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Home My WebLink AboutPermit Building 1980-05-29s 726-3753 Job Address Lega1 Description EIIERGY SOURCES Hea l,later Heater Ranqe q Ftq Ftg Ftg n Sq. Sq. . Access . 0ther w _llew_Add A1 ter_Pep. _Fence_Demo Change/Use 0ther oooI ? 6acO Owner 4 Va] ue of tlork: .l.9rlrr.o-, Address Phone n u'l d ingle I Construction Lender Addres s Phone DES I GN TEAI,I name address (lics. no.exD t req phone no. Pri Structura l E l ectri ca I t'lec ha n i ca I CONTRACTORS nante a ddres s "lics- no.'exD I res (nhonc no Genera I PI E I ectri ca I l.lechan i ca I PLUIIB i NG ELECTR I CAL MEC HAN I CAL FFF CHARGE NO FFE CHARGF NO FFF CHARGF Each single fixture Residence of SQ FT furnace/burner to BTU' s Relocated building (new fix. additional) New circuits alts or extensions Floor furnace and vent S. F. Residence(l bath)SERV I C ES Recessed wai I Soace heater and vent Duplex (l bath) each Additional bath Temporary Construction Apol iance vent sepa ra te l.later servi ce Change in existing rpc i dpnrp Stationary evap cool er Sewer multifamily, comrn, or I ndus tri a I Vent fan with sinole duct Storm Sewer 0f -am2s. Vent system apart from heatinq or A.C. COMI'I./IND. FEEDERS Mechanical exhaust hood and duct Instal I /al ter/rel ocate di st-ri b. feeders tr'Jood stove/heater 0f amp s. /,I /,//1 ///t/V /T /r /r /t/ /> ISSUANCE OF PFRI1IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE Ll\N REQUIRES that the Electrical work be done by ashail not be valil until the label has been signed by an Electrica nE'I S 'lectrical Contractor, the electnical portion of this permit upervisor and returned to the Building Division I HAVE CAREFULLY EXAIIINED the completed apnlication for permit, and do hereb.y 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 0rdinances of the Cityof Soringfield and the Laws of the State of 0regron oertaining to the work described her'ein, and that flO OCCUPANCY will be madLof any structure without the permission of the Building Diviiion. I further certify that m.y registration vrith the Builder's Board is in fuil force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and thatonly subcontractors and enrployees who are in comcliance with Ol?S 701.055 r.rilI be used on this Dro.ject. trAr{E(please p";ntl ZrlU e/z I E//tjt fl sTGNATURE (- rE F - ?/-fl) Zone oelCons t its - So Ftg Ftg Ftg l'la i x Val ue Fire Zone Bed rooms - Occy Load Access. 0ther X Val ue Flood Plain fD_stories 0c cy Grouplll!21__S<1 X Val iiWTOTAL VALUATI BUILDING PERT'IIT Charges and Surcha rges a-4q Plan Ck. Comm/Ind 65%/Bldo Per Fee -Q-,c-rcr Bo Sar.,rt Svsteris Deve charqe (1.5q opment Plan Ck. Res 30%/Bldq Per eFe tl zoo^\.\"-5fl PLUI4BING PERMIT Charges and Surcha rges Fence Demo A/C Paving Curb Cut ELECTRICAL PERI1IT Charges and Surc ha rges Total Comb. Permit I4ECHANICAL PERMIT Charges and Surcharges TOTAL fa{?L J IPnTEP rc nht f 4zu- I lidewalk I **-j.--..$lill?;,1 d 3 COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Lega l Description l. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lender PERMIT VALIDATION D. Energy Sources 1. exampl e- heat/2. ExEmEl-e- waterE. Square footage or electrical cei I in r forced air qas solartereeccaor valuat o[' iI l. example- 1250 sq. foot house, 500 sq. foot garage?. exampie- if new project, check new - if addition, check add, etc.F. Building permit information:1. example - construct single family house with an attached garage2. example - remodel existing garage into family room3, example - convert single family rec,idence into iEsTt-urant ( change of -use )G. Value of work as defined in