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HomeMy WebLinkAboutPermit Building 2001-08-17Job# 99-00687-01 RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Addition: SPRINGFIELD Page 1 of 3 225 North Fifth Street Springfield, OR97477 Location Of Proposed Site: 342 S 00035th St AssessorsMap#: 17023134 Lot: Block: spr Job Number: 99-00687-01 Office:726-3759 lnspection Line: 726-3769 Tax Lot#: 00200 Subdivision: ctTY oF sPRrNcFtELD, OREGOTV Owner: Randy St. Clair Address: 342 South 35th Street Scope Of Work: Single Family Residence $83,568.00 Phone Number: City/State/Zip: Addition 541-726-1531 Springfield, OR 97478 Value: $0 Quad Area: # Of Units: Constr. Type: Water Heater: 3RSC Office Use - Land Use: Zoning Code: Bedrooms: Range: # Of Buildings: Occupancy Group Heat Source: Sq. Footage: To request an inspection callthe 24hour recording at726-3769. 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 working day. Required lnspections Transfered Records Curbcut Underground Plumbing Footing Rough Gas Sidewalk Underfloor Plumbing Foundation Rough Electrical Rough Mechanical Rough Plumbing Electrical Service Gas Service Post and Beam Sanitary Sewer Line Shear Wall Nailing Storm Sewer Line Framing Walllnsulation Drywall Special -After forms are ereceted but prior to placement of concrete - Prior to filling the trench. -After trenches are excavated. -Prior to insulation or decking. -After forms are erected but prior to concrete placement. - Prior to cover. -Prior to cover. -Prior to cover. -Must be approved to obtain permanent power. -After line is installed and line has been connected to a minimum of one appliance. Pressure ter -Prior to floor insulation or decking. -Prior to filling trench. -Before covering sheathing with finish materials. -Prior to filling trench. -Prior to cover. -Prior to Cover -Prior to taping. -See Plan Review and/or lnspectors Notes, or prior to cover if applicable. Job# 99-00687-01 Page 2 of 3 Required lnspections Rough Electrical Underfloor Plumbing Rough Plumbing Final Plumbing Gonstruction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? (Sq. Feet) Main Electrical -Prior to cover. Plumbi -Prior to insulation or decking. -Prior to cover. -When all plumbing work is complete. Accessory: # Of Stories: Height (feet): Current Units: Proposed Units: Census Code: Does not apply Total: Fee Paid On Receipt# Value/Quantity Fee Amount Transfered Records Plan Check Fee Building Permit Electrical Permit Plumbing Permit Mechanical Permit SDC-Storm Sewer SDC-Sanitary Sewer SDC-Administrative Fee Mechanical lssuance Total Transfered Records 05/1 9/1 999 06/16/1999 0912111999 06/1 6/1 999 06/1 6/1 999 06/1 6/1 999 06/1 6/1 999 06/1 6/1 999 06/1 6/1 999 34101 34484 35637 34484 34484 34484 34484 34484 34484 $250.25 $385.00 $80.00 $80.00 $15.00 $272.40 $707.10 $48.98 $10.00 $1,848.73 Electrical Branch Circuits With Feeder or Service State Surcharge - Electrical Administrative Fee - Electrical Total Electrical o2t07t2001 02t07t2001 02t07t2001 4401 4401 4401 $8.00 $.so $.24 $8.80 4 Plumbing Minimum Plumbing Permit Fee Number of