HomeMy WebLinkAboutPermit Building 1986-09-04I
I
I
.. RESIDE\IrIAL..
SPFI',vGF'ELI)
t4
Loedticn:
ssors Map fl
lioision:
dt,es s:
NeJ
Additicn
RenoCeL
7otsr 2
(,k,;D\\\\\\
&>
APPLICAruU*/PERilTT
25 North |th Street'pringfield, )t'egon 97477
,uL Ld.Lng DLDLsLon
,zo-c/D.)
5
?as lat #14o
Desct-ibe llork:
Va7.ue
Aodress
Phone:
ceneral OU-lnpn)
Plunbinp
L
l.!eci"ar.ic,zl
Construetiot Leruier
it is the, resoot'tsibility of the permit hoZd.er to see that alt inspections ate nad.e at ihe ?rope! tim., thdt ecch aiitess is rpad.^'.;.?om the atreet, anc that the permtx eatd is Located at the front of tte orooerty
'Zu!!ri.i:l7 Diuisiotz acpro'u'ed pz'an sitll renain on tk Euilcinb sltc at aL[ tines.'
rr''^-'r''r tAD =teD=For0il P??UEST:CALL 726-3769 (record.er) state uour City desigra.yed job ru.o::ber, ,|ob aiitess, t.g:e oi ir.spee=icn
-
?2.oucs;ea ane u)zen'y;ou.uiLL be ready fcr ir;socction, Contracxc?s c? Ct^me:s ncne cnC ci-one nunber. .1eqr"s;" receil;ei c-eicre' 7:Cc c1:iLL be made the sane dcy, ?equests nctie cfter ?:00 rr,11 ttill be naie the ncst:.;oy,kin: i.z;.
Zacsb?Ycu? City Desigr,ated Job liumber fs:?pati.rai Trcnoa+i cns
c--5 7r!^-q^-'^i7r -^ be macie afcerffi.u b"t prLar tc set ip of
forna.
UI|DE.?SLAB PLU.ErilG, ELECTPICiLL I
i9Cil-:.iliCAl: ?o be macie before cnyttork is eotset,ed.
F1cT.titG I F)u||D.|TICil :
Af t e ;' t r. e n ci; ar;ic ".IZ r\i #
forms ate enected., but prior to
pourlr,g ccnerete.
u !: D!RGpOU:] p ?Lltl !3 lrlc, stfft?., tt.|TE.?,
x -;,-c un- jLr / y'.A y('k C..1:1yIai M!?!C?I}l; :-rr,1-7--a'. -, r,aT=- tr-
a
?o be nai.e after aLL insulcticn ad
rcq.u7?ed uapot, berie?s dre in place
but before ory lath, Wpswn bcard. or
unLL couet ing is cpplied, ar,d before
any insulation is concealed.
a
Scnitarl seser cqoei ct ot,ocetty Lite
Septic tctk pzc:ned and fnLled trith gratei
lincl - hthen abcoe itens are ccncleted
arci uhen iencL;-tion is eontle=e br s*zt-
tuye naoed a,c pz,etises cLeanec, uc.fiW,"Y"l#Z:'
-
but prior to cny taping.
DRAIIIACE: To be naie prior to fil-Lirq xrenches.
UT|DERFLOAR PLUI,EI?]G & I,IECI]AIITCAL :
To be maie priot to installation of
floon insulction or deckinc.
To be natie prior to
floor insulation oy
MASjI|RY: Steel Loeation, bond
beans, qrouting or Deyticals in
aecorci.otce Lt|th U.B.C. Section
I./OODSTOI.IE:
cctnpleted.
After installation is
fl
- .GtiL thcse inspeetiors itaue beernoie arui aporouei.
FIPEPITACE: Prior to plceira lceingmaterials arul. before franing inspee-tion.
FP,j,llIllC: ttust be "equested afte?
approoal of rough plwr,bing, eleetri-cal & nechanieal. AL! roofing
braeing A chinmeys, e.tc. tntst be
. eompleted. llo uctk is to be con-. cealed until this inspection tas'been nade anC approoed.
POST AIID BEAI4:
LnstaLLatlcn of
deckinE.
FTUAL PLUI|BIIIC
FIIJAL I.IECIIANICAL
FINAL ELECTRTCAL
IEIICE: hhet conplete -- ProtsiCe
aates o? notsable aections through
P, U.E.
