HomeMy WebLinkAboutPermit Building 2000-12-28Job# 00-01101-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of4
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SPRINGFIELEl
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 2309 00035th St Spr
AssessorsMap#: 17021943
Lot:6 Block: Addition:
Job Number: 00-01 101-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 00600
Subdivision : Ambleside Meadows
ctTY oF SPR n GFiELD, OREGON
Owner: Barbara Zentner
Address: 723 N 70th
Scope Of Work: Single Family Residence
Phone Number:
City/State/Zip:
New
541-736-4044
Springfield, OR 97478
Value: $163,063
Contractor Type
GeneralContr
Contractor
Ron Kephart
2656 33rd, Springfield, OR97477
Registration # Expiration Date Phone
541-746-2129
Quad Area:
# Of Units:
Gonstr. Type:
Water Heater:
3RSC
1
(VN)Wood Frame
Gas
Office Use
-
Land Use: Single Family Dwelling
Zoning Code: LDR
Bedrooms: 3
Range: Gas
# Of Buildings: 1
OccupancyGroup: Dwelling
Heat Source: Forced Air Gas
Sq. Footage: 1726
ISNOT
FOR
To request an inspection call the 24 hour recording at 726-3769. All l
a.m. will be made the same working day, inspections requested after
working day.
Required lnspections
Site
Verify Ground Rod
Footing
Foundation
Post and Beam
Floor lnsulation
Ceiling lnsulation
Shear Wall Nailing
Framing
Walllnsulation
Drywall
Final Building
Verify Ground Rod
Rough Electrical
Electrical Service
Build
-To be made after excavation but prior to setting forms.
-lnstallground rod atfooting, and callfor inspection in conjuction with footing and/orfoundation i
-After trenches are excavated.
-After forms are erected but prior to concrete placement.
- Prior to floor insulation or decking.
- Prior to decking.
- Prior to cover.
-Before covering sheathing with finish materials.
- Prior to cover. I
- Prior to Cover I
-Prior to taping.
-When all required inspections have been approved and the building is complete.
Electrical
-lnstall ground rod at footing, and callfor inspection in conjuction with footing and/or foundation i
-Prior to cover.
-Must be approved to obtain permanent power.
5?-uu i-
rul0s by
riiOfle
ication
ConiurmcEp oR ls
I
Final Electrical
Underfloor Plumbing
Underfloor Drain
Rough Plumbing
Water Line
Sanitary Sewer Line
Storm Sewer Line
Fina! Plumbing
Underftoor Mechanical
Rough Gas
Rough Mechanical
Gas Service
FinalGas
FinalMechanical
SW-Curbside
CC-Standard
Job# 00-01101-01 Page2 of 4
Required lnspections
Electrical
-When all electrical work is complete
Plumbin
-Prior to insulation or decking.
- Prior to cover or placement of concrete.
- Prior to cover.
- Prior to filling trench.
-Prior to filling trench.
- Prior to filling trench.
-When allplumbing work is complete.
Mechanical
- Prior to insulation or decking
-Prior to cover.
-After line is installed and line has been connected to a minimum of one appliance. Pressure tet
-When allgas work is complete.
-When all mechanicalwork is complete.
Public Works
-After forms are erected but prior to placement of concrete
-After forms are erected but prior to placement of concrete
Sidewalk Type:Curbside - 5'
Additional ROW?
Street lmprovement: Fully lmproved
Curb Cut?f lmprovement Agr.?!
San Sewer Depth (Ft): 6 - 4 Size Of Line (in): B
Storm Sewer Availabte? f Downspouts/Drains: To Storm Sewer
Special Req.: Enchroachment Permit:
Security Required: San Sewer Tee (in): 6
Bond Begin DateTime: 00/00/0000 00:00 AM Bond End DateTime: 00/00/0000 00:00 AM
Special lnstructions: ROOF & FOOTING DRAINS TO STORM SEWER PROVIDED
Other Utilities: Types Of Warning Devices Reqd.
Project Supervisor:
Zoning: LDR
FloodPlain? [ Wetlands? [
Journal numbers
1: 2z
Comments:
Planner: AlWard
Urban Growth Boundary?