Fixtures State Surcharge - Plumbing Administrative Fee - Plumbing Total Plumbing 02107t2001 02t07t2001 02107t2001 02t07t2001 4401 4401 4401 4401 4 $.oo $40.00 $2.80 $1.20 $44.00 Administrative Fee - Mechanical Miscellaneous Mechanical State Surcharge - Mechanical Total Mechanical $6.s0 $.46 $7.16 7 $.20811712001 08t17t2001 08117t2001 6468 6468 6468 Grand Total $1,908.69 l 250 385 BO 80 15 272 707 49 10 Job# 99-00687-01 Page 3 of 3 By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. Signature Date Edit Vie+v Tot'!s \t'indow E ,M ldc 00687 01 a raJ+L Re Lllair lDr,,{ I 7t20CI1 t--=--: r=--:-I U 41i lL)M I E.5tl @-r I l- 99 35rh -t G 1 I l'Jarnes I Addrers Appl (cr:nt d.j on Ch*csneralP I Ftanningt rrq Fe P I ;-+Llnlir lnspectian ] .h Sneciat Noter I e rch e-hanical rl l T-r-r r---, l******--**Tle' Fee !escriptinrr Value/*uarrtitv Amo.unt lnommentl Faid Date I oris. R*t Cashier rfist;tlij m\tt - Msilbox lfi IElMicrssoft\f,rr,J I ,I APTWIH - il ffiB s {f r Hechanical Hiscellanerus ls/17t2c01 lssued lor/lr,rDol H Permits ExtenderJ?'[- .80 Hrld? l* Lot Strurture Modng Payrnent lilechanical I$ Fees Previnus Fermit Billed itechanical Admin D.?ll llilschaniral .'ffi irtlr:l x> -{3t=71-{ T} :L}_42. 73 m Ltfrrt.. *+rf, f: :rJ '.:r> t= E: (=CD .. IIJ P - HFJ IH L-] I'J C:m:tr{#{f}c)c}nD (}.. Z.A -l I'J 6''.o f3-l' " c] J}-C}mrJF-r(;'*.JL,,l ., H Lrt tJ FJ F,AY T[ THE IftTER ilT EFfi I I'IET TEI[. BTTANII.{ U5 I'{ATIONAL E{ANri OF OREECIN FilR 0EP03II UNLY 1 53& 0145 I50B IITY OF SFRII.iGFITLD TEUELilPI'1TNI SERUIITS DTPflRTI,IEI{I nuE 20 1001/?.L5/0L-0006471 .i: Job# 99-00587-01 RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety SPRINGFIELD Page 1 of2 225 North Fifth Street Springfield, OR97477 Location Of Proposed Site: 342 S 00035th St Spr AssessorsMap#: 17023134 Lot: Block: Addition: Job Number: 99-00687-01 Office: 726-3759 lnspection Line: 726-3769 Tax Lot#: 00200 Subdivision: clTY oF SPRINGFIELq OREGOil Owner: Randy St. Clair Address: 342 South 35th Street Scope Of Work: Single Family Residence $83,568.00 Phone Number: City/State/Zip: Addition 541-726-1531 Springfield, OR 97478 Value: $O Quad Area: # Of Units: Constr. Type: Water Heater: 3RSC Office Use - Land Use: Zoning Code: Bedrooms: Range: # Of Buildings: Occupancy Group: Heat Source: Sq. Footage: To request an inspection call the 24 hour recording at726-3769. 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 working day. Required lnspections Transfered Records I Gurbcut Underground Plumbing Footing Sidewalk Underfloor Plumbing Foundation Rough Electrical Rough Mechanica! Rough Plumbing Electrical Service Post and Beam Shear Wall Nailing Storm Sewer Line Framing Wall lnsulation Dryrvall Special Rough Plumbing Final Plumbing -After forms are ereceted but prior to placement of concrete -Prior to filling the trench. -After trenches are excavated. -Prior to insulation or decking. -After forms are erected but prior to concrete placement. -Prior to cover. - Prior to cover. - Prior to cover. -Must be approved to obtain permanent power. - Prior to floor insulation or decking. -Before covering