ALL project conditions, such as the i.nstallatton of atreet tt,ees, conoletion o1' the
required Landsccpir-7, etc., Daat be satisfied beiote the BULLDINC FIIIAL can be nequested.
p Electnical, otC Neeinnical Inspeetions isue been nade arui aopnouei.
llcbile licnes
Bloeking od Set-up
PLunbing eonnections -- sa)e? a.l. acaet
Electtical Connection - Bloekirry, set.-u=
and plwnbing cotttiections r;st be eprgo-eibefore requesting elec:r'ical inspec=io::
Aecessor; BuiLC'-rq
Pinal - Aftcr pcrel..es, skirting, decks,etc. at,e eompleled.
Pa3e 1 o! 2
x
'ALL \|AIIHCLES AND CLEANOUTS ilUS? BE ACCESSTBLE, ADJUS?!!1iD TO BE I.,!!iDE t-? UO C?ST TO CITy
ffil-
Date of apptt"oti", 1- l5 -K b
CURB & APPRCACH APP1N: Aftet, fornsare erecteC but prior to pourLng
conc?ete.
SIDEWALX 4 DRI\Tt//.y: For aLL eon-
crete paoing uithin street tight-
of-tny, to be made after aLL etca-
oating sanplete & forn uork & sub-
base naterial in place.
L-CO Gjl
JOB NO.
[-ot Sq. F*.
Z cf Lct Ccoerage
! of StorLes
iotal Height
TopograPhY
oE_
?-4^'FM
LCT TWE
/ rnterior
_ Corilet
_ Panhandle
_ Cul-de-sac
Lot Faees '
-- Fzes --
sb SOLAR ACCESS REQ''
G"oltu -R3 Bedrooils
Sounces
!!eai
Ca.raae l,ccess.HouaeDf
Notth llEast tovellSouthIIWest
:?r:.t
TOTAL VALUE
S.D.C. 1.5 s
Euilding Permtt
State
?otal Chatges
lesiienti.al (1 bath)
Seuer
Plunbtng Perrit
Building Vqlue & Permit
This permLt is granted, on the express eondition tlnt the said contstruetionslwll, in all respeets, conforrn to the Ordirnnce adopteC 6y the City ofspringfield, including the zoni-ng cydinance, regulat'ing thb ccnstructibn
ord .use o^f buildings, otd may b.e, suspend.ed or ybuokeC Lt o"y t..ne upon uic_l.a.tion of @ty prcuisions of Zaid OrdTrances.
lD lL -lb,zs = lz,bo7uEfre2 rr,
SC
Sigtzed:
FEE
Plumbing Permit
No- person slnll consfuwet, instal'!., alter or citange cny neD cr e:istinc
4lwtyitw or drainage sys_teJz in uhole on in part, LnLesL sueh person i"'thuLe_gal possessot' of a ualiti pltmber's license, escepx tl".at a D'e?scn ro" ii-plunbing uo,k to p"ope"tu uhich is oaned, Leased o, operated. by the ;ipi;-cant.
x ValueSQ. FTG45 /o s*5o
34Sd
PLan Cheek Fee:I b,"25+4b 8* /5 * 8'ADate Paid:
Receipt #: B V642E4.A#
\
e":/Ezterui Circuits
Service
Stete
Permit
Electricol Permit
ttrhete stete Lan reouit,es titat the electrical uork be done bu an rleclticaicont?acior, the eleetrieaL cortion of tizis oermit dic.Ll nov 'ce vai.ii utztt-|tize Label ius been signea cy the Elecctieal' Conxyccray.
Mechqnicql Permit
C::,-7::a
shanst HooC
ent Fol
codsto;se
PernrLt Issucnee
Mecitanicel Petmtt
u. i !a- I
Z I zz- €o
3,fi
\?ot
\
-- Ei]CRCACHI4EN? --
.Ceualk
*
r IlAw 2AREFULLY nxL.trNED the eornpleted application for permit, cnd dchereby certi,.f.y that aLL info:,rr,ai:ion hez,eon' is ty,ue arti e'onecx', cnd. ffut thet, eertifg that any ar.d aLL uork penforned shall be do:te i'.n o."on-dance tttlt the ordincnces of the city of spningfield, and. the Lcis of thestate of oregon pertaininc to the uork ceseribcd herein, cnd thz.t No occ,J-PAIlcv uitl r! nlae of any" stnucture uithout permtssion Z7 tnn siila;.ng oi-Dlsion. f funthen eertifr- thet only eont?aeto"s a,;d enplcyees uho aie inconplianee uith CRS Z01.0SS ui.LL be used on this projeet
L L
'bile Hone
)
,,20
J2,G9
-TAL All1UlIt DI|E:.l?,e Signeci Date
- ts -Gb
94
FireoLact
-
.. RESID -NTIAI..