Quantity Of Fill:
Supplier:
Drainage:
Floodway FEMA: n/a
Overlay District:
# of Street Trees:
Land Use: Single Family Dwelling
Pave Driveway? g2
3:
Additional Requirements: LDAP Required
tr Glenwood Area? [ Required Attachments:
Source Locn:
Material:
Flood Plain FEMA:nla
Construction Types(VN) Wood Frame
Occupancy Groups: Dwelling
# Of Buildings: 1
# Of Bedrooms: 3
Handicap Access? [
(Sq. Feet)
Main: 1726 Accessory426
Job# 00-01101-01
Accessory Structure
# Of Stories: 2 Height (feet): 25
Current Units: Proposed Units:1
Census Code: New SF - detached
Total2152
Page 3 of 4
Fee Paid On Receipt# Value/Quantity Fee Amount
Plan Check
Residential Plan Check
Additional Plan Check
Total PIan Check
07t14t2000
1212812000
2577
4131
128,267
51
$323.86
$51.19
$375.0s
Building Permit
State Surcharge For Building Permit
Building Administrative Fee
Total Building
Building
12t28t2000
1212812000
12t28t2000
4131
4131
4131
163,063
Electrical
Wiring Footage 1,000 Sq Ft or Less
Wiring Footage Each Add'l 500 Sq Ft
Temporary: 200 Amps or Less
State Surcharge - Electrical
Administrative Fee - Electrical
Total Electrical
12t28t2000
1212812000
12t2812000
1212812000
12t2812000
4131
4131
4131
4131
4131
1
4
1
$85.00
$60.00
$40.00
$12.e5
$5.55
$203.50
Plumbing
Minimum Plumbing Permit Fee
Three Bathrooms
State Surcharge - Plumbing
Administrative Fee - Plumbing
Total Plumbing
12t28t2000
12128t2000
1212812000
12t28t2000
4131
4131
4131
4131
1
$.oo
$192.50
$13.48
$5.78
$211.76
Hood and Exhaust
One to Four Outlets
Minimum Mechanical Permit
Administrative Fee - Mechanical
Less than 100,000 BTU
Vent Fan to One Duct
Gas Fireplace
Dryer Vent
Mechanical lssuance
State Surcharge - Mechanical
Total Mechanical
Mechanical
12t28t2000
1212812000
1212812000
12t28t2000
1212812000
1212812000
1212812000
1212812000
12128t2000
12128t2000
4131
4131
4131
4131
4131
4131
4131
4131
4131
4131
1
1
$4.50
$2.00
$.00
$.e6
$6.00
$12.00
$4.50
$3.00
$10.00
$2.24
$45.20
1
4
1
1
Public Works
New Sidewalk
New Curbcut
Total Public Works
12t28t2000
1212812000
4131
4131
70
1
$60.00
$60.00
$120.00
Residential- Single Family - Storm
Sanitary Sewer
Deve
1212812000
1212812000
2,346
25
$562.92
$1,246.50
4131
4131
$577.00
$40.39
$17.31
$634.70
Job# 00-01101-01 Page 4 of 4
Fee Paid On Receipt# Value/Quantity Fee Amount
System Development
Residential Transportation
Residential Sanitary MWMC
Residential lmprovement MWMC
MWMC Administrative Fee
SDC Administrative Fee
Property Annexed 1997
Total System Development
1212812000
12t28t2000
12t28t2000
12t28t2000
12t28t2000
1212812000
4131
4131
4131
4131
4131
4131
1
1
1
1
$507.82
$242.76
$22.05
$10.00
$128.78
$-16.53
$2,704.30
29
S.F. Residence - Willamalane
TotalWillamalane SDC
Willamalane SDC
1212812000 4131 $1,000.00
$'t,000.00
Grand Total
Plan Check Type
lnitial Review-Res
Engineering-Res
Planning-Res
Structural-Res
Checked By
Lisa Hopper
Steve Templin
AlWard
Don Moore
Date Completed
07t2112000
0B/03/2000
08/03/2000
0B/09/2000
$5,294.51
Comment
Held for solar information. Roof pitch will be
changed in order to meet minimum solar
setback requirements.
D->7 -oa
By signature, I state and agree, that I have carefully examined the completed application and do
hereby certify that all information hereon is true and correct, and I further certify that any and all work
performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of
the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made
of any structure without permission of the Community Services Division, Building Safety. I further
certify that only contractors and employees who are in compliance with ORS 701.055 will be used on
this project.