sheathing with finish materials. - Prior to filling trench. - Prior to cover. -Prior to Cover - Prior to taping. -See Plan Review and/or lnspectors Notes. Plumbing l -Prior to cover. -When all plumbing work is complete. r trYPiF Job# 99-00687-01 # Of Stories: Height (feet): Current Units: Proposed Units: Census Code: Does not apply Page2 of 2 Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? [ Area (Sq. Main:Accessory:Total: Fee Paid On Receipt# Value/Quantity Fee Amount Transfered Records Plan Check Fee Building Permit Electrical Permit Plumbing Permit Mechanical Permit SDC-Storm Sewer SDC-Sanitary Sewer SDC-Administrative Fee Mechanical lssuance Total Transfered Records 05/1 9/1 999 06/1 6/1 999 09t2111999 06/1 6/1 999 06/1 6/1 999 06/1 6/1 999 06/1 6/1 999 06/1 6/1 999 06/1 6/1 999 34101 34484 35637 34484 34484 34484 34484 34484 34484 250 385 80 BO 15 272 707 49 10 $250.25 $385.00 $80.00 $80.00 $15.00 $272.40 $707.10 $48.98 $10.00 $1,848.73 Electrical Branch Circuits With Feeder or Service State Surcharge - Electrical Administrative Fee - Electrical Tota! Electrical 02t07t2001 02t0712001 02t07t2001 4401 4401 4401 $8.004 $.56 $.2+ $8.80 Plumbing Minimum Plumbing Permit Fee Number of Fixtures State Surcharge - Plumbing Administrative Fee - Plumbing Total Plumbing 42t07t2001 0210712001 02t07t2001 0210712001 4401 4401 4401 4401 4 $.oo $40.00 $2.80 $1.20 $44.00 Grand Total By signature, I 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 701.055 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. +a -7a7 f lY- $1,901.53 2-7-a/W"-Date Lrsn ?rt e6pq o\ ,n ",o,, oR*{gf.io,,,}**L*"1, "*, ",225 FIFTE STREET zonrng ano doeiffifrEggggq)citic land use SPRINGFIETD, OREGON ryp49?r INSPECTI0N REQUEST z 726-96hs OFPICE: 726-3759 Date ,PFlINGFIELEl ELESTRICAL PERHIT PLICATION City Job Number 3. COHPIJTE FEE SCEEDTILE BELOV Services or Feeders fnstallation, Alterations or Relocation: 1. LOCATION ignature PERMIT IS pettrlY igog$Y BEH!q?a"" f erable and expi reif vork is not started vithin 180 daysof issuance or if vork is suspended for 180 days. 2. CONTRACTOR INSTALI,ATTON ONLY Electrical Contractor Address Ci ty Phone Supervi.sor License Number 1*gS Expiration Date Constr Contr. Number -f445/ Expiration Date Signatu erv].s1 ng trician o rJ Of, 3t 3\t c)'O &ob Ovners Name ]11 Address g1> 5 Ci ty tnt-vhoneaLb ' 17)3 f \ OVNER INSTALLATION The installation is being made on property I ovn vhich is not intended for sa1e, Iease or rent. Ovners Signature: DATE:-2 Nev Residential-Single or Multi-Family per dvelling unit. Service Included:Items Cost 1000 sq.ft. or less $ 85.00 Each additional 500 sq. ft or portion thereof S 15.00 Each Manuf 'd []ome or -Modular Dvelling Service or Feeder $ 40.00 A Sum B 200 amps or less I 201 amps to 400 amps -40L amps to 600 amps -601 amps to 1000 amps_ Over 1000 amps/volts Reconnect 0n1y s s0.00 s 60.00 s100.00 s130.00 s300.00s 40.00 5p? C Temporary Services or Feeders Installation, Alteration or Relocation D. Branch Circuits E 200 amps"or less $ 40.00 over 401 to 600 amps - S 80.00 Over 600 amps or tbOO voEs see rrgrr uffif- ,\ Nev, Alteration or Extension Per Panel 0nerCircuit ' S 35.00 Each AdditionalCircuit or vith Service- a - a-6or Feeder Permit 15 $ 2.00 g Hiscellaneous (Service/feeder not included) -Each installation Pump or irrigation sign/outtine Lighting- Limited Energy/Res - SUBTOTAL OF ABOVE 7frYl state Surcharge 32 Admini.strative Fee TOTAL 00 00 00 00 40 40 20 36 s s $ s 5 RECEIVED B @ SPRINGFIELD RESIDENTIAL PERMIT APPLICATION CITY OF SPRINGFIELD COMMI]NTTY SERVICES DTVISION BUILDING SAFETY Page 1 ilob Nurnber: 990687 225 North Fifth Street Springf ie1d, OR 9'7 4'71 LocaEion of Proposed Work: 342 S 35TH ST. Assessors Map #: 17023134 Lot: Block: office Inspection Line 7 26 -37 s9 7 26 -37 69 Tax Lot #: 00200 Subdivision: SPilNGFIELI', Owner: RAIiIDY ST. CLAIR Address:. 342 S. 35TH Describe Work: ADDITION Phone #: '726-l-531 clty/state/zip: sPLFD oR, 974'78 ADDITION QUAD AREA: 3RSC CONSTR. TYPE: VN -- OFFICE USE -- LAND USE: 1111 SQ FOOTAGE: L200 OCCY GROUP: R3 To request an inspection, call the 24 hour recording aL 726-3759. A11 inspections requested before 7:00 a.m. wil-l be made the same working day, inspections requested after 7:00 a.m. will be made the followj-ng work day. --- REQUTRED TNSPECTTONS --- FOOTING - AfLer trenches are excavated. FOIINDATION - After forms are erected but prior to concrete placement. ITNDERFLOOR DRAIN - Prior to cover or pLacement of concrete. TNDERFLOOR PLITUBING - Prior to insulation or decking. POST AIiID BEAITI - Prior to floor insulation or decking. INSULATION - Floor; prior to decking Wa11/Ceiling; Prior to cover ROUGH PLTMBING - Prior to cover. ROUGH MECHANICAL - Prlor Lo cover. ROUGH ELECTRICAL - Prior to cover. SHEAR WALL NAILING - Before covering sheathing with finish materia]s. FR.AMING - Prior to cover. INSULATfON - Floor,' prior to decking Wal1/Ceiling; Prj-or to cover DRYWALL - Prior to taping. FINAL PLITITIBING - When all plumbing work is complete. FINAL MECHANICAL - When al-I mechanical work is complete. FINAL ELECTRICAL - When all electrical work is complete. FINAL BUfLDING - When all required inspections have been approved and the building is compl-ete. Total Height: 20 Item Main Garage ADDTTION Total Value Building Permit Fee Surcharge/admin --- BUILDING PERMIT --- Square Feet x $/Square Feet 54 VaIue 0.00 0.00 83,558.00 83,558.00 385.00 30.80 TOTAL FEE ffi-wmw (A)4L5.80 SPRINGF!ELD ilob Nurnber: 990587 SPilNGFIELD, Page 2 PLIN{BING PERMIT Item Fixtures Plumbing Permit Surcharge/admin TOTAL CHARGE 8 Fee 80.00 80.00 6 .40 86 .40(c) MECHAI{ICAL PERMIT Vent Fan Mechanical Permit fssuance Surcharge/admin TOTAL PERMIT 2 6.00 15.00 10.00 L.20 (D)26.20 MISCELLANEOUS PERMITS Surcharge/admin CITY SDC TOTAL MISCELLANEOUS PERMITS 0.00 L,028.48 (E)1,028.48 (Excluding Electrical) unless oEherwise noted TOTAL A.I{OI'NT DUE - - - (A, B, C, D, and E combined)1, 555 . 