APPLTCATI1N/PERtr?
225 North |th Stz,eet
Sprirqfield, )regon 97477
BuiLding Dtuision
7 26-37 53
lob Locaticn:
Assessoz,s Map #
O
SPH"VGFIET.D
Sttbdiuision:
Otmet:
a7f-f?
"igi,
? 7,O2-2=//-2-,
-5>
,e'> 7.
Tc,s lot #
7r
uol
I[ \
)
Date:
General
MechanicaL
Conatmrct'ton Lendet
It ia the respons'ibi,Lity of tle pez,nrLt holdet, to eee that aLL inspeetions are nade at lhe prope! time, that each adlress is z'eaCabi.e
fron the street, and that the penrrit card is Located at the front of the p"ope?tA.*Suilding Nuisiot^. appto"*ed plan sLnLL yemain on the Building Site at aLL tines.
PROCEDIIPE FOR hNSPECTIOIT RIQUEST.'CALL 726-3769(z,ecorder) state yout, City desigrnted. job ntmber, job aCdz'ess, type of i.nspeeti,cn
requested and uhen you uiLL be readg for inspection, Contl,actc?s or Oumers nctne and plnne nttrnber. P.equests receixed befcre 7:00 aq
ILLL be made the sone dcy, requests ncde after ?:00 an tiLL be nade tke neat uorkirq dag.
5=Phone:Addtess
k*zu@Prza fuu.z
Date of opplr:"orl"n /'?,58
Descz,Lbe lv'otk:
Ad&Lti.cn
RenoCeL
Ne0
l-l
t-t
value Q,/17O
ELectrieal
SI?E INSPEC?ION:
ezcil;ion; but
To be nade after
pt*Loz, tc set up of
forns.
UNDERSLAB PLUMBINC. E!"ECJRTCAL &
I'|ECHLIIICAL: To be made befoz,e any
t'loz,k ie cotsez,ed.
FOOTING & FOUNDA?ICN: To be rmCe
after trenches a?e ercauated and
fonns are erected, but ptiot, to
pour*ing ecnereta.
UNDSRGROAIID PLUMBING, SE',/ER, WATER,
DRAIIIAGE: To be made p"ior to fil-
T@-iFinehes.
AT|DERFLOOR PLUI,EING & IIECI]ANTCAL :
o7
floor insulation or decking.
Ioup Designated Nwnbet, Is: o
To d
tequired oapor baviez,s @e in plaee
but before ory Lath, gApsltm bcard ov,
tnLL cooering i.s applied, and before
oty iraulation is conceaLed.
DRYWALL INSPEC?I)N: Ic be made
aftet, aLL dryuall is in pl.ace,
but pnior to ang taping.
ILAS1NRI: Steel Location, bond
difrilg?outing or oerticals in
accordqtce Llith U,B.C. Section
WOODST)IIE: After installation is
ccnrpleted.
DEMOLTTIO!] OR
Sanitaty seuer captped ct Pt'opet4i Line
Septic tank p'arped and. filled uith g'z,a:;el
Final - hOen abcoe itens a.re ecmpleted
and ahen dqnclition is cornplete or stlue-
ture moued and. y,emLses cleaneC up.
Mobile Hcmes
Bloekin4 utd Set-up
Plunbing connect'Lons -- saJ)e? od. aatet
Electrical Connection - Bloeking, set-uu
and plwnbing eonneetions rn;st be appt'c"^ed
befot,e requesting el.eclr'tcal inspection
Aceessory BuilCing
Pinal - After pcrckes, skirting, decks,
etc. a?e cornpleted.
POS! 4!! 984!4: ?o be made Pnioz' to
6fiiTffil6{of floor insulation or
CURB & APPROACH 4?."i0N: A,fter forrns
d,e e"ectA-ffi p;lo" to pouring
co?rcTete.