I further agree to ensure that all required inspections are requested at the proper time, that each
address is readable from the street, that the permit card is located at the front of the property, and the
set of plans will remain on the site at all times during construction
C
nature Date
1
€$
(
NAME hr"- Z
ADDRESS: 7ZT '1*tt
LOCATION OF PROPOSED BUTLDING SITE:
Willamalane
Park & Recreation District
SYSTEM DEVELOPMENT CI{ARGE
WORKSHEET
PHONE: 7
Job. No. tO'o l'6 r
D L+
STATE: b(L ZIP: q -1q -tr
1. DEVELOPMENT TypE (check
ype definitions are on the back.)
A. Single-Family Detachecf
,/,/ Single Family home
ruO. Or UNITS
appropriate dwelling(s). SDC catartations and dweffing t
Manufactured home not in a park
Street Address:5Et^.
Plat Name:_ Tax Lot Number:
X $1,000 per unit = $
B. Singte-Family Attachecl
NO. OF UNITS X $924 per unlt $
C. Multi-Famity Apartment
NO. OF UNITS X $692 per unlt
D. Manufactrrred Home park
NO. OF UNITS
WILLAMALANE SDC
X $699 per unlt $
2. SDC CREDTT (lf appticabte) SDGpayer must fumlsh proof of
Wllamalane Credit approvat. See SOC Crcdit Wokshoet.
3. TOTAL WILLAMALANE NET SDC ASSESSED
(( SDC reduced (or Credit)
D ervices Department
$
$
$
$o. -
City of eld
Date
D
tl
lLr-24, oO
lao.)- -
Report lD: SPRA103
Voucher lD : 00033994
Handling Code : RE
Kephart,Ronald
2656 33rd Ave.
Springfield, OR 97478
City of Springfie_J
Voucher
Account Fund Orq SubClass BY
215500 821 2001
Description
Street Tree Refund
Vendor Number:
lnvoice Date :
lnvoice # :
Approver:
Operator :
Gross Amount :
Proi/Grant
0000002084
Jun 26, 2001
6-26-2001
Puent,David
wtLS5940
500.00
Amount
500.00
Comments:
Refund for Street Trees
job Number 00-01 101-01
Atu7 fu' s;
-sE$INGFTELED
SiPRIilGFIELD
BACKFLOV PREVEMION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FITTH STREET
SPRINGFIELD OR 97477
OFFICB:
INSPBCTION LINE:
726-37s9
726-3769
JOB LOCATION:23oi 4<r)J
T{5r
OREGO'UCITY OF
MAP *: /-7 O> /I +s TAX LoT *: OC Q' OOASSESSORS
OIINER:
ADDRESS:
CITY:
CONTRACTOR:
ADDRESS:
PHONE #:
SHALL EXPI
STATE:
AUTi.
BACKFLOV PERMIT IS $15.00 + 1.05 (STATE SURCHARGE)5 (ADMrN.'IDONED FOR
FEE) = $16.50
PHoNE *, ]qb'6VL/"1
?afil
L J
B-
CITY:STATE: Of?ZTP
CONSTRUCTION CONTRACTORS REGISTRATION #:c1 EXPTRES: 3<i1 - 6L
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOU PREVE}MION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSo STATE THAT ALL TNFoRMATI0N 0N THIS PERMIT/APPLICATIoN IS
CORRECT.
-f t'-o
FOR OFFICE USE
DATE oF APPLIcATI oNz'7 - 2 i -D/
RECEIPT #:b>q3 ISSUED NI fl , fY) NT} TO
JoB +: OO// o/ o/
r)
D.s-{ (=;{]
:f,> :f)
77 -1 Z.rflm c.rfn., **13 c-{ .,.. EC)
r.J r F"
I
{r? r.J L:}LN CfFL)
cr.. f'J trr'-.OrJLN(}S"cf ts L'l
::tr--CD
TOTAL AMOI'NT COLLECTED:/1, s=4
F-i [*Jm:tr;tr l?