Sectjon 303 (a) of theStructural Specialty CodeH. OESIGN TEAI,I AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriatepersons regarding design'information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except vrhere blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the appiicant need filt-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumb'ing, 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 installed are not covered onthe abbreviated schedules you should consult thefulI schedulesC. BUILDING DIVISION STAFF WILL 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 electricalsupervisor. The general contractor is not authorizedto sign the electrical label. Applicant to sign and date Hhenever possibie, the initial application will be used asa worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theappiicant at the time the actual permit.is issued for h.is s ignature. Fees and Charges Plan check fees are due and payable at the time of theappiication, and no plans w.ill be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY iII IV V Perm'it Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: o 0 Permit applicant exempt from regjstration with the Builder's Board because: Add'itional Project Information : PLANS REVIEWED BY: name sig nature ,0^-date 6 ^/3- rO INjPECTI 725 - t7 69 t]N LiNE COIlB I iIATI N APPLICATION RMI T 7?6-37 I ( 4 Phone acn Owner Add res s Job Address Legal Description Sq. Ftg. 0ther_ _t'lew_Ad da i IE r_:Gp . - _Fence_Demo Change/Use 0ther .e., Build Single Sq 9q Ftc In 0 s den lla nEIIERGY SOURCES Val ue of tlork Hea t Descri ch l,lork Ga ra l.later Heater Ranqe rts. Access. l'l ?J ) oo oI Phone Construction Lender Addres s addres s iics. no.exoi res )ohone no.DtSIGN IEAI.!name Structura I Pri ma E I ectri ca l l'lechanical CONT ACTORS n ame addres s Iics- no. Pl umbi \.j, ^\! E l ectrical Itechani cai ELE CTR I CAL MECHAN ICALPLUIlB I NG FFF CHARGF iln FFF CHA RCF ll0 FFF CHARGF Each single fixture Res idence of FTSQ s furnace/burner to BTU Relocated bui 1 ding (new fix. additiona l ) New ci rcui ts al ts or extensions Floor furnace and vent S. F. Residence(l hath)SERVICES Recessed wal I Soace heater and vent Duplex (1 bath) each Addi t ional bath Temporary Construction Apol iance vent seDa ra t-F I,laler servi ce Chan rpq 1 ge in existing dencp Stationary evap. cool er Sewer I ndus tri a I multifamily, comrn. or Vent fan with sinole duct Storm Sewer 0f amps. part from c. Vent systern a heatinq or A. c0r.1t1./lND. FEEDERS l4echanical exhaust hood and duct InstaI I /al terlrel ocatedistrib. feeders tlood stove/heater 0f amp s. 1'/'/ ISSUAIICF OF PFRI'liT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES I.JHERE STATE L1l,l REQUIRES that the Electrical work be done by an Electrical sha'll not be valiJ until the label has been signed by an Electrical Supervisor Contractor, the electrical portion of this peniljt and returned to the Building Division i HAVE CAREFULLY EXAIIINED the completed application for permit, and do hereb.y certify that all information hereon is true and correct, and I further certif-v that any and all work Derformed shall be done in accordance with the Ordinances of the Cityof Soringfieid and the Laws of the State of Oregon oertaining to the work described her'ein, and that t{0 OCCUPAIICY will be madeof any structure without the permission of the Building D.ivision. I further certify that rn.y registration vrith the Bur"lder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemrrtion is noted hereon, and thatonly subcontractors and ernployees who are in comcliance with OPS 701.055 vrill be used on this Dro.ject. l.lAllE(please print)S IGi{ATURE D!