88 BUILDING VALUE, PLAI{ CHECK A.I.ID BUILDING PERMIT This permit i-s granted on the express condition that the said construction shall, in all respecEs, 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 provisi-ons of said ordinances. Plan Check Fee: 250.25 Rece j-ved By: Pl-ans Reviewed By: AL WARD BuiJ-ding Site Reviewed By: BOB Date Paid ': 05 /L9 / 99 Date: 06/1,s/99 BARNHART Receipt Number: 034101 --- ADDITIONAI, COMMENTS A SEPERATE ELECTRICAL PERMIT IS REQUIRED By BignaEure, I staEe 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 sha11 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 cerLify that only contracEors and employees who are in compliance wit.h ORS 701.055 wil-l- be used on this project. f 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 t.he front of the property, and the approved set of plans will remain on Lhe site at al,l- times during construction. t ry-( i16"^L"i7 g- Date // *?r SPFINGFIELD Job Number: 99068'7 SPruNGFIEI*D, Page 3 ION Receipt Number Date Paid Amount Received Received By D a IctTYoFSPRNGCLDIT APPLIGATI 225 FIFTH STREET SPRINGFIELD, OREGON 97477 SPRlN(l''ELD rElf- hFilil.r JouRNAr oR JoB xo . 44 or" g *ra, ATTACHMENT A jR:- CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET LOCATION Z4z43 5fL- DEVELOPMENT TYPE: AdA^Ai C,-T.. BUILDING SiZE NO. OF PFU'S (See Reverse Side) 3. TRANSPORTATION 4. SANITARY SEI^IER-MWMC A. REIMBURSEMENT COST: NO OF UNITS X TRIP RATE X COST PER TRIP x _ x $475.32 x _ x $475.32 X $47.14 PER PFU $10J ' lo $ $- $..- SiZ a. Ft 1. STORM DRAINAGE IMPERVIOUS SQ. FT. Vrc X $0.227 PER SQ. FI . $ 21A ,+ O 2. SANiTARY SEI^IER-CITY l{ NO. OF FEU'S X PER FEU B. IMPROVEMENT COST NO. OF FEU'S X PER FEU Mt^Jt-4C CREDIT IF APPLICABLE (SEE REVERSE) Mt'lMC ADMINISTRATIVE FEE $-' <$ $1 .00 $9 19,50 $ 4E,q? T0TAL SDC $ l0zg ,.+( TOTAL-MI^II.4C SDC $ SUBTOTAL (ADD ITEMS 1,2,3 & 4)5. ADMINISTRATIVE FEES: BASE CHARGE (SUBTOTAL ABOVE) X .05 rv6 L Date: 5 SDC Coordinator ATTACH'A. t,'lPD WARNING DEVICES TO BE UTILIZED: signing and to bs in complianco with the Manual on uniform Control DESCRIPTION I WORK SHALL COMPLY WITH C HAPTEB X ARTICLE 5 OF THE CITY CO REV|S|ONS 8t24195 +oRM # 116 DE. CONTRACTOR TO COMPLY WITH MUTCD (MUTCD) NAME OR COMPANY: 7 // PLAN REVIEW COMMENTS / SPEA^qL INSTRUCTIONS: RESTORATION WORK SHALL BE IN CONT.IRMANCE WITH EXISTING CITY CODES AND IN C1CIVIPUIAruCE WITH CURRENTSTANDARD SPECIFICATIONS, EXCEPT AS NOTED BELOW. 001 002 003 004 005 006 007 008 009 010 011 o12 013 014 015 016 o17 018 019 020 021 o22 o23 o24 025 026 o27 028 029 030 031 032 033 343 Backfill with %" minus rock. Compact every 1 8" loose depth. Requires compaction with a steol rolller. A.C. to match the greater of existing depth or 4". All cuts sealed for final inspection. Temporary patch may be used at the end of the day. Signing and Zone protection to comply with MUTCD Cut concrete only on score lines or cold joints. Sidewalks and driveways min. 3,O00psi. Curbing min 3,SOOpsi / No patchwork less than 3'. Meet min. requirements on curb cuts, Spfd, code. Restore planted areas, Spfd. code 206.3.05 . \ Spec. to Bore / Jack / No A.C. cuts. Mechanical compacting required. ir: No patchwork allowed. Lateral cuts to have control density fill. Cuts to be polymerized crack sealed for final inspection. Mininum 2" crushed rock %" minus. Minumum 4' clearance at