HomeMy WebLinkAboutPermit Building 1987-10-12t,
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INSPECTION LINE
726-37 69
CITY OF SPRINGFIELD
COHBI IIATION APPLICATION/PERMIT
INFOR'IATION LINt
7?6-3753
Job Address 63 ? S-+z<<ar 5r.
llater Heater
Ranqe-
EIIERGY SOURCES
Hea t
Value of l.lork:
//2- 6a42' *'
Sq . Ftg . I'lai n_
Sq. Ftg. Access..-
Sq. Fto. Other_
lew_Add__.yAtlffifi. -
_Fence_Demo_C hange/ U se
-other--
Legal Oescription
Owner
'a6
Fami
Work 'e., Bui ld SingleAddress ?7">a ./*v? 2? /y.Phone
eO
Construction Lender o
s
N
0\
N
{.
Address Phone
namiFDESIGN TEAI.!address lics. no.exol res ohone no.
Pr
Structural
El ectri cal
Mechan i cal
ftallte I icq nn nhonp no-CONTRACTORS addres s (exot res
2a
P1
Genera I
I
PLUiIBtrI$G ELECTR I CAL MECHANICAL
FEE CHARGE NN FFF CHARGF NO FFF CHARGF
Each single fixture Residence of
FTSQ
furnace/burner to
BTU' S
Relocated huilding
(new fix. add'itiooai)
New circuits alts.
or extensions
FIoor furnace
and vent
Recessed wal l
Snarc hpefpr rnd vpnt
S.F. Residence(l bathl SERV I CES
Duplex (1 bath) eacil
Temporary Constructi on Apol iance vent
seoa rateAdditional bath
Change in existing
rps i dpncp
Stationary evap.
cool er[.later serv,ice
multifamily, corrn. or
Tndrrctri a I
Vent fan with
sinole ductSewer
Vent systern apart from
heatino or A.C.Storrn Sewer 0f
COMI.I./IND. FEEDERS
Hechanical exhaust
hood and duct
Instal I /al ter/rel ocate
di stri b. feeders l'lood stove/heater
0f amps
)zzi ,ae>7,/-.4r'r5,2*z 3e,v 'trrs fu*'?z r',rs B*urZ
ISSUANCF OF PFRIlIT
TOTAL CHARGESTOTAL CHARGESTOTAL CHARG€S
WHERE STATI I-AI,I
shall not be vaiid
RE'qUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
until the label has been signed by an Electrical Supervisor and returned to the Building Division
EXAI{INED the completed application for oermit, and do hereb.y certify that all information hereon is true
and correctlamd I further certify that any and all work performed shall be done in accordance with the 0rdinances of the City
of Springfil-eld and the Laws of the State of 0regon oertaining to the work described herein, and that HC 0CCUPANCY will be made
of any struclh/r.e wit.hout the permission of the Building Division. I further cert'ify that my registration with the Builder's
Board is in funl force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and empioyees who are in comoliance with 0l?S 701.055 wil| be used on this proiect.
,
tlAl'lE (pl ease S IGNATURE DATE
I HAVE CARIFIfi-I-Y
Fire Zone Bedrooms 0ccy toad /22 Sq. Ftg
rOTAL JArt-A{l,/ lt- )a
#b
x
0N_
Val
zone L,t/7 t
. Access
Ftg t'la i n I
v-z Fto. other x Value
Uni ts
Flood Plain Stories / }cc.y Grou
22aqnoPlan Ck. Conrn/Ind -65%/A1do Ppr Fee Sfa.72 Svstems Deve
charqe tl.51
dPEgIttBUILDING PERI.IIT
Charges and
Surcharges )-
G8=25--
26.Plan Ck. Res
30%/Bldq Per Fee
Fence
Demo
PLUI.IBING PERMIT
Charges and
Surcharges
Sldewal k
A/C Paving Tota'l Comb. Permit ,6r.6?
ELECTRICAL PERTIIT
Charges and
Surcharges
Curb Cutt,,IECHANICAL PERMIT
Charges and
Surcharges Vlza,89TOTAL
\
COMBINATION APPLICATION/PERMIT (CAP)
I. App'licant to furnishA, Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, Znd Addition toSEiliq'field EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition,
check add, etc.F. Building permit information:1. exampie - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. elqlple - convert single family residence into
iEETEuFant (change of use)G. Value of work as defined in Section 303 (a) of theStructurai Specialty CodeH. OESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where biank spaces occulin 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 Electrical Schedules
are available at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the 'item(s) to be instal'led are not covered onthe abbreviated schedules you shouid consult theful I schedulesC. BUILDING DIVISION STAFF I^IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be de'livered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label
Applicant to sign and date
Whenever possible, the initial application will be used asa worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual 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 andpayable when the permit is issued.
FOR OFFICE USE ONLY
II
III.
IV
v
/el ca
val uation,
forced air gas
or soiar
1. exampl e- heat,2. EfEmElE- waterE. Square footage or
PERMIT VALIDATION
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI'ICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
date ft>-/?-g>name si gna ture
2.d*# /ost{P
SPRI.GFEI.GI
fJ
-'q u ire d ln spec . Jh s ..aa
/f IT IS THE RESPONSIBILITY OF TIIE PER!4IT HOLDER TO SEE THAT ALL INSPECTIONS ARE MADE AT TI{E PROPER TI}{E,
THAI EACII ADDRESS IS READABLE FROI{ T1IE ST.RNET, AND THAT TI1E PER].TIT CARD IS LOCATED AT TIIE FRONT OF THE
PROPERTY. BUILDINC DIVISION APPROVED PLANS MUST BE ON JOB SITE AT ALL TI}IES.
PROCEDURE FOR REQUESTING IIISPECTIONS: Cal1 726-3769 (recorder) state you CITY DESIGNATED JOB NUMBER,job address, type of inspection requested and when yorr will be reedy for the inspection. Contractorso! orrners name and phone number. Requests received before 7:00 am will be r-ade the sarne day, requests
received after 7:00-am will be nade the follol"-ing work day.
