Downspouts/Drains: adoPted by the Oregon UtilitY NOTICE: THIS PER MIT SHAL L EXPIRE IF Notes: 'lotification Center' r' h ose rules are set for AUTHORI ZED UNDE 952-001-0010 th rough oAR 952-0C c090 ou may 1BO DAYcalling the center (Note REQUIRED PAR]flNG Total: Handicapped: Compact: THE WORK Storm Sewer Available: Special Instr0f,tfrH I'i T I O follow rules R IHIS PER MIT IS NOT N ED FOR nutnber for the Ore gon util Square Footage or Bid Amount PERIOD a2-$ Per Sq Ft or multiplier Total Value of Project Pase I of 2 DEVELOPMENT INFORMATION PUBLIC IMPROVEMENTS Description Type of Construction Value Date Calculated Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-00211ISSUED: 0212312004APPLIEDz 0212312004EXPIRES: 08/2312004 VALUE: Fee Description + l0o/o Administrative Fee + 1oh State Surcharge Demolition Sanitary or Storm Sewer Cap Total Amount Paid Amount Paid $9.00 $6.30 $45.00 $4s.00 $105.30 Date Paid 2t23t04 2t23t04 2t23t04 2t23t04 Receipt Number 1200400000000000237 1200400000000000237 1200400000000000237 1200400000000000237 Plan Reviews To Request an inspection call the24 hour recording at 726-3769. All inspection 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. 1 Demolition: After demolition is complete, sewer is capped or septic is pumped and filled and inspection is requested and approved, and all debris is removed from the site. 2 Sanitary Sewer Cap: Capped within five (5) feet of the property line and capped with an approved material as required by the code. Reouired Insnect lr</8/rw Owner or Contractors Signature Pase2 of2 Date r ees raro I By signaturer l 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 701.005 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 plans will remain on the site at all times during construction. /zs/4 s ffm wsrmffi ffi #r? fmf $ery-r##sr dm s Living Stone Church 942 N.28th street Springfield , 4R 97477 October 6, 2003 K-563 Re. Asbestos Survey for the house located at 980 N. 28th Street Springfield, Oregon. At your request, KOOS Environmental Services, lnc. (KES) _conducted^a survey for asbestos in ine house located at 980 N. 28th Street Springfield, Oregon on September 16, 2003. The survey found the building contained asbestos in the Top Layer of white tile located in the Kitchen and living room, the middle layer of sheet vinyl in the Kitchen and the bottom and middle layers in the hall. No other asbestos was detected during this survey. . Backgroundinformation The building was constructed as Single family dwelling 1940's. lt had been used as a private residence until it was vacated and left empty for a long period of time. The structure is currently empty awaiting demolition. This survey was conducted in preparation for demolition. o Building description The building is about 1260 square feet total living area. lt is wood frame, post and beam foundation, gable roof, on a single floor. The siding has been removed; three tab roofing. The interior walls and the ceilings are wood framed with sheet rock and surface texturing. Floors are wood and covered with Tile, vinyl and carpeting. The ceilings throughout the house had popcorn style surfacing material that had been removed prior to the survey. o Surv€y methodology The survey was