SIDEWALK & DRIIWAI: For all con-
cret; pAW-AIffi street right-
ef-twy, to be nade after aLL erca-
uating conplete & forn uoY'k & sub-
base naterLal in Place.
?ENCE: hrhen conplete -- Ptouide
gates or morsabLe sections tht'ough
DIID
decking.
maLe cnd approued..
PTPEPLACE:
^at;;l;G
FINAL PLUVAING
FINAL MECHANICAL
q,4
FINAL ELECTRICAL
inspections haue been
Pt tot, to placirq
and before froning
faeing
inspee-
tion.
Ffu4ylllG: lhust be requested aftet,
app""o"?" of rough plttrbing, electti-
cal & meclwnicaL. AL! r'oofing
bracing & chinmeys, etc. rmtst be
. eornpleted, tlo ucrk is to be con-
, ceaLed until this inspeetion \as
'been na.de anC apptoued.
t4
ALL p?oject conditions, sueh ae the instal_Lation of stteet t?ees, conpletion-of the
onqiLrn|- tona"ecping, Lt.., ,*"t be satisfied befoz,e the BUTLDTNC PrNAL ean be requested'
FINAL BUILDING: The Einal Building Inspection mrct be requested after the Final PlunbinS
;1;;;;";;;L:-'oia uZ"ha"t"al rnspeetions haue been nade and approuec'
M
*ALL I4ANI\CLES AND CLEANOUTS TIUST BE ACCESSIBLE, ADJASTITENI TO BE I'L4DE AT IIO COST TO CITY Pege 1 c
#
tr
ii
tr
I
I
L-co c
JOB NO
Int Sq. Ftg.
% cf Lct Cooerage
# of StorLes
Total Height
iTopograPhY
SOLAR ACC ESS REQ.-
Gz'c
LCT TWE
_ Interiot
Cornet
Panhand.Le
CuL-de-sae
*
Laee
This per'mLt is granted on the erpress eondition tlat the said_eonstruction
slwll, in all respeets, eonfcnn to the Or&Lnance adopted biy the City of
Springfield, incLuding the Zoning Cndinance, r,egulating the ccnstyucticn
and use of buildings, and may be suspend.ed ot, rettokeC at cnA time upon uic-'La,tion of anA prcoisions of said Ozdinances.
Building Vqlue & Permit
b€1 !.
Lot Faces -
AccessCaraqeHouseP. L.
North
East
South
West
VaLuerTEMSQ.FTG x
Main
C,saae
Ca.rpoyt
Aceessor,ll
TO?AL VALUE
DCS.D.C. L.5 c
PLan Check Fee
Date Paid:
.7
-2
Building Petnrit
lotal Clnrgee
State
Signed:
fieeeLpY
N0.FEE UMNUL
cant
the
-t{*
I that a pe"son nay do
opez,ated by the appli-
No 7n 1L ned c?ting
or 7.n oruhole LNten Lessun sueh thePtrtrogope"son
Liduaa Ltrnber Licens e,p ercept
toaork uhich o?Leasedpoulned,property
L portion of nhis permit slnll
by the Electrical Contractor.
LanState done !; Leet?LcaLby
the benot untiuaLiC LLectrica
lns been signed
Fi.ctures
Resil.ential (1 bath)
Seuer
Plwnbing Pernrtt
Nan/Eatend. Circuits
Sez"uice
State
Total
Plumbing Permit
consttact, instal'!., alter ot elnnge ang
Electricql Permit
reqtires tlnt the eleetrieal uoyk be
NC,F!E CIIARCE
I
bhanst EooC
llcodstoise
Vent F@l
PetmLt fssucnee
MeehanicaL Permit
Mechq nicol Permit
-- ENCROACHMEN? --
Secar[tA Deposit
Stot age
Maintenqzce
he?e
fuz't
Curbcut
Sideualk
?ence
Electz,ical Labe.L
Mobile Hone
TotaL
rHA
dance* statepl Nrv
4 -2f- v3
TOTAL AMOUNI DUE: *5a sr
conp
Date
Bedtoons:
ITEM
llatet,
State Suteh"arqe
State Swchanoe
Total Clnraes
I
J
.' RESrDEr-,'lA[..
APPLICA?IOII/PERI[?
25 North Sth Street
pz-ingfield, Oregon 97477
tutlding oiuiston
'40-6 / bJ