\IE ,{ - 2/-fl) Fire Zone . .- Bedrooms 0ccy Load - Sq Fl ood Pl ai n '1-; Stori es - - Occ.y Group . ' .- Sq lue Val ue Value ) .-'rrt€) x x TOTAL VALUATI TZone H-, Ftg. Access Ftg. 0ther yoelConst. .--i:' Units Sq. FtU. l,lai i t ir--. B.cr I;'1.t, ,1 I Plan Ck. Comm/Ind 65%/Bldq Per Fee Svsterils Deve locment Charqe (1.5c)'BUILDING PERI'IIT Charges anC Su rcha rges Plan Ck. Res 30!i/Bldo Per Fee .l \\n I t -L . t- FencePLUI4BING PERMIT Charges and Su rc ha rge s Dgmo Total Cornb. Permit lidewalk Curb Cut A/C Paving ELECTRICAL PERI1IT Charges and Surcha rges I,IECHAIIICAL PERMIT Charges and Surcharges TOTAL .2 /1 / ./ ..- -,_{./L..1 ., | -2 rsvv pYnl rp< C -)'w ,a ITY OF SPRINGFIEtD ( CitY Holl Springfield, Oregon Deportmenl of Public Works OFFICIAT RECEIPT 0. B 538i8$+,, I ved For rnt Received ED 58ELTON,TURNAULL PRINIENS EUGEIE OR 97'OI !6!I!'S i Permi t Cl erk COMBINATION APPLICATION/PERNIT (CAP) I. Applicant to furnish A. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. examole- Lot 1. Block 3, 2nd Addition toffiffiield Estates C. Name, etc. of owner and construction lenderD. Energy Sources l.) Squa exar"ole- heat/electrical ceil ing/ exanol e- waterheater/el ectri ca'l /ore footage or valuation, etc. or forced air gas r solar E II 1. elamole- 1250. sq. foot house, 500 sq. foot garage ?. exampie- jf-new project, check-iEw - if aOOition, check add, etc.F. Building permit information:1. example - construct single family house rvith an attached garage 2. example - remodel existing garage into family room3, examole - convert single family reqidence into iElTi-urant ( change of - us.e )G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEAI.i AND CONTRACTORS To avoid design or construction de'lays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. Abbreviated Plumbing, i4echanical, & Electrical SchedulesA. Except vrhere blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules, the appiicant need fi I l-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 installed are not covered on the abbreviated schedules you should consult the ful l schedulesC. BUILDIIiG DIVISiON STAFF I,IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to the electrical contractor for s ignature by his elecLricai supervisor. The general contractor is not authorized to sign the electricai label. Applicant to sign and date Hhenever possible, the initiai application will be used as a worksheet only. Where possible, Building Division Staffwill prepare a type vinitten copy and return it to the applicant at the time the actual permit is issued for his signature. Fees and Charges PIan check fees are due and payable at the time of the app'lication, and no plans r^/i11 be processed until these fees are paid. All other fees and charges are due and payable vrhen the permit is issued. iII IV. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registratjon wjth the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: \ name s i gnature da teI * ( ( ( (. ( - ; ,1.:;D, _ L >-- -- ii€ JPTCT I 5-.1769 ilL c0rlB I ON CATI 726-3753 Job Address Legal t)escription Hea Ranqe EIIERGY SOURCES llater Heater --7-o i;i cnL Owner (Va I ue of tlork : _l.l e w--_rAd d_A I t e r--.oe p-:- _Fe nc e_Demo_C ha n gel U s e -other- ;EZ tnI c q AcceFtg Sq. Ftg. Other uAddressPhonel?sci Ga e t Info:.€. r ng e Construction Lender Addres s Phone oo a (n o name Pri Structura l E l ectri ca l l'lec ha n i ca I r .)