conducted in accordance with the sampling protocol in 40 CFR 763.86. There was no attempt to breach any covered or inaccessible areas. The classification of asbestos are as used in the AHERA standards, either SM (Surfacing MateiaD, TSI (Thermal Sysfem lnsulation), or MBM (Miscellaneous Building Mateiat). Each is further characterized as either friable or non-friable. The condition of the ACM (Asbesfos Containing Mateiatl is further indicated, as is the potential for future disturbance. Each assessment is divided into the respective functional space they are found. The analysis of the suspect material has been done in a laboratory accredited by NIST (National lnstitute of Standards and Technology) under NVLAP (National Voluntary Laboratory Accreditation Program). The primary identification will be PLM (Polarized Light Microscopy) using EPA 600/R-93/'116 method, the current accepted standard for bulk analysis of asbestos containing material. P. O. BOX 4068. COOS BAY. CIR 97420 Fntrclne {br€i ?tjfi-*5,,<i Faz: i6;tf } 3fr$-ff72f E-mail koosenv@harborside. com - re Asbest'ty's sur'rey ggs nr. Zgtft sfreet springfie*, oR gr4TT 17 samples were taken from the various suspect materials inside and outside of the structure. o Asbestosidentification Our inspection found no asbestos containing SM or TSI in the building, but found asbestos containing MBM (miscellaneous building material), in the various room floor coverings. SM None found TSI None found MBM Tile. Kitchen (2 layers) Living room (1 layer) Hall (2 layers) Description: Condition: Potential for Disturbance approx 136 sq ft approx 394 sq ft approx 50 sq ft Friable ACM 2lo 30o/o Chrysotile Damaged and loose high There was no evidence of random pipe insulation or insulation that would normally be suspect for asbestos content. Recommendations It is our recommendation that the ACM be removed prior to demolition of the structure. This would be considered a friable abatement due to the type of material in question, DEQ category A (which includes single family residences). o Cost Abatement cost for asbestos miscellaneous building materials usually run about $7.00 to $8.00 per square foot, depending on the size of the project. I would expect to see bids in the area of $3,250 to $3,750 for this project, depending on the contractor, disposal costs, equipment requirements, labor rates, etc. Any contractor used should meet the minimum OR OSHA requirements for working on an asbestos abatement project, specifically the respiratory and training requirements. A good way to insure compliance is to ask for both an OR CCB and an OR DEQ Contractor Abatement License - AshesU* Survey $SS N. ZSth Street $pringfia._-, CR gy4TZ . Other Although we did not test for it, there is also a likelihood of lead based paint presence. . Supportinginformation Survey Firm: KOOS Environmental Services, lnc P.O. Box 4068 Coos Bay, OR 97420 Phone 541 266-0511 OR CCB #: 135210/LBP OR DEQ #: FSC665 ORHD# 1153 Survey lnspector:Ken Newman, KOOS Environmental Service, lnc EPA/AHERA Building lnspector lD# 1005057 Laboratory:EMSL Analytical, lnc 382 South Abbot Avenue Milpitas, CA 95035 Phone 408 934 7010 NVLAP #: 101048-3 ELAP #:1620 Owner/Customer Living Stone Church Joe Williams 942 