c) r1()m
l.tF,
.r rlc
I
Feb Og O1 1O:57a
Fob-OZ-Ol I I :3l'/\
Kevin I'l .Peterson t 5r+ 1 J 688 -3020
P.OZ
p.2
Cohnuhity Smictr Prv. Ilurldlng Safcty Jutr
CTTY OF SPRINGFIBLD, OR.EGON
?rl 5n Slrltr, sp'rnlfrold, OR V14?1 P1r.726'1?59
Cir, Ioh t
D
AMBLESIDE MEAITOWS S U TIDIVISION -T SI APPITTOU
Slte Investigution Questionorlrr for Consulting l)olgn Plofeesionslr
.llcw on
fth lorm mry De ustd u E terrrponrDr vedlcedon lo ullow currlnrction to conllnuc
on UrcJob rltc turtU thc cor$irltatu's sllmpd rllidevlt on thc ilitc 6oil compectlort
cnd *trbltlratlon [q trrbmlttcd to rhc Clry. Thb form rmrct. Dc uxrrplettrl by r
licenr4d dr.rtgo pmfc*donrl (cndncor or lnshltacr) or hir/hsr autLoriaed anploycq
rrrd rubmlfud lrr the bulldlng lneptcror prior to llqurrilDi Ciry inrpectiour r
pfeclng foundntlon c9.t4rel6. It fu importenf fhrt ell qqesllons lre Orrrvcnrl
somplelrly for tha (oundrtlot *ih to bc rpprovcd for eonttntcdon.
a {!^ZT)cl '35"^ 5f
Owrrrard/or Crntrnctr €oFl (e .pttfieT
I. Drte of thc rlee lgn p.ult+sl4ndte sltc Cvdurlkrn?at ZL 0
2, llrr6 thc dcdgn prlfslri.,hEl rrriarcd u crrpy of the georechnlcrt imformnlion
for tfic nuh{lvlebn thct wts pnrvldrd yith rhc bulldtng Frmif? f w_Nof
lf aot, glcusc cililqrt thit efrce fir u aqry of thc rzport- Tlu tlaipl pz6fa5si6aat
Dut, tE t'dfillidr with thc Xeorcchttlcol inlitttrutiot hdore complelinx this .[orm,
3. Whst vrs thc $rra snd depth ofthcercevedon end /or ri!t? _LL!.Erl4Mr4-
Wos cristing Don-structural lill ur cxgursivc xril snruuntcrcd on tln lor?
YcsdNo_ If "ycs*, whar typcs. dqrthr und leurioas']
ffi.ir
whal rnoiL\urEr wcrE rukcn (o rnmsly thc loil coodition (inclu<Ic r.54r of
cngincdrcd fill urrcd to ,irubilizc thc soil)?
-
(Q.F;tc 6-11 "Ft r u( m0,.t .b.,r!1 f!.f
It thd sitc ar prupgred ulcquate D iaadcquolc E lo maintuin conrl.4nt moisture
conto[t in tlro rub gr'urlc? /Vatc.' Ycilfication of itolstafz tluhililutityt in the SUtt
Brade i.t u requirament oJ rlrc geotccfuictl rzporl. and nust be qllin*d bttitrc
Lrrnil t uG il on adrt ct mtinzc.
lf inudcqualc, wh{t mcasurcs arc ncrxlcrl r0 prOvirlc Consltnt moi*ture c()ntcnt in
ths *uh
-< /:- tYl . rt t
Feb Og O1 1O:57a
Fqb-o2-oI' l]':32A
Kevin Fl .Peterson t 5r+ 1 J 688 -3020
1, - o:4
p.3
(lorn,rruniry S.ili&E Div, Builditt! $nfot, Ioh
CTTY OF SPIIINGI'IELD. OREGON
225 .5q .Strtct, Spri ngliulit. Ol 97 477 l'tr. 726-:l?.19
tu,o*-zjo1-ffyI-
city )*br a() - ...QtJ_g_-l -_9- I
It the sire os prcprucrl odt4tate f iaaclequatc E to NupFl( thc proposr,t
flnfcturo? fut 4fiimutlir+ ansttet is rctluisitc to prot:cclitt8 wilh cotstryctillla,,
Il lnudcquefc. rrhst rddltloDrl wurt is Dudcd to prnvldo rd*{s*te
foundation
( Dld lbc dailgt prolcnslonol viincs plnccm+nt rnd cmpscrlon of lhe
errglncctrd tlll or L rDerc r rpotiel insptclon rogrrt forlhcoming l]rrnr a
qnrlil'led l8€ncr? I witaesccd Ptu.zruat d Sprclul Insplcont**tion reportf,
5, Th. drxi5n prdrrrlrnrrl lntende b ure lh followlng mrrtlrod for Inrtrllrrrim
of Fcdomhd pertnrhrlotlng dmlnr:
Tho rtcsigrr on thc rtl$ched drnuing providcd by ttre tleri5n profcssiooal.,... C
Thclncthrxl .shownorr ttroriginal s)n]ilruclion drawingt.--..-...,,,,.,,.,,.,.... tr
The rypicnl'Foundsdon l)rain' drnving atErhcd to Fnqit tr
PcrforgEd pcrin*rcr drainri arc not rcquimd ,gComrncn!s:
Nolc; City idspecto i will insVcct httnlhd dralas lrritrr t, ctlwr ttlrot rcqucst,.-
Coll : 726-3769 to .tthtdulc lnsltcctiln.