(-\ lr. l;tGenera I PI n l'lec ha n i ca I PLUIIB I NG ELECTR I CAL MECHAN I CAL Each single fixture Residence of FTSQ furnace/burner to BTLI' s Relocated bui ldino (new fix. additional)New circuits alts or extensions Floor furnace and vent ence SERV I CES Recessed wal l Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent l.later servi ce Change in existing ationary evap Sewer multifamily, comm or I Vent fan with Storm Sewer 0f Vent systen rt COI,II.I./IND. FEEDERS exhau s tnca Insta I I /al ter/rel ocate l'lood stove/heater amp s.0f t' 1.,/ t," /' ISSUAIICF OF PFRI',IIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L1t.J REQUIRES that the Electrical work be doneshall not be valiJ until the label has been signed by an Elec by an Electrical Contractor, the electrical portion of this pernittricalSupervisorandreturnedtotheBuildingDivision I'lAl.lE ( pl ease pri nt )S I GiIATU oermi rfo rmefyany of f exempt .055 r.ri l Y tca n rFULLXAIlEtI NED he ecomp d hedo rt f t tha aant fon rmareb.y v t on re0nhe s uetrc0trrecandnda ap!-) and a rklrocfu rthe r ert hat t DE shad ac nccorda wl ht thenedonbe Ordi ncena ofs cthefoeanddSoriethwsLatheofteStantannng fi t0 th r^io r k beddescri relhe n nda ath ilt c0reqoperg OCCUPA wlilcY mabe ty deofstructutv'lre tt hou th ermi ss on of rfurthe rtce ttha re strptBuhedDison t no thvn Buthen9fymyg der sBoa any rd n fu e tffec arce0dan s red 7010Rs 0 55 tha ba s fors e 0ntherBqubyxempt s henoted reon and tha no s u bcont rSrac to ndav s awho re wlance th ORS 0 usedbe ton h senr)oyee comD ectproj YEUSE FIoodPlain3ifStories.--0ccyGroup.j,..,sq.Fts.0the"-----_--_-xVaI,e- x nst. ----,' Uni l'c a.Ftg. Acce q<cy Load Zo Ftg, lla in x VaI ue_ ToTAL vALUATtott_ 3_..-^fr_ Fi re Zone-[l-_gedrooms.I Val ue P an Ck. Corrn/r-.'j l.5cs teri s rqe 0pmenBUILDING PERI{IT Charges and Su rcha rges 301 an Ck. Res n al \ t.-l'1 FencePLUI4BING PERMIT Charges and Surcha rges DBmo SidewalkELECTRICAL PERI,IIT Charges and Surc ha rges 'l Comb. Permi tA/C Paving Curb Cut TOTAL -: 4 , / j.:_,-.-/ \. -/ ./., ,. ,2 rrr PERi,I I T st \ I LAt'!addre s s (r hnne nn AC I 0RS nimP addrpc<(r E l ectrical FFF THAAnF lln ECr atlap/:F fl ETF Snacp hpalpr and vpnt cpni ra lp rno.l pr dicl'nih faodorc r I l I COMBINATION APPLICATION/PERiIIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl, example- Tax Lot 100, Lane County I'lap Reference T7-T3-q32. examole- Lot l. Block 3, 2nd Addition to SFFiIITieta EstatesC. Name, etc. of owner and construction lenderD. Energy Sources l. exampl e- 2. examp I e- E. Square footag hea t/e l ectr i ca I l in or' forced air gas solarwa e or valuation,etc. II l. examole- l2!Q sq. foot house, 500 sq. foot garage2. ExarlnplE J7-i-ew project, ctreit<-i6w - it aoaitioi,ElecE-i-dd, etc.F. Buiidin3 permit information:t. examDle - construct single family house with anattached garage2. examole - remodel existing garage into fam.ily room3. exarfiE - convert single iailiry"ie.,ioence intoiEiTilrant (change of-us.e)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAIi AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except vrhere blank spaces occur in the descript.ionportion of the l'lechanical and Electrical Schedules,the appi icant need fi l t-in only the No. Boxes adjacentto the appropriate item(s) to be instal ledB. Ful l Plumbing, l,lechanica'l , and Electrical Schedulesare available at the Building Divisionl. 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 should consult theful I schedulesC. BUILDIIiG OIYISION STAFF WILL FILL OUT ALL FEES AND CHARGES OII THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for s.ignature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label.Applicant to sign and date l,lhenever possible, the initial applicat.ion will be used asa vrorksheet only. l.lhere 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 gna ture. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans w.i11 be processed until thesefees are paid. AII other fees and charges are due andpayable vrhen the permit is jssued. FOR OFFICE USE ONLY III IV v PROJECT CONDiTIONS TO BE SATISFIED BEFORE OCCUPAI{CY: r-].,-f,. ilC ri.,u-,, *,,-.,., -.;1 .j-z: . ,. -r,\ !-;1 Permit applicant exemnt fronr registration with the Builder's Board because: Addjtional Project Information : r1 ame Si gn PLANS REVIEWED BY: ature ,/ i.,date '. ^.'l -;-I t-':l?t . (*t I (J\\ -& 'a ITY OF SPRINGFIELD' CirY Holl Springfield, Oregon Deiortment of Public Works OFFIC!At RECEIPT $+,,B 538i8, 3SS ved For: rnl Received 5X!LIOx.YUiHEULL PRTntEFS ' EUGEiE Oi 97aor !6!t!_! : Permi t Cl erk ( \ C INSPECTIO]'; PROCIDIJIII.S I:()Ii BUILDING DI\'ISIO:i INSPECTIO\S 726-376..) IIIE CITY OF SI'RI.\GFII]LD 3.16 irL\IN S'illEi:T INF()lt\ l,\'f t()\ 716 - 5755 I The fol lorving ind icatccl ins pcctions arc reclrrircd for youl construction at It is the responsibility o t permit hol eI to see t at aIl i.ns1;c'ctions arc rnttdc at the proper tinc, that each address is rerdlble frorn thc strcet, and that the pcrmit card is located at the front of the property. 1.x Site Inspcction: To be made after t4 x x;'2-,41 <. excilvution, bllt plior to setup of forms. 2.n U.a-"I. l-ab' ru-gmb.i.-q, E 1 e_ctri ca 1_ti ileciranical: To be nrade betore any 3 l rrork is covered. Footings & Foundution: To be made atter trencires are excavated and fornrs are erected, but prior to pouring concrete. 4 x Underfloor P1r-rmbi.n Nleciranical: To be e prior to installation of floor insulation or deckings.f,Post tr Beam To be made prior to ins t a.L iIt 1 on of floor insulation or decking. 6.tr nqlrsh _!lrrlus,Electrical & Iiechenical: No ruork i.s to be ?.I covered until these inspcctions have been made and approved. lr14ir1g tnspection: l.lust be requcsted after appror,,al of rough p1r-rmbing, electrical & mechanical. Al1 roofing, bracing & fireblocking, etc. must be completed. I'lo rvork is to bc concealed until this inspection 11 l plastcring. To be made after all lathing.is in place, bnt prior to any p I ast cr ing. Dr)'r"a l1- Inspcct.ion : To be madc after al1 dryrvaLl is in place, but prior to any taping. Ilasonry lt'a11s: Steel locati-on, bond tir]gg[k e-. _Drivervay: Rcquirecl for all cottcrete paving rvithin strcet right of rvay; to bc,made after all excavatirrg comptete 6 form rvork Q slrb-basc material in pIace. GLIJ-l,fl.! Bearns: Inspection Cert. (by ;rprbved -agencyj sr,rpp I ied to Builcling Inspector before beams are placed 16 Serrer, rvater fr draina qe Iines: Prior to filling in trenches Fire Retardant _Roof ing: llatcrial to be inspected before instullation. It'oodstoves: i\ft.er instel lation is completed. 0thq llspeqt1e1s trIa1.' bc reqrrired 15 l ,,.8 ,t.x 1eil . has bcen made and approvcd. s. [l F i re €, Separat ion tvi t r : Locat ed __ €r constructed according to p1ans. 9.[lventilllro,, {mechanicai) : -Required -rihele no openable rvindorvs are pro- in accordrnce rvith Brri l.ling Cocle, to be indicated in plans or by notice f rorn Bui Iding Inspector. 20 x Succiai In-spe.J----ct iorts : lVhcn rccltr i red by Building Codc, special inspcctor to be present rviren rvork is in pt'ogr.cs: fl St.r-,.t.rra1 Concrete having a design strcngth in excess of 2000 PSI, rvith copy of spcciai testing report to b'e ftrrnishcd to Building Division. il Strttc:trrrai l'ieIds perforrned on the j obrvith cop,v of special testing reportto bc fr"rrnished to Building Division. Pltono Datc v i dccl. 10.