Your City Designated Job Number Is .Q?oZ =q
Job Addres s, 672 *<<E ? €7
Owner:2 4)-//?O
_Contractor:_
SITE INSPECTION:ffixcaffin
I,INDERFLOCR
MechanIAl
To be made
, but prior
, Plunbing, Electrical,
To be made prior to
STRUCTURAL CONCRETE:F=T.-(3d',ea:il--In excess of 3000
to setup cf forms. ).1 ,
T'NDERSLAB PLI.'},IBING, ELEC'I'RICAL
& IIECHANICAL: To be made before
any r,'ork E-covered.
CONCRETE SLAB INSPECTION: To beffitding
service equipment, conduit, piping,
accessories and other ancillary
equipment items are in place but
before any concrete is poured.
'1 )
Fooffitcs E FouNdATroNS: To be nadeffivatedand
forms are erected, all steel in
INDERGROUND: PI unbing, Electrical,
Gas, Sanitary Sewer, Storm Sewer,
llater and Drainage 1ines. To be
nade pri.or to covering or fiJ.ling
trenches. )O t 4l
t
ATTIC-DRAFT STOPS & CURTAIN WALLS.
FIREPLACE: Prior to
;ffi and before
placing facing
framing
inspec^tion. / 61cl t d
INSUI-A.fION 6 VAPOR BARRIER: To beffind
required vapor barriers are in place
but before any lath or gypsurn board
interior wal1 covering is applied.
FRNING: To be nade.after the roof,
all framing, fire blocking and
bracing are in place and all pipes,
chimneys and vents are complete and
the rough electrical, plumbing and
heating wires, pipes and ducts are
approved.
FIRE & SEPARATIoN WALL: Located 6
ccnstructeC according to plans,
LATH AND,/OR GYPST'M BOARD INSPECTION:
To be made after all lathing and
g)?sun board, interiol and exteri.or,
is in place but before any plas
is applied or before gypsum boardjcints and fasteners are taped and
finished.
WOODSTOVES: After installation is
compff;4.
o the ding Code a special
shall be employed by the Orrner/
during construction of the
llowi.ng work. A copy of the special
esting reports shall be furnished to the
ing Division
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STRUCTUR{L I{ELDS: Preforrned on thej;6:-@zr-f;
HIGH STRENGTH BOLTING: During all
b-G-lnstafitlon ana tightint
operations (306 a.5)
SPRAYED ON FIREPRooFING: (U.B.C.@
SPECIAL GRADING, EXCAVATION .qND
FILLINC: During earthwork. (306 a.11
& Chapter 29)
GLU-LAM BEA},IS Inspection Certificate,
by an approved agency, furnished to
the Cityrs Building Di-vision before
beans are placed. (2501-U.B.C. STDS.
2s-10,11) .
\b
installaticn of floor insulation,
decking or floor sheathing.
POST 6 BE/tltl: To be nade prior to
installation of flocr insulation,
decking or floor sheating..
FLOCR INSULATION & VAPOR BARRIERS:
To be made prior to j.nstalletion
of decking or flcor sheating.
lrlASONRY: Steel location, bond beans
gro"tfig or verticals in acccrdance
with U.B.C. Secticn 2415.
SIDEWALK G DRIVEWAY
a1I concrete paving
lio, q t
: Required for
within street
ROOF SHEATHING AND NAILING:
to installing any roofing.
ROUCII PLU}IBING, ELECTP.ICAL 6
i\IECIIANCIAL: No worl< is to be
unTil-thGe inspections have
made and approved
2q
FINAL PLUMBING
->4
FINAL ELECTRICAL
\ot
FINAL I\IECHANICAL
t^l
FINAL FIRE DEPARTIIE}IT
right-of-way, to be made after all
excavating conplete 6 form work &
sub-base naterial in place.
CURB AND APPROACH APRON: After forms
are erected but prior to pouring
PARKING LOT: After gravel is in
place but prior to placing asphalt
or concrete.
* In addition to the inspections
specified hereon, the Building
Official nay make or require other
inspections of anY construction
work to ascertain compliance with
the Building, City or Zoni.ng Codes.
Must be requested 2 days in advance of the date you
w
Prior
3 2)))
l4a
E
8
w
n
cov
b
re CITYIS SITE PLAN REVIEI', BOARD INSPECTIOI.I
wish inspection. A11 project conCitions such as landscaping, parking lot stripj.ng etc. nust
be completed befcre requesting this inspection.
FINAL BIIILDING: Ilust be requesteC after the final Plumbing, Electrical, l'lechanical and Fire
Department inspections are made and approved. No Occupancy of the premises can be made until
a Certificate of Occupancy has been issued by the Building Divisicn and posted on the premises
DATESICNA'
(
*ALL r-rimHoles AND cLEANours uusr BE.q,ccESsIBLE, ADJUSIvENT To BE t'tADE AT No cosr ro rHE crfi.
tr
tr
l*tr
place, but prior to pouring concrete.
trg
-ADDRESS-
632 SHELLEY ST
DESCR: BLDG ADDITION
.OWNER-
MAJNR DEFOEq3370 HhlY sq
JUNCTION CITY,
BUILDITIG DIVISION JOB# 870236
-LEGAL-LOT BLOCK
17032710Ct8401
FINAL
-VALUE-
20000
/ sn0108
998-5560
0R 97488
870429
-EI'IERGY- -STATS-HEATI. 2- BLDG ZONEHzO- STORIES FLOODPLAIN
RANGE- BEDRM OCC GRP H3
UNITS
SO FEET 1605
CONST TYPE 5N
-CONTRACTORS.
GENL.
CONTRACTOR PHONE-
PLMB.
ELECT-
MECH-
DESGN.
VALUE--.
REPT CAT #727
EQ.PEOUIRED PERMITS-- FEE-..SURCHARGE.DATE.RECEIPT-..PERMIT#
- I NFO.