N. 28th SL Springfield , OR 97477 Survey Structure: Survey Purpose: Survey Dates Attached EPA/AHERA 1 005057 uilding lnspector Single Family Residence 980 N. 2gth St. Springfield, AR97477 For identification of hazards prior to demolition. Physical survey done September 16, 2003 Report completed October 6, 2003 Analysis by EMSL - 4 Pg Chain of custody for samples EMSL - 2 pg Expires May 6, 04 .],. -. ..i - j .; EMSL Analytlcal, lnc !01 South Atrbott AYenue' Mllpltaa, CA 95035 Phonoi 0JA.7010 Atn: Fax: Pro,ject: Kan Nounnen Koo3 Envlronmental P.O,Bor 4068 Coos Bay, Ot97420 (541) 266-8721 K-563 Eugone Demo Sample Popcorn ceiling Phone: (541) 266-0511 Cuotomcr lD: Customer PO: R.celvad. EMSL Orciel: EMSL Prolect lD; Analysir Oale: KOos50 o9/16/03 10:21 AM 0s0302850 gt22l2AO3 Aabeetos Analysis of Bulk Materialg vla EPA 600rR'93t116 Method using Polarized Light MicroscoPY NetrrAEhsuer Locetion App6ettncc TlErtnent % Flbroul A3bestoG Nons Detectod K-563-1 PC ogafi2gao-0001 K-563-2 ESV-VinYl 090fl?8il{002 Back entry Ehsat vinyl Tan Non-Fl&sua Wh[o Non-Fibroug Cruih6d Heated Crushed H6et6d Toased Cruahad Heated 2% Flbroue (other) 930/6 Non-flbrous (othE0 5% Celluloec t0% Synthettc 50% Ccllulose 4006 Non-llbrour (other) None Ootected 40o/o Non-fibrous (othao Hone Oot cted 10% Flbrouo (oth80 500/6 CelluloacK-56$2 ESV- Backing o0lil28ffi-O018 BacI entry 6haet vinyl Bl.c* Flbrous EMOL 6t 6l aonactmdtM8Lluil.in MnonMmoi.{b,vben6teE0pleoproYelrcp,oduced.may tho St {sU6ilcd Govamm6itofa0enoynor5nyAn6!y0crl,Th9 tbovo ThE ilpo.t uy HVLAP Bobo6toB6nl8lnlnBob€8too tctLdi(nmrlhsThcabdvgTEM, c!oh ffdGilementnolmuol@dbetnacrl6^l orcdu(l(08t by dslgclgd *rflld be Erted ellh Uon. Dotocted Cru6had 8% Collulose 92% Non-llbrouB (othor) K-563-3 SR-SR oggfr2,go-0003 K-563-3 sR-Jc Sh66lrock W joint White compound Non-Fibrous Sheetrock W ioint Whhe compound Non-Flbroua Crushed 5% Celtuloea 95% Non.fibrous (othel)None Detected 090302e6o-ool9 neoua 88% Non'fibroua (othe4 2% Chryeotlle Kitchen tile Kilchen lile Kltchen tilr Living room wall surfadng Wh'te Non-Flbmus Black Fibrous Y6llow Non-Fibrous White Non-Fibrou3 Cru6hGd Heated Teaaed Crushed Heated Teased Crurhed Heated Crushed Heated t0% ColluloseK-563-4 KFT-Tile ot0fi2t&.oN)1 K-563-4 KFT- Backing a9aio2taoJ,oao K-583-0 KFT- Maglic 0903028A04021 K.563.5 LVWS ocoiozs60oQ06 40% Non-fibrout (otheo l{one DetactEd l0o/o Flbrous (olhsr) 50o,( Cgllulom 3% Flbrouc (othcr) 2% Cellulose 3% Flbroua (othcr) 2olo Cellulote 95% Non-librous (olheO None Detected 95% Non-fibrous (other)None Deteoted Analyst(t) Etlc Rogen (27)or other oPProved 619natory a t Nonflbroua 1 EltlSL Anelytical, lnc !82 Soillh Ablott Avcnue, Mllpltai, CA 96035 EMS or'l 9a n0roalItmellAerPl..mrttton88PLMmownD t€n EMSLby00DmvEllomolartebove.6lotcebs6hNldThs1EM,cpod onlytostoddoloctcl,ol.i6tertndmu8tu!€0D6 lh9 clieot lo p.oducltbovrThDwAnBlyll€1, 934-70?0 Ken Ncwman Koog Enylronmcnlal P.O 8ox4068 Coos Bay, Or97a2O (541) 288-8721 K-663 Eugeno Demo Emoll: Phons: (54'l) 266451 I Cuatomor lD: CugtomGr Po Recelved: EMSL Ordar: EMSL Projcct lD Analysrs Datc: KOOS50 09/18/03 10:21 AM 090302880 9t22t2003 I Alln: Fax: Prolecl: Top laycr o9@a2ioo4ooi K.563.7 LVR SV. Vlnyl 2nd laYer oquozn6Goo?2 red sv Lrving room lloor red SV 9570 Non'fibrous (other) &Ies!s! l{onc E}etectcd Aebestos Analysis of Bulk Materlals via EPA 6O0rR-93r{16 Method u3ing Polarized Llght MicroacoPY Nco4rbeEloc Non-Flbrous Hoated 27o Cellulose Living room red SV floor Black Fibtou9 Cruehcd Heated Toased Cruehcd Heated Tan 3% Flbrous (othe0 2% Cellulo8. 