l,ow.poinl cnwl rprr drelns nre rtqufi'crl ro Drtvelrl the build-up of Grftrr
rri*turg inrirlc the foundetlonr durlnt (rnd dt f,) coilstructiou. Thls dreln
rnay he lnsLrllod g![91 loundotion pattmenl onlv vilh rhc crore*r q:rmhlion
o[ thc drslfn nroferfiionfll.
n. Tha daign prot'essional has dcterminsd thc ibllowingr
The crawl sryt:c druin it rcquind. whtn tht Jbuntlarian b installcd,.... O
Tfia bn-llolar drdln tun lx in:aal.led ofitr Jbundution placeutnr without u
si gnificctat tllaisrurt bulLl-q pnhlcm rit hi^ thc lounlurknr-.... - -. -,,,, !
(The low-ytint drain tuy fu inilulled at ,lu
- --
ilap.
,,l r:rrnstro.tiori FE7-FE l^nt-q' *'ttiiiil
b, Hs,r the daslga qrolz,rxilrruI ilt:rerutd and upprovcd ilrc itsrallatian o! ilrr
rcqaircd ltnv point drctinl..,.. Yctt, _No _
if 'ycs". where is ile low potnt draia locarcd utdtr tht. buiUiag and
wlwre thrct il lcnrinate ar thls tiat? (nttr lt an approwd localiott. i,c.
strf,il grttcr, slortil :iey,44 ,wnp pwfip nill ilisclurga lino ro lhe street.
Thc dcsign pmfe$$iontrl mu6t dcrctmiflc whcthcr thc appmvcd permi( dnrwing:l have
rdc(tuee lhunddlron srccl. [r eny eddirirnd krrrodrtlon rkd requlrrd thd Ir our
rrhown on Lhc
ftrs_ Na
rhc huiHing?
*Iditionol ilcel rc<luired (or pntvkle drur+ring).
fouqdrllon dnwlagp for
/-- tt "t*'. dcvcih(
Feb Og O1 1O:57a Kevin f'l .Pet'erson
Fsb-O2-Ol, 1l :324
hmcin. "l'hc
submirtul t<r
wirh
t5r+1J 684-3020
P- 04
P.4
C.rmhuiry Stlwicsr Div, Duil{iag g1f31y Jr*r Addrcsr-L)O
enY OF SPIIINCFIELD, oR.EGON clry Joblt
?25 5h Strcl, Springfiold. Ok n477 ?h,726.\75',
Tht followhtg sl?tema, ,nust be slgned b.t tlu indlvldual clairyq tJrc ohserwtiont urul
ltrovhliasg ilirucrinnJbr llx crcuvalina arul ,tirc prsptration work dd tlr prt)perN.
The ualcnlgttd iletipa pruterrlonal (at autlniQil a,npltycs) allosb tlsl hclrhc
obterard lequirrd noislen tubillry Ftnc.furet on thB tilc, ard lfu.l ruch pncct atct
l/cft accoilpbhcl bq,fon cry cl'E,Bges occ/(.l"/.il ,^ lhe moishrt co,tleil of ths tab-
gxilc atd* aal oottttd tfu bullding (vhcm etpasilc toi/l- rs/; Gtwouotcrdl 7\e
undrryltnad ltfithcr ed,csU thd lh. ssW, $ pn@, b a&quztc to stppor, the
b*iHiag pwposd lor th/s sitc.
Addhloul cornmerl6:
(Nom)l I crrpy rrf thb repon rhall ba kcpt on Cte wlth lhc upprovad plens et ell
tlmcs.