ADDITION
COMMERCIAL
5300
NT.OOl.PLAN CHECK FEE
N2.NO2-BUILDING PERMIT
O3-NO5-PLUMBING
.04-OO4.ELECTRICAL
,01-00?.-F00TING
,N2-OO3-FOUNDATION
,n3-n27 -ST0RM SEI.lER
O4.042-ROUGH ELECTRIC
N5-N31.ROI'GH MECHANICAL
N6.OO6-FRAMI NG
O7.O I?.F I REt,lALL
NB.O1 O-L ATH/ PLASTER
O9.O4q-F I NAL ELECTR ICAL
1O.O3q.FINAL MECHA[IICAL
.J ]..O19.FINAL BUILDIilIG
'01-003-F0Ul'!DATI0N,02-OO6-FRAMI NG
'03-009. I NSULATION
,04-OO6-FRAMING
N5.NO6-FRAMI NG,06.039.FI NAL MECHANICAL
'07-O49.FINAL ELECTRICAL,08-002-F00TI NG
'09-O23.ROLIGH PLUMBING
.J 0.026-SANITARY SEltlER
I1I -023-ROUGH PLUMBING,12-004-SLAB
tT3.O27 -STORM SEI.IER
I14-O2O.UNDERGROUND PLUM}] 5.NN6.FRAMING
) 16-OO6-FRAMI NG
I17-01 l.NRYt.IALL
'] 8.0I?-F IREt,{ALLI1g-N49-FI NAL ELECTRICAL
'20-O64.FI NAL FI RE DEPTI21.N39-FI }'IAL MECHANICAL
'?2-OIq.FINAL BUILDING
'?3-O49-FINAL ELECTRICALI?4-3q -FINAL MECHANICAL,25.019-FINAL BUILDING
91.33
140.50
I 5.00
??.50
0.00 870413 68085
5.62 870429 68184
0.60 870429 5R184
0.90 8704?q 68184
20,00
0
0
0
0
EO.MINIMUM INSPECTIONS +REQUIREMENTS- ---EXP DATE.--ACT DATE-
EO..INSPECTIONS. .-COMMENTS. .DATE RESULT--INSP...
870430
870508
870515
870515
870518
870825
870825
870n31
87 090 1
870901
87 0921
870921
e71002
87 1 009
871021
87 1 A23
871026
87 t027
87 t21 I
87 1218
87 l21A
87 t2L8
87 1? 23
BB0 I 08
880108
870430
87 1223
870825
0K 25POK 090K 25
NOTOK 25POK 250K 27NR 33
WADD 25t{IR 280K 280K 28WIR 25POK 28OBS 25POK 25
NOTOK 25NR 25POK 25POK 330K 2qr0 28
NOTOK 250K 330K 2e0K 25
ENGINEER TO VERIFY ACCEPTATICE
ENG I NEER BRACKETS , BEAMS
BLKG.t'I.WALL,KNEE BRAC.
FIRE BLK'G OK
DUCT GRAI{GE VENT
N. E. }lALL ONLY
EXTND TO ROOF
1ST LAYER OK
LABEL PANELS
BRACE,OTHER APPROVALS
a 9L
(!jL
SITE PLAN REVIEI.J DEVELOPMENT AGREEMENT
THIS DEVELOPMENT AGREEMENT, hereinafter "Agreement", is entered into thi t ,/ f
day of O.+ , 1987 (ifre "Effective -Date") 6V and between the CITI-0FSPRINGFIEff-ffiiI"i'fter "City", and MAJ0R DEF0E hereinafter "Applicant", in
accordance with Section 31.090, and Section 3.070(3), 3.080(3), 3.090(3), and
3.100(3).
REC ITALS
HHEREAS, or the l/1 day of nAW( , 1987, the City approved Site Plan
App'lication submitted byTfRpplicant T6r-fhE p[rpose of allowing:
The addition of a 20,000 square foot boat manufacturing facility at 632 ShellyStreet. City Journa'l Number 87-07-104.
WHEREAS, in consideration for Site Plan approval, the issuance of a Bui'lding
Permit, and the issuance of an 0ccupancy Permit, as specified in the Springfie'ld
Development Code Section 31.090, Applicant agrees to comply with a'll the standards ofthe Springfiel d Development Code and Springfiel d Municipal Code which may be
applicable to this development project, including but not limited to, the following:
,(
,1
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,.16.
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The access road to the rear of the property needs to be increased from 15 to 20feet. This access road needs to be paved.
The building, if relocated a distance of 20 feet from the north property linewill not require fire walls.
The bike rack needs to be relocated away from the fire hydrant.
The curb cuts need to be redesigned. 0nly two curb cuts are permitted by the
code, therefore, one curb cut needs to be eliminated.
The fence needs to be sl atted across the north
screening from the residentia'lly zoned property.
property line to provide
A j-box or shallow manhole needs to be instal'led at the end of the 10" storm
sewer.
A 5 foot sidewalk needs to be installed across the entire frontage if not
already installed.
B. The Fina'l Site Plan needs to inc'lude the names and types of trees and shrubs tobe installed. A permanent irrigation system needs to be incorporated into the
l31dscape areas.
WHEREAS, in consideration for Site Plan approval, the issuance of a
Building Permit, and the issuance of an 0ccupancy Permit, as specified in the
Springfield Development Code Section 31.090, Applicant agrees to comply with the
following specific conditions imposed by the City as part of the Site Plan approval:
None.