10% Synthetic 500/5 Ccllulose 40% Non-fibrout (othe0 Nono Detectod Non-Fhrous K-563-7 LVR SV' Bad(ing lrom 2nd layor o90r02rto-0022 g6olo Non-libror.rs (other)None Detcctod K-583-8 HTSV ogo?ozaao&o0 K-563-9 BR 1 R- Trb ogo302ail1.0009 Hall lloor tile toP Tan Non-Fibrour Bedroom 1 red tile Pink Non-Fibroue CruBhed Crushed Heal.d 2% Flbroue (olhe0 2% Cellulose 75% Non-fibrous (other)Nonr Ooticted 100/o Flbrous (other) 15% Ccllulose 400/0 Non.f lbrous (otheo Nom Detectad K-583-9 BR 1 R- Backing oeBt2g6anoz1 Bed.oom 1 rcd tll€ Black FlbrouB Te63od Crushed Heatcd l00/6 Fibtou! (oth34 5oo/o Cellulose HeterogengQ!E K-s63-10 BR 1 B. Bedroom 1 brown Tan crushed 1oo% Non-libous (othsr) Nonc Det'cted Mnyt tllc NOn-F1broue Heatad 0r0r02seo4ot0 Anatyst(s) Etlc Rogors 87)or other approvad tignalory 2PLM.l EMSL AnalYtlcal, lnc 302 South Abbott Avonuo, itlllpliec, CA 060t3 Ann: Fax: Proiect: 934.70t 0 Ken Newman Koos Environmental P O tsox a068 Coog Bey, Ot 9742o (541) 268-8721 K-863 Eugene Demo Phon.: (541) 256-0511 Custorner lD: CrEtomer PO. Recorved: EMSL Order: EMSL Proiect lD: Analyols Date: KOOS50 09/18/03 10:21 AiI 090302860 9n2t2003 Asbestos Analyels of Bulk Materials via EPA 6O0tR-93r116 Method using Polarized Llght MicroecoPY Non-Aeberlgl Flbrous 7. Non'FibroueAppearenceTrcatment 'fc Arberlqr oi lYPc Nono oetectedEampleLocallan Bedroonr I browr'! Blsck tal6 Ftbrous K-583.10 BR 1 B- BBcking oe,ro2c60oa26 T6rred Crughod Hs!ted 10% Fibrou! (olho0 '10% Nonjlbrous (othen 50% Cellutore EMSL EMOL br rtortduc6o, 6t a$ In full. whhout wnlE^ igency ol lhe UnlEd SLt.a Gov6mmerit no.6sSemplesglat^ttadreBull0PLMca^nd EMSL!ppa6l Dynotmey ntr 0ny dPCrnl.g!lg6p!oroEaaDslotmit6 lGarad TfuIthrloilrhi!b&a 18,r MtislalBgleol9dDETEM,Tha roPonwllhrhoultd.lcclad NVLAPclalmto€nd0o6mnt by!onot urcd chonl producllheabovtThomulbytorfAna!ylFol. Het6tooan6ouB 100% Non-flbrous (other)None Detectod K563.1 I BTH Y. Mnyl a90302060-0o1t K583.11 BTH Y. Backing 090,f29a)4028 Bathroom SV yellow Balhroom SV yellow Non-Flbroug Gray Flbrous Crr,rrhed Ho.lod Tcgsad Crushed H6st!d Taas6d Crushed 40elo Non-f rbrous (olhe.)None Dotccted 1070 Flbroua (other) 50% Cellulo6e 100/o SYnlhetic 50% Cellutose 40% Non-libmu3 (othor)None Dctected K563-1 2 SF o909?r@-00r2 Sidlng fctt PePcr Black Fibroug 1dr6 Flbrous (other) 50% Celluloee 40% Non-flbrou3 (olhefl Nooe Dotected K563-'13 R ogtxto?Nolnti Three tab roorlng Black Fibrous T.aE.d Crughed 45% Non-fiboue (othor)Nono DEtectcd K563"14 w o0c302060401. Balck breided wl]e Black Fibroue Heterogeneous 5% Fib,oua (othe4 50% Cellulose Tersed Cruihsd l-heted Tan Non-Fibrou9 Tan Non.Fibrous Gray Fibroul Cruthed Heated Crushed Herted T6as6d Crushed t0% Ccllulose 20% Callulose 85% Non-Rbrous (other) 0% Ghryrotlle K563.i5 HTB oe,9a2860.0015 Holl tllc bottom K563-16 HTM-Mnyl Hall tile middb agojo?800-00t6 K563-16 HTr\G Backlng ogo3oznooqmT Hgll llle middb .l00% Non-fibrouo (othor)Nonc Del,ectod 50% Non-frbrous (other) 307o Chryrotlle or other epproved Siqnalory Anllyst(s) Enc Roryrs (27) J Tan EMSL AnalYtical, lnc 382 Sonth AObdtt Avcnrro, Itlllpltar' CA 95036 Plrofi5;(,{08}Q34.7010Far:({08l9x4-7o16E.,.,.'l - Arm: Fax: Projecl: Phoner (541) 266-0511 Customer lD: Customer Po' Received: EMSL Ordei EMSL Projed lD: Anelyals Datc: KOOS50 09/1E103 10121 AM 000s02860 9t2?