any point, swing-away. Concrete minimum 4" depth, 3,000psi. Trench to be "T" cut. Needs State / County permit'' l No above ground enclosings in sidewalk or handicap ramps. Diamond cut A,C./Concrete value boxes to grade, Fresh Oil signs / Graded. Comply with Americans with Disabilities Act. Concrete slabs, 72hrs. curing tim6, 45Oopsi. Concrete slabs require joint seal material. Driveway requires dowels every 1 8". Submit traffic control plan prior to excavation. Notify Traffic Division before excavatipn. Core drill main line, insert tee, 2olo min. grade. Must comply with the provisions of ORS 757.541 to 757.57'l 6" Circular hole/H2O-Vac. Comments: r at' rH E LAN E urrLdifld"ibtHUiflr"Afi N G cou Nct L's"oNE CALL NUMBER" 1-800-332-2344 48. HOURS BEFORE DIGGING INSPECTIONS: ALK INSPECTIONS CALL 726.3769 (RECORDER} STATE YOUR DESIGINATED CITY JOB.R, JOB ADDRESS, TYPE OF INSPECTION REOUESTED, AND WHEN YOU WILL BE READY FOB OR OWNER'S NAME AND PHONE NUMBER. REOUESTS RECEIVED BEFORE 7:00 A.M. WILL BE JUESTS AFTER 7:00 A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE To BE ,.VATIONS ARE MADE AND FORM WORK lS lN PLACE BUT PRIOR TO POURING CONCRETE .T:lyER, ENCRoACHMENT pERMrr AND orHER rNSpEcroNS CALL CTTY MAtNTENANCE Artr NUMBER/PFP' INSPECT'- SANITARY S,-rVEB, 726-3761 tr cuRB cur AND' MADE THE CALLED IN SIGNATURE: Bv siqnature, I state and aqree, that I have carefullv examined the completed aoplication and do herebv certifv that all information herein is true and correct, and I further certify that'anv and all work peiformed'shall be done in accord6nce with the Ordinances of the Citv of Sorinqfield. apolicable Citv Standard soecifications and Drawinos, and the laws of the State of Oreaon oertainino to the work described heiein. I'fdrther certify that only cohtractors and employees"who are in compliance with ORS 7d1 .055 will bd used on thisproiect. The Citv mav insoect the work site described in this oermit at anv time durino a one vear oeriod followino the receiot bv the Citv of notice cif corhpletion of the described work and specifv, at the City's sole deScression, an'i additional resioration wbrk iequired io return the site to a standard acceotable to the Citv. The oermittee'will be notified in writinq of anv work required and will have thirtv days (30) from the date of the noiice to complete'the work. Work not completed at the en? of th6 thirty daVs will be performed by fhe City and the costs will be billed to the permittee. I furthor agree to ensure that all required inspections are requested at the proper time, that project address is readable from the street, and the apbroved set of plans will r'emain ori the site at all times during constiuction. Date b,-Z (/-2 7-7A RECEIVED BY DATE PAID VALIDATION: Signature AMOUNT RECEIVED RECEIPT NO: FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER. INSPECTION: ' DATE: ( f rrrnrrureNANCE : ELEVENTH MONTH: AT TIME OF COMPLETION: DEPOSIT RETURNED DATE INSPECTION:DATE WORK IN PROGRESS DATE DATE: DATE: DATE: DATE:f, renvrr TSSUED BY: E eucrrueERrNc REVTEWED BY: f rnnrrrc REVTEWED BY: DATE: DATEI {-