Site Plan Development Agreement
1
NOt,l THEREFORE IN CONSIDERATION OF THE FOREGOING RECITALS WHICH ARE EXPRESSLY
MADE A PART OF THIS AGREEMENT, CITY AND APPLICANT AGREE AS FOLLOWS:
AGREEMENT
1. FINAL SITE PLAN. The appl icant a
accordance with Section 31.080 of the Springfielthis Agreement.
grees to submit a Final Site Plan in
d Development Code concurrently with
obligation of the property owner to
140 of the Springfield Development Code
ther invading vegetation. In addition,
e trirrned to meet the 2 LlZ foot height
the Springfieid Development Code.
provided by law or equityplicable state law or city
cant' s responsi bi'l i ties by
2. STANDARDS. The appl i cant agrees to ful fi I I al I appl i cabl e standardsspecified in the Springfield Development Code and the specific standards listed in
RECITALS prior to occupancy, unless certain standards have been deferred to a later
date in accordance with Section 31.110 of the Springfield Development Code.
3. CONDITI0NS. The Applicant agrees to fulfill all specific conditions ofapproval required by the City listed in RECITALS prior to occupancy, unless certainconditions have been deferred to a later date in accordance with Section 31.110 ofthe Spri ngf i e'ld Devel opment Code.
4. MODIFICATIONS. The applicant agrees not to modify the approved Final Site
Plan without first notifying the City. Modifications to the Final Site plan shall be
reviewed in accordance with Section 31.100 of the Springfield Deve1opment Code.
5. I4AINTAINING THE usE. The appticant agrees to the following:
(a) The building and site shall be maintained in accordance with theprovisions of the Springfield Development Code in order to conttnue the use.
(b) It shal I be the conti nuimaintain the planting required by Sectionin an attractive manner free of weeds anplantings in the vision clearance area shal
standard in accordance with Section 32.070
(c) Parking 'lots shall be maintained by the property owner or tenant in acondition free of litter or dust, and deteribrated'pavemeirt conditions shall beimproved to maintain conformance with these standards.
(d) Undeveloped land within the deve'lopment area shall be maintained freeof trash and stored materials in a mowed and attractive manner. Undeveloped landshall not be used for parking.
n9
31.
do
1b
of
6. In addition to all other remedies which may be(including. but not limited to penalties provided by apordinances) Applicant agrees that City may enforce n-ppliwithholding or terminating Applicant's Occupancy permit.'
7. Any Final Site Plan approved becomes null and void if construction does notcomrence within one year of the date of this Agreement.
Sf te Pl an Devel opment Agreement
2
IN WITNESS WHERE0F, the Applicant and the City have executed this Agreement as of thedate first hereinabove written.
APPLICAfBY
BY:
0, /{Cou nty of
1987
la*zSTATE OF OREGON
PerSohally-appea the above named
who acknowledged the foregoing instrument to
re me:
,
o(9
vo un
tl/p/a7
DatE---
STATE 0F OREGON, Coun
Wbe thei-r voluntary aet. Bet6re me:
My Commission expires 3'+-€o'it;,
t,"'r\ \ j''
'/t (
C ITY
. ,','t.
!
su:aea-fr,\ffi'-
D$el($n$t c6ile Admi nI stFatoa-
ty of l^A^f-
L9B-7 @d the above named
, who acknowledged the foregoing instrument to
r r
My Commi ssi on erqires/ 2. t f ,Eq
/
'.../ l,
r\1 jit
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Site Plan Development Agreement
3
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IN
7?
T CITY OF SPRiNGFIELD
COMBI |IATIOI! APPLICATION/PERMIT 726-37 53
l.later Heater
Ranqe
EIIERGY SOURCES
Hea tSh
O
Owne r o
Job Address
l-egal Description
2 of l.lork:
t r>ee -o,'g,
Sq. Ftg. Access.--
Sa. Ftq. 0ther__
_t{ew_AddJI ter_Pep.
_Fence_Demo_C ha nge/ U se
0ther
So. Ftq. l'lain
Addre
Constructi on Lender k YL
l,lo r kDescri
IZ
a
ng e
Farni ce lli th A
/
PhoneRaaress 0
00
\s
0\
N
.(.
DESIGN TEAM -name addres s I ics. no.exDI res phone no.
S dPrima
1)-l t {Zoc/Structura l
T !v
dEl ectri cal
i{echani ca l
n ame address )I i cs . no - )exp'i res ohone no.
O},1(c A,D o
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umbin
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PLUIlB i NG ELECTRICAL MECHAN I CAL
FEE CHARGF NO FFF C HAAGF NO FFF rHA PGF
5 Each single fixture 78.7?.*Residence of
SQ. FT
furnace/burner to
BTLI' S
Relocated building
(new fix. additional )
New c i rcui ts al ts
or extensi ons
Floor furnace
and vent
S . F. Res i dence(l ua*r )SERV I CES Recessed wal I
Snace heaier and vpnl
Duplex (l bath) each
Additional bath Temporary Construction Apol iance vent
seDa rate
,v/a I,later servi ce lf,*ge in existing
dence
Chan
res i
Stati onary evap.
cool er
/?d Sewer {a.^multifamily,
Industrial
comrn. 0r Vent fan with
si nol e duct
5/Storm Sewer %n 0f s.Vent systern apart from
heatino or A-C.
c0t1H./IND. FEEDERS l4echanical exhaust
hood and duct
Instal I /al ter/rel ocate
di stri b. feeders ['lood stove/heater
0f amp s.
ISSUANCE 0F pFRtlIT
TOTAL CHARGES /fr.-TOTAL CHARGES TOTAL CHARGES
I,IHERE STATE LlI,I R
sha'l I not be val i:l un
EQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permittil the label has been signed by an Electrical Supervisor and returned to the Buiiding Division
any
rd
in comclianc
,]-*
EF LUL E XAIl I EDN the atca trml and odforon he cert t tha a forman +nc0mpp!-)DE reonhereb.y f.y
dan nda fu hert certr tha at a edon n co rdanceac twl h nan fandkl./Or r ofi rmed ha be the 0rd ces of-v ny DCofsfedDr'l tand Lawshe fo het taS ofngte on rtDE a n1 tto wohe drk crles hereibed n thaand0regng I'lct CYOCCUPAI'I t{rrutctusofreLuthothessthofw1perminBeudnsonfurtrrttthares!l tr ta o n t theh Bufym.y g
aBo n fu for a effend asct r ed ORS 7 05 5 ttha f t ba s forstherequ ted nhereonoonbyexemp
onl U bcons trac tor an d e trhov are tJI onedtw1h0t?s 701empoye us ectro,jp
rL0NAI,IE ASe r ntpp S GIIA TEDA
s true
the CityI be made
ilder's
and that
Ftt:
Ft!