This rcport shull bc foltorvod by an lffidrvit, sip;rcd and surmpsd Uy thc dcsiga
pmfessionnl undEr whtsc Buspiccs this roprn war oonrplctcd, alfiming rhc information
-'(h)57tlol- o
this
u copy of this rc;rrrr shull trc
inrJrction for tbc building.
Tirte 'fE. 6g +\\ocl't L
cnlp"ny Clcle.r)-Q1(9,t8 t'Nalnlqcrt ,
Ph61a hbb' :a-Q'L-O-
Ltxnrce--. lKEj
Liccnsa #+,
Thc gcorccnniqrl rcport tbr thc Amtrlesitlc Mc;down - 1'' Addition Suhdivrston
rccoourrcnd$ immcdiatc moisturc stabilizution ef exposod r-upln-rivc ruh-gradcs, nnd tlut
expunsivc rcils bc ovcr<rcav$ted nnrl n:phcr:tl vith iit lcrrt l2 iocEr of 6ll compsclcd
to nl lrvrct 95*' of ASTM D69R fir foundelioo pnlprtruti{rn, I'hc rcport also rccornmcnds
llur( hcrlrurus hc tukcn lo provcot wutcr f(lrn collccting io or rrnrund thc frrundrtion arcas
duringlnd ulicr thc construclion Droccss. anrl thut posirive sitc drninog: bc pnrvidqd to
rcduce thc infilrarion of turfucc wutEr into tttc ctptntive srrils.
Thc gcotcchnical topo,rr funlror entplinirer ihot thc fiuish gnLde of larrdtcapc soil
rxl.iaccnt to the ftrunrtr*ion sbould bt cl lqurt 24" lhovc thc expansive hearing vrilri. f1;!tY
sgElplglgd lo roduce (hc infiltrarion of wotcr tt lhr rurfsrc. fho adcquacy r'rl'fil| ;<ril
rhulErial ruound thc brril<ling murt hc vcrificd to lhJ salihfia(ion of thc dcsign
prottssrooal.
3
Feb Og O1 1O:57a
Feb-()2-O1. I1!3zA
Kevin ll .PeBerson r5/+1J 6aA-3020
City Ioh t a'() ,-(4tI
p.5
P. O5
Ioh nddrcss 7 7-X)cl 55u' 5TCornttttrnity S*rvrscs Div. lllilding Saltry
CITY OF SPRTNGFIIiLD, OREGON
225 -stft Sucr:r, Spring,'icl6, oR 97671 ph.7Z6-11s9
NGFIELD
Affidavit
For Si te lnvesri garion Qtrestionnairc
Foundation Sub-Crade Approvol tbr
Residential Building Sire in Ambleside Meadows - l" Addition
Subdivision
Thc undcrsigncrl hcrcby affirmr; that rhc cxcavation, srructurul fiil and rnoisrurc
stabilization merheds for tlre building sirc ar the ar.ldrcss strown ab<>ve wls obscrvcd by
me or fln authrrrized enrploycc rrf my firm and rhar the following is rruc:
l. I'he loundarion sub-grade is capablc uf supponing n nrinirnum of I.500 pst, an<l is
rtdcquatc t() suppon thc btrilding proposcd firr thir site.
2. The moisturc coiltcnt of thc cxcavdrion was adcquately nraintained during the site
prcl)urirti(,)n prcc&\.t and wus irdequatcly covered ro stahilizcd moist.ure contcn(
prior to rrry significanr change in moisturc conront uf rhc suh-grodr..r.
3. The site is tdcqttarcly gru&d und draincd to prEvenr thc collccrion of watcr in thc
exoavuled urea during @nslructien.
4. The lccompanying rcport tirlcd ".Site Invesrigation Questionnairc for Consulting
l)csig2 ProFssirrrrals" con(ilining l'icld obse^rvltions xnd instructions nttdc tln
t Ll.^(,J d I (datc) tbr thc building sile wns corrrpleterl eirher by
rnysclf or hy an employcc of my firm urrdcr rny supe,rvision. -['o rhc bcsr o[ nry
krrowlcdgc. rhe infrrrmarion conlairred in that refron is corrrplete und uccrrrate.
Nilnc of Licc
.si
1
J
':Il.i'.,..' r'-12
I N
I t99',i2
OREGON
,8
Fmires: 6-30-