[l.LQf_ln:pSt!!o.n , The inspect ion isl-r-:=':rc(luircd for both interior Q extelior l2 bearns, grouting or verticals in accor- dance rvith U. B. C. Section 2475. ,3.x F ire lace or Chirlnev Prior to plac- in g fac ing nrat er ia 1s . I r.inat Plunrbing ! t,inat Electrical I Final t{echanical I Final Building A11 project conditions, such as the installirtion of street trees, completion of the required landscapirlg, etc. must be satisfied before thc Building Final can be re- qucsted. The Final Building Inspection mrrst be requested aftcr thc Filtal plumbing, EJectrical and )lechanical Inspections havc been made and approl'cd. ilo occupurrcl, of the premises can be mlde until thc Final Building Inspcction has bc.en mlde and approvecl, and a CERTIFICATE 0F OCCUPT\NCY IIAS Blll-li ISSULD BY'l'llE BUILDI\G DIVISION r\ND POSTIjD ON'tllE PREI!ISES. Namc of permit S i gnaturc ho I dcr BUILDI\G DI\./ISI0N r\PI']liO\'tl[) Pt.,\NS SIl,\1,1, RII|L\IN 0N TtlE BUII.Di);C SITI] AT ALL TIIlES, ANDALL lioP.K,\lusr BE CO)IPI.E'[ED IN i\CC0lit),\NCE l\'ITII TIIoSIi,\Pt'nOVllD PLANS N.OTE: Al I m;rnholes lncl cleanouts urc to be edjustc(l at no cost to thc Ci tv. f 1 .: 4P7l'oxa-oc t'llt! s NN n' N N ) l'.{r}e, fiause- o*l al\eA lo..a*,c"\r t t-"arf* yer g?l oc s. ,')o )q + Sn Owner Elh so Addt/sZ N,_='sl , ) Btk# 5 S ubdv TL#gaoo_Ma ,14, S"..\n I Date Issued Lot# froVe r) y ./ta e r, \ \ ) \ \:l tY) ,f!o" t ,4rt c lor /o// s o'-O o>1 4 /r"/)?o , q'x if n' ,,:1, , I E ' See s A 3e T L*botlB{' ,ll -D(€ Tyr - . a tl t ZXA = /6 tloe O r -/t uSS ,S /"fir,t {i€ 2la" lll #,i"1 r,.'.t i;j-ti T;ltt.'i Ca)f t?i,..)\ ,JOU I I tF,-/- 2 LI t*ry0t, (.-'l*i 4orerc/e 'g/d/ 2t& R"rt l/ls e e.ll iJe - - _".t t*-". ers o €ll Ita Z' F/Y'"/ / 4,:Pz':ri 99 2x6 th 3o z/ r''" el/rs r E ztr //4/tou 2o 2ol o 5t .L 1:,' . ;. 2..--'18" f .;t :''j... \ _[fr 6" 7 x'd ,rii!:"/ * r -il 0 't- I,t4 ,t 1e60, U?-f !.ti, i :'j.'. ". .t' /O/ , t.,'- f t t)-' (- -o 4rt ,6 -o tl o e COo oca e c e Oa Co Cc4Qr d t6 e 6 o o6 a *.il f (: c e 4 4 ct ,e o al d c* 4'v -cPco I(r i i erooo -6 d0 €4 d .. Ib t,0J hc i€ V€ 6 4 o 0lf" c Ct/, LJ 60 6 c(t4)o ca 6' a /4 o c fa (?\ G \ I a t -. ') 'l I lr O /)/av Ca 3 /0 I \, \ *\\ CIT'Y OF t.ji:,r.-,,-.r- ;.:LiJ, (jitiacLi\ THE CONTENTS iiI.I:;F Iii,Vi D[tII IiEVIE\{ED AN} APPROVFI^ v,/rTH ANy ALTERAT:0lis ii':r,riniro lN ccl-0RED Ptii'lL' BY 1;lt iivianr ctTY DLPAiiiirlliilS'l's liilrllLED' Date Received ........6..--..5. .:. FIRE DEPT. CiilClitD: Dair Etliq. DEPT. Cii:Ci(E3: Drie ll Di Ir -rT Cil:0i{!l: D:t? o E E ) () 1,*/ nrrrrldrrutl 9art@ A ; 4t i o.,;orru - Gom(,,/a; oot 9o {oom,a,to orto/,%t o/,eot; on )L-flcE g 9ASE NUMB zs., -5 e e ADDRESS: RESIDENT: TYPE: ADDRESS: ZONE:I COIvIPLAINANT:6a*lfr ADDRESS: PHONE: //L7 N ,3 lzt I NATURE OF COII,IPLAINT: 5 /oz 14L-bo11 NOTIFIED: REFERRAL TQ CITY ATTORNEY:REFERRAL PROSECUTING ATTORNEY: .{ INITIAL INSPECTION: COMPLIANCE CHECK: PHOTO: INFO: OTHER: , q '.. * tEEtE-EaEaEtttt tttttttttt *ttttttttttttttttttttttt ttt* tttttttttttttt** tt**t*tttttt t*t* ttttttttttt, DESCRIPTIOU OT OBSERVATION -,/1st Insp ection VALID VIOLATION? CODE SECTION: I I tl NO BurLf fr;rk.*r{ L2 I rt *************************************************** ,- INSPECTOR SIGNATURE DATE *************************************************************************************************t Srd Inspection' 4th Inspect 10n _'.(rII INSPECTOR SIGNATURE DATE --------- '-tiIETEIEE EETIIEEE ETtETiEEI TETEETEEE EEET EEEET EETETTEE EEEEEEE ETTEIT E EItE TEEEI E EEEEEE EEEEEETEEEIEEE: ADDITIONAL PERTINENT INFORMATION: . Invalid Date Referrai Hold Recheck Finaled Date Date Date Date DATE I