Ftg
tiain ia>,aazrfl) x- Vatue
+tws flrz= l t/ao:4 7t .u;r,
}the Y r&),xpra//a* O/< ? t l a1 u e
Tone 1 ,)/r? /
Fl ood Pl a.i n
an
Fire Zo ne
Con
Lo ad
0c cY GrouP 8- ? SOStories
rD
?f *so-'>Bed rooms
TOTAL VALUATI
aa
$t.iiry, TD?.units
0ccY
P l an Ck. Comm/ Inil-
65%/B1dq Per Fee /€z9? - /a/Ne
t-7 7-(--/
rqe ( 1. s%
Sys
Cha
tems Deve opment 1 675-*
Plan Ck. Res
30%/81dq Per Fee
Fence
BUILDING PERI'IIT
Charges anC
Surcharges e
PLUI4BING PERMIT
Char.ges and
Surc ha rges r aa-z 7-fD
_J=?"_,t"_
8.
Demo rL
Sidewalk /60't v/."-ELECTRICAL PERIiIT
Charges and
Surcha rges A/C Pavins 24o+f "o /42. So Total Comb. Permit 6/4.8/I . V r.rtr..{,Curb Cut /-f/, \
i1 .2 5-,45(t/2IIECHANICAL PERMIT
Charges and
Surc ha rges I / 2A?.3 /.-
,1 4b TOTAL
7
I
correct,I 1
I
I
s '|
I
corlBINATI0N APPL r CATI 0N/pER[1tT ( CAp )
I Appl i cant to furni shA. Job AddressB. Legal Descriotion
l. examole- Tax
1/ Ui 4J2. example- Lot
Sp-FTngfi e1d EC. Name, etc. of ownrD. Energy Sources1. example- hdat,2. exarnole- watetE. SquaFEEotage or
ne County l4ap Reierence
2nd Addition to
truction lender
ceili or forced air gas
or sol ar
Lot 100, La
1. Block 3,
s ta tes
er and cons
/e I ectri ca i
eater
valuation,
1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition,
check add, etc.F. Building permit information:1. example - construct singie fami)y house with an
attached garage
2. example - remodel existing garage into family room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structura'i Specialty CodeH. DESIGN TEAII AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, I'lechanical, & Electrical SchedulesA. Except vrhere blank spaces occulin the description
II
III
IV
portion of the Mechani.cal
the appl i cant need fi I I - ito the appropriate item(sFull Plumbing, Mechanical
and Electrical Schedules,
n only the No. Boxes adjacent
) to be installed
, and Electrical Schedules
are avai lable at the Bui lding 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 thefull schedulesC. BUILDING DIVISION STAFF l^JILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the iabel must be deliveied to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electnical iabel.Applicant to sign and date
l,rhenever possibie, the initiai appl ication will be used asa urorksheet oniy. I,lhere possible, Bu.i lding Division Staffwill prepare a type written copy and return it to theapplicant at the time the actuai permit is issued for hissignature.
Fees and Charges
Plan check fees are due and payable at the t.ime of theapplication, and no plans wi ll be processed until thesefees are paid. All other fees and charges are due andpayable vrhen the permit is issued.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
Perm'it Cl erk a__
\ o?r'{ I
+ Jeqql
PROJECT CONDITIONS T0 BE SATISFIED BEFORE -OeeUffi$eF:/222-.lzvc-d I
Cr <'1_
€" <,
Permjt applicant exempt from registratjon with the Builder's Board because:
Addjt'ional Project Information
PLANS REVIEWED BY:
name si gnature date ?-/E-8>
lPnraofEt-o [ ,quired ln spec i .rllS..
IT IS THE RESPONSIBILITY OF TIIE PERI,IIT HOLDER TO SEE THAT ALL INSPECTIONS ARE MADE AT TI{E PROPER TI}IE,
THAT EACII ADDRESS IS READABLE FRO}{ T}iE STREET, AND THAT TI]E PER].,IIT CARD IS LOCATED AT TIIE FRONT OF THE
PROPERTY. BUILDING DIVISION APPROVED PLANS MUST BE ON JOB SITE AT ALLTI}18S.
PROCEDURE FOR REQUESTING IIISPEC?IONS: Cal1 726-3769 (recorder) state you CITY DESIGNATED JOB NIMBER,job address, type of inspection requested and vrhen yorr will be ready for the inspection. ContracEors
or olrners name and rrhone number. Requests received before 7:00 am,will be nade the same day, requests
recei.ved after 7:00"am will be rnade Che following work day.
Your City Designa ted Job Nnmber Is: 3 7A62 /
Job Address:232 fuca 7
Owner:Phorie:
conrractor. awmrp Phone
aa
K
K
tr
SITE INSPECTIOI'I: To be madeffi efi,rm6;, but prior
to setup cf forms. r-)
w n E ns rAp41fi ii6: N c-) E LE crR r c A Lffie
any r^oil-Is covered. L.1
CONCRETE SLAB INSPECTION: To beffiraing
service equipment, conduit, piping,
accessories and other ancillary
equipment itens are in place but
before any concrete is poured,
",
',1.
F00TINGS G FOUNDATI0NS: To be made
ffivatedand
forns are erected, all steel in
place, but prior to pouring concrete
l-FI INDERGRouND: fiumbing, t'#.t'iiar,l' 1 Gas, Sanitary Sewer, Storm Sewer,
Water and Drainage lines. To be
made prior to covering or filling
trenches.
FIREPLACE: Prior to placing facing
materials and before framing . .i
inspection.
INSULP.TION q VAPOR BARRIER: To be
made aft.cr all insulation and
required vapor barriers are in place
but before any lath or gypsurn board
interior wal1 covering is applied.
FRAMING: To be made after the roof,
Et1-Ening, fire blocking and
bracing are in place and al1 pipes,
chimneys and vents are complete and
the rough electrical, plumbing and
heating wires, pipes and ducts are
approved.
FIRE E SEPARATION WALL: Located 6
constructeC according to plans.
LAIT{ AND/OR CYPSIJM BOARD INSPECIION:
To be made after all lathing and
Building Code a special
inspector shall be employed by the Orr.ner/
Contaactor during construction of the
fcllowing work. A copy of the special
testing reports shall be furnished to the
Building Division.
STRUCTURAL. CONCRETE :
F.tr1. -G66;fif-In excess of 3000
STRUCTUR{L fiIELDS: Preformed on thejob. (2722 f)
IJNDERFLOCRffiiEa
POST & BEAM:
instal 1at ion
:, Plunbing, Electrical,
. To be made prior to
To be made prior to
of flocr insulation,
g)?sun
isinp board, interior and exterior,
lace but before any plast
HIGH STRENGTH BOLTING:During all : i.
bblt installation and tighting , .,
operations (306 a.5)
SPRAYED ON FIREPROOFING: (U.B.C.@
SPECIAL GRADING, EXCAVATION AND
FILLING: D.ring earthwork. (306 a.11
G Chapter 29)
cLU-LAM BiAI,{S: Inspection Certificate,
by an approved agency, furnished to
the Cityrs Building Division before
beams are placed. (2501-U.B.C. STDS.
25-10,11). .-:
r
* In addition to the inspections
specified hereon, the Building
Official :nay make or require other
inspections of any construction
work to ascertain conPliance with
the Building, City or Zoning Codes.
Plumbing, Electrical, llechanical and Fire
Occupancy of the prernises can be made until
Building Divisicn and posted on the premises
DATE
installation of floor insulation,
decking or floor sheathing,
is applied or before gypsum boardjcints and fasteners are taped and
finished.
WOoDSTOVES: After installation is
I'IASONRY:
groffing
tr
tr
tr
decking or floor sheating,.
FLOOR INSULATION & VAPOR BARRIERS
To be made prior to installstion
of decking or floor sheating.
ql
Required for
all concrete paving within street
right-of-way, to be rnade after all
excavating conplete € form work &
sub-base rnaterial in place,
CURB AND APPROACH APRoN: After forms
@pouring
concrete.
PARKING LOT: After gravel is in
place but prior to placing asphalt
@o,
SIDEWALK G DRIVEWAY:
Lffi-
Steel location, bond bearns
or verticals in accordance
Prior
with U.B.C. Section 2415,
ROOF SHEATHING A\D NAILING:@
ROUGH PLUMBING, ELECTRICAL 6
IUECHANCIAL: No work is to be
G;Il-;frEse inspections have
made and approved.
FIN.q,L PLUMBING
FINAL ELECTRICAL
FINAL I\,IECHANICAL
FINAL FIRE DEPARTMENT
covered
been
CITY'S SITE PLAN REVIEI^I BOARD INSPECTIoN: Must be requested 2 days in advance of the date you
wish inspection. A11 project conCitions such as landscaping,parking 1ot striping etc. must
be completed before requesting this inspection
FINAL BUILDING: Must be requesteC after the final
Department inspections are made and
a Cert of Occupancy has
ed. No
by the
SI
*ALL n r,^11otts AND CLEANOUTS MUST BE ACCESSIBLE,TO BE MADE AT NO COST TO THE CITY
7 ///2 '
ATTIC DRAFT STOPS q CURTAIN WALLS.
uru
tl
INSPE7?6-3 CITY OF SPRINGFIELD
COI1BI IIATI OII APPL I CATION/PERMIT 726-
l-egai Description
Job Address
Hea
Ranqe
EIIERGY SOURCES
l,later Heater
0wner <-
Vai ue of llork:
3q. Ftg, Access..---
Sq. Ftq. Other_
_llew_Ad d_A f ter--6p. -
_Fence_Demo Change/Use
-ot
her-
liain
Addressq.a) lO L Y q"q on""QL{ /^ ,
Pernri t Ij 0 e ng e
.vE I
Addre s s Phone l'f" \
o\-S
C)
$
Na_
DES I GN TEAII name addres s tcs- no_exD'res ohone no.r
St ructura I
Pri ma r
"f 5U I a?v-Electrical
i"lechani ca l
?0
n
I
I
4 \
l.lechani cal
I
PLUI,IB I NG ELECTR I CAL MECHAN I CAL
FEE CHARGE NO FFF CHARG F NO FFF CHARG F
Each single fixture Residence of
ttSQ
furnace/burner to
BTLI, s
Relocated bui lding
(new fix. additional)
New ci rcui ts al ts.
or extensions
Fi oor furnace
and vent
S.F. Residence(l bath)SERV I CES Recessed wal l
SDace heater and vent
Duplex (l bath) each
Additional bath Temporary Constructi on Apol i ance vent
qpDaratp
tiater service \ge 1n exlsrrng
dencp
C han
res i
Stati onary evap.
cool er
Sewer Tndrrstrial
multifamily, comm. or Vent fan with
sinole duct
S rm amps.0f Vent systern apart from
heatinq or A.C.
COI4I.1./]ND. FEEDERS Mechanical exhaust
hood and duct
Instal I /ai ter/rel ocate
di stri ir- feeders l'Jood stove/heater
amp s.0f
-Aal
ISSUAIICF OF PFRIlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
l,iHERE STATE LAl,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAI1INED the comrrleted apnlication for oermit, and do hereb.y c
and correct, and I further certify that any and all work nerformed shall be done in
n oertaining to the work described herein, and that NC OCCUPAITCY rvill be
Division. I further certify that m.y registration vrith the Builder's
SI ,,9/2t)V il,lAtlE(please print)tr0v
Ci ty
made0rego
the Bu ng
701 t
ertify that all inforrnation hereon is true
accordance with the Ordinances of theof Soringfield and the Laws of the State ofof any structure without the permission of
Board is in full force and effect as reoui
itdi
red by ORS 055, that if the basis for exemption is noted hereon, and thatonly subcontractors and ernployees who are in comcliance with 0l?S 701
exempt
055 r,r'i I I be used on this
t4A.AKIa rl. DE
Fire Zone Bedrooms
Flood Plain Stori es 0cc.y Group Val ue
ToTAL VALUATIoN__
Zone
X
Val u
an Ftq. l'lain
Load Ftg. Access
Ftg.0ther
Const. Uni ts Val ue
Plan Ck. Comm/Ind
65"1/8111o Per Fpe rqe ( t. sz
Svs
Cha
terns Deve opmentBUILDING PERI'IIT
Charges and
Surcharges Plan Ck. Res
30%/81dq Per Fee
FencePLUI,IBING PERMIT
Char.ges and
Surcha rges
___t5
7S
oo
Dgmo
Sidewa l kELECTRICP.L PERtlIT
Charges and
Surcha rges A/C Paving Total Comb. I'ermi t
Curb Cut (s,7sTOTAL
I,IECHAI'II CAL PERMIT
Charges and
Surc harges
t
COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfieid EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. exampl e-2. exarnp I e-E. SquaiE-T6ota
heat/el ectri ca I I i r forced air qas
wate ea er e or sofEr-
ge or valuation, etc
II
1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition,
check add, etc.F. Building permit information:1. example - construct single family house with anattached garage
?. example - remodel existing garage into family room3. example - convert single family residence intorestaurant (change of use)G,. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DEsIGN TEAI1 AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job s.itecorrections, etc.
Abbreviated Plumbing, Mechan.ical, & Electrical SchedulesA. Lxcept r.rhere blank spaces occur in the descript.ionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaientt0 the appropriate item(s) to be .installed
B. Full PIumbing, Mechanical, and Electrical Schedulesare avai lable at the Bui lding 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 thefull schedulesC. BUILDING DIVISION STAFF I,IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his eiectricalsupervisor. The general contractor ii not authorizedto sign the electrical label
App l icant to sign and date
l{henever possible, the initial appl.ication will be used asa.worksneet on)y. [^lhere possible, Building Division Staffwili prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
s i gnature.
Fees and Charges
Plan check fees are due and payable at the time of theappiication, and no plans rvi11 be processed until thesefees are paid. All other fees and charges are due andpayable vrhen the permit is issued.
FOR OFFICE USE ONLY
p{:^I
III
IV
Perm'it Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
?
Perm'it applicant exempt from registration with the Builder's Board because:
Additional Project Information
PLANS REVIEWED BY:
name gna tu re datesi
/?,.:.,
[.;:.' '- ,SITE PLAN REVIEI,I DEVELOPI1ENT AGREEI1ENT
THIS DEVELOPI'IENT AGREEI'IENT, UEnEINAFTER ,,AGREB,IENT,,, IS ENTERED INTO THISG DAY oF
F-spnrnerr
1987 (me "EFFEcrrvE Darc") By AlrD BETy{EEN rrtE CITY
, HEREINAFTER "CITY", AlrD l'lAJ0R DEF0 E,
070
HEREINAFTER ,,
(3), 3.080(3)
APPLICANT,,,, 3.090(3),rN AccoRDANcE wrrH Secrrou 31.090, AND SEcrroru 3.
AND 3.100(r).
WHEREAS, oN rHE 4fr oov o,
Punru AppuIcATroN suBl4rrrED By rHE
RECITALS
lharclr-, L987 , THE Ctrv Rppnoveo Srre
Fppurcnnr roR fie puRposE oF ALLowING:
A 1600 seuARE Foor ExpANsIoN To rHE ExrsrrNc ttANUFAcruRrNG FAcTLITv
LocATED Ar 632 SHeuuev SrReer, Assesson's IlAp 1l-03-27-10 Tex Lors
9500 nno 9600. Crw Jounruru Nureen 87-02-18
WHEREAS, rN coNSTDERATToN FoR Srre Pleru AppRovAL, THE rssuANcE oF A
Buruottro PeRMIT, AND THE ISSUANcE oF An 0ccupancv Penmtt, AS SpEcIFIED IN THE
SpRtruerrem Drvelopmerur Cope SecrroN 31.090, Appr-rcenr AGREES To cCIvrpLy wITH
ALL THE STANDARDS oF THE Spntruerrem Developt'lENT Cooe Rrrp SpRrruerrem ltluxtcrpeu
Cooe wHIcH mey BE AppLIcABLE To rHIS DEVELopMET'rr pRoJEcr, INCLUDING BUT Nor
LIMITED TO, THE FOLLOWING:
1. A cURB SHALL BE INSTALLED ARoUND THE I-ANDScAPED AREA ADJACENT TO
THE DRIVEWAY TO PROTECT THE LAI\DSCAPING.
2. WHeeu srops sHALL BE TNSTALLED rN THE NEr{ pARKING spAcES.
spAcES L, 2, 7, 1l ervo 12 oN THE srrE pLAN.
PnnrrNe
3. THe strce RAcK sHALL BE INSTALLED As sHowN 0N THE sITE pLAN.
WHEREAS, rN coNSTDERATToN FoR Srrr Puu AppRovAL, THE ISSUANcE oF A
Butlolrue Penmtr, Al,rD THE ISSUAITcE oF Ar'l 0ccuperucy PERMtt, As SpEcIFIED IN THE
Spnlruerrem Dgvelopmenr Cooe Secrroru 31.090, ApplrcRrw AGREES To co4pLy wITH
THE FoLLowrNG spEcIFIc coNDITIoNS IMposED By rHE Ctry es pART oF rue Stre Plaru
APPROVAL:
No coruotrloNs oF AppRovAL HAVE BEEN REoUIRED oF THIS pRoposAL.
NOI,I THEREFORE IN CONSIDERATION OF THE FOREGOING RECITALS I.IHICH ARE EXPRESSLY
HADE A PART OF THIS AGREEI'IENT, CITY AND APPLICANT AGREE AS FOLLOI'IS:
A6REEI,IENT
1. FINAL SITE PLAN. Tne AppLrcANr AGREES ro suBr4rr n Frrunl StrE Pueru tu
AccoRDANcE r^,rrH Secrron 31.080 oF THE SpRtruerrem DEvelopt'rENT Cooe corucuRRENTLy
wrrH THrs AoReeMeNr.
1..:2. STANDARDS. TNE APPLICANT AGREES To FULFILL ALL APPLIcABLE STANDARDS
SPECIFIED IN THE SPRIruETIEUO DEVEIOPI'IENT Cooe Rruo THE SPEcIFIc STANDARDS LISTEDIN RECITALS PRIOR TO OCCUPANCY, UNLESS CERTAIN STANDARDS HAVE BEEN DEFERRED ToA LATER DATE IN ACCORDANCE WITH SCCTTON 31.110 oF THE SpnlNorIeuo DeveIoPMENTCooe.
.,
3. C0NDITIONS. Tne Appt-lcANT AGREEs ro FULFTLL ALL spEcrFrc coNDrrroNsOF APPROVAL REOUIRED BY THE CTTY ITSTED IN RECITALS PRIoR To occUPANcY, UNLESS
CERTAIN CONDITIONS HAVE BEEN DEFERRED TO A LATER DATE IN ACCORDANCE WITH
Secrroru 11.110 oF THE Spnrruerrem Deveuopt'lENT Cooe.
4: IIODIFICATI0NS. THe npputcANT AGREES Nor ro r'loDrFy rHE AppRovro FrrualStre Punn wlrHour FIRST NorIFyrNG rHe Crry. ltloorrrceuoNs io rHe frruer- Sire
PueH SHALL BE REVIEWED IN AccoRDAncE trrrH Secrroru 31.100 or nre SpniruErier-o
Developmerur Cooe.
5- I'IAINTAINING THE USE. Tne npprtcANr AGREES ro rHE FoLLowrNG:
(e) THe_suluoING AruD sITE sHALL BE ,VIAINTAINED IN AccoRDANcE wITH THE
PROVISIONS OF THE SPRTUETICT-O DCVCIOPMENT Cooe Tru oRDER To CoNTINUE THE USE.
(s) Ir sHALL BE THE coNTINUING oBLIGATIoN oF THE pRopERTy owNER To
MAINTAIN THE PLANTING REoUIRED By Secrroru 31.140 oF THE SpRlruerteuo Eveuopt'rENTCone IN Af{ ATTRAcTIVE mANIIER FREE oF wEEDs AND orHER TNVADING veeernriolr. -iru
/- ADIITION, PLANTINGS IN THE VISI0N CLEARANCE AREA SHALL BE 'lRltvlvlED TO mEET me 2( ': L/'l F00T HEIGHT STANDARD IN ACcoRDANcE wrrH Secrrou 32.070 oF THE SpRtNertem\ Developmenr Cooe.
-
(c) Penrtrue Lors sHALL BE mAINTATNED By rHE pRopERTy owlER oR TENANTIN A CONDITION FREE OF LITTER OR DUST, AND DETERIORATED PAVEMENT CONDITIONS
SHALL BE IMPROVED TO MAINTAIN CONFORHANCE WITH THESE STANNARDS.
(o) UtlogvelopED LAI\D wITHIN THE DEVELopMENT AREA sHALL BE MAINTATNED
FREE 0F TRASI'I AND STORED MATERIALS IN A tlDl,rED AI'ID ATTRACTIVE f',!ANNER.
UruorvelopED LAND sHALL Nor BE usED FoR pARKING.
6. . Itt ADDITIoN To ALL orHER REmEDTEs wHIcH t,tRy BE pRovrDED By LAt^t oR
EQUITY ( II'ICI.UOTIIG BUT NOT LIMITED To PENALTIES PRoVIDED BY APPLIcABLE STATE LAWoR CITY onotruerucrs) Apputcem AGREES THAT Crry mAy ENFoRCE Appttcnrut's
RESPoNSIBILITIES By wITHHoLDING oR TERIvTINATING Appr-lcnrur's 0ccupRNcy Penmtr.
Developmeur
2
(
Srre PUH AeReemeNr
(r
(i 7. Attv Flrueu Stre Pun nppRovED BEccHES NULL AND voID rF coNSTRUcrroN
DOES NOT COI'II,IENCE WITHIN ONE YEAR OF THE DATE OF THIS AGREEMENT.
IN I'IITNESS WHERE0F, rHE AppLIcAI{r At{D THE Crry HAVE EXECUTED rHrs AeReemerur Rs
OF THE DATE FIRST HEREINABOVE WRITTEN.
1/atefl
DATE-
STATE 0F OREG0N, Courlw sp <n "
fuLl4dl 6 , tssrz.
APPL
B
BY
BE THEIR voLUNTARy Acr. BrroRe me:
PeRsoruet-uy AppEARED THE ABovE NAtvtED
WHO ACKNOWLEDGED THE FORE@ING INSTRUI'IENT TO
F-,^w
z,'(
t,) -\,.
:(
ARY FORI
rud& 4 /?s 7DATE-
R VOLUNTARY ACT.
['ly CotttttssloN EXPIRES
CITY
INISTRATOR
I4II-IO ACKNO}YLEDGED THE FOREGOING INSTRUMENT TO
l4E:
FOR
|vly Col'u"lrssIoN ExPI
BY
STATE 0F 0REG0N, Couury or
f/a-d- ,G 19Sf-. PeRsorueuy AppEARED THE ABovE NlllED
Srrc Puruq DrveuopmeNr AoReefiENr
3
W
(