/2003 Agbestos Analysis of Bulk Materials via EPA BOorR€3rl16 Method using Polarized Light MicroscoPY Apperance Treetm.nt tA Non.ArlErtgt Fibmus % Non-Flbrous9emple K563.17 KFT B oc0N2AA0-0017 Analyst(s) Locetlorl Kltchan floor tilo middle Tan Non-FrbrouS Crush€d 5olo Ccluloee oh 92% Non-flbtous (other)3% Chryaotlle or other approvod srgnetorYErlc Rogers (27) 4 EMSiL o,rcn9csmltGulltt!bsrlorl€0PLM DBSN EMSLSrttcotPPrcvalVtnolra07oduced,DOmayTheTEM6b0v6rh6uldddtrdtartedbeYlth 0,? lnonorlBsncy!nylsl^ol 6€dbefhc PLM.1 aa Anslyllql, itoml trttadto lhe tts Ken Newman Koos EnvtronmentBl P,O.Box 4068 Coor 8eY, Or 97420 (54r) 266-8721 K-663 Eugeno Demo AGbestor r\wcrwo CHAIN OF CUSTOOY ASBESTOS EMSL ReP Your ComPrnY Name. Strool; Boxil; Clty/Slate: Phone Results, E: Nome: Tetephona f: PrdBcr Nema/Number EMEL AnelYtlcol, lnc- R$Ed o7rqrm PO Box 4OBE K-563 Euoone Demo Thrd Fslty Dltlho BqetG sihrn aubiletlon tom tnld po,ty EMSLSILL to St?s.l: Bc(rl Cily/State: Fex Rretlts tp. Namc: Fax t Purchoae older r: (s4 2ea-8721 K6n EiTSL OR ztp: TU E charge EEmplcB. lou udll Oe $ked io.lon Bnd aJlhorE.tloo lmn irr lhle o€Mca 12 hoi/B tnutl E"'Ye by r l:00 r. m Mon-Fr[ .) PEate rE{er lo prics qustc lx trI sotlEFtooRrletr RrR bulk I D w8stelvtNlea Water Ezr nom o, t d.1ELm. orvo. ralo'tr 3ho fl thrs SG hrE I 5 daYs tl8 hrs days 72 0 3days 4 deys OumtlEthre F.ltrod AIR OTHER u TEM BULKAIIEC E-oropttount(Qualltative) TEM TEM -Air t{osH 7400 . BULK 600/R-93/1 16 SEM Air or Bulk EI lxenr E tuosx zoz E epe rcvel z tr Chatfisld trTEM NOB (Gravimotric) NY 19E'4 XRD tr Asbestos tr Silica D w ETEwATER E oRtt'tKttto wlrER EPA I(D,l tr WATER-l.lYWaslridlt, D wsbr-t{v Orrnllng Wcrar tr EPA POINT COUNT E NY Statiliod Polnt Count E PLM NOB (Gravimetric) E Other: E osxr DorxER: tr tr -VOLUME (lf Appliceble)ONLOCrSAMPLE NUMBER )eilin0K-563-1 PC roet vlnylbackK.563.2 ESV K-563.17 KFTB Totel Samples i Time: Time: Time: Time: 17Cllent Ssmple # (s) Rslinquishad: Received; Relinquished: Rocoived: Date Date Date Date 4:00 PM Pdtl) 9/16/2003W Pt Lqb0 EMSL AnelYtlcal, lnc Rcvlged oTlOTng CHAIN OF CUSTODY A38E8TOE EMSL ffi LOCATION K-563- 3 SR.--.-SEFRFT L\M/S -- K-sGB€LV COMP rn@nsv red hall floor tale 1R -- KE6t -10BR1B I brown tile K-563 - 11 BTH Y Yellor sldlng felt Paper t8b 1 K-563 -15 btack - heiltile bottom K-563 - 16 -tra[ tile middte . 17 KFT VOLUME (tf aoollcable) -sheet rocFw loint comp--Tiiotrentite Troom I rsdtile l-56-5:T K-58s -1 tnree {TB --Xilctren lloor tile mlddle- $ftFf tf.lSFIEl-U& 225 FIFTH STREET . SPRINGFIELD, OP.97477 o PH:(541)726-3753 o FAX: (541)726-3689 DEMOLITION PERMIT APPLICATION Structure to be Demolished:'Aa,tg€ Job Number:2 4go ^) Lg,tl" 5fAddress: Signature The applicant is hereby notified that any redevelopment of the subjegt site must "o-piy *ith all of the ipplicable laws, codes, ordinances, polices and plans in effect at the time the redevelopment proposal is accepted as complete for City review. This would include coirection of substandard conditions associated with the present development. Examples of such corrections may include. modification of inadequate drainage facilities; complian-ce with building set- backs from propertylines; correction ofsubstandard sidewalks and street improvemertt,-ir"lrding driveway width and pla-cement; and other corrections which m.ay be ne""ttury to comply with existing development standards. Furthermore, if an existing use is demolished or otherwise removed prior to.the development of the propoied use, then the system development charge credit for the pre.'riously existing use shall expire two years after the date of issuance of the demolition permit or6ther removal of the previously existing use. (Springfield Municipal Code g.+t6(t)). My signature below indicates that I have read and understand the above conditions relating to the demolition of the above mentioned structure- E zlza(o ,l Date 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3733 r FAX:(s4t)726-3689 w, DEMOLITION PERMIT APPLICATIONS $F'F!Tfi&FTELl, I 7<4-Sortzf your demolition permit is currently being processed. There may !e a slight delay, of up to z rvorking days for small structures, due to the time required to- rer.'iew the history of the slruciure to determine if it needs to be documented before demolition. This documentation is for archival purposes only and u'ill not affect the granting of the demolition permit. If the structure is very large or complicated the documentation process may take up to a maximum of 4 rvorking days. Documentation u,ill consisi of photbgraphing the building, taking measurements and making scaled drawings. The documentation will be undertaken by the City at no cost to you. Documentation is being done on all structures dated prior to 1940 that may have historic importance to the City's development. THIS DOCUMENTATIONWILL NOT IMPEDE THE DEMOLITION PROCESS. An age cut-off of tg4o was chosen because this is the date that the National Parks Servite and The Springfield Development Code use to determine potential historic significance. If you would prefer to complete this documentation yourself you must provide the Ciiy wittr the following information: r) black and white photographs-of each elevation, a floor plan-with measurements, and z) a set of elevation drawings with measurements. Thank you for your patience. I grant the City of Springfield permission to enter my property to complete documentation prior to the requested demolition of the structure located at: Address:ll Property Owner Signature: Job Number:Date:zlz-s lo( 1il,,flflTY OF SPRINGTIULD; OREGQi{ "'225 Fifth Street Springfield, Oregon 97 477 541-72G3759 Phone rit City of SpringlielU Oflicial Receipt Development Services Department Public Works Department Receipt #: 1200400000000000237 Ji,bTfoumam'rmEaF Amult P.id COM20M402I I Demolition 45.00 COM200440211 Sanitary or Storm Sewer Cap 45.00 COM200440211 + l0% Adminktsative F.e 9.00 COM2004-00211 +7%Statesucharye 6.30 Item Total:$10s.30 Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid Check LIVING STONES CHURCH dlm 3663 In Person Payment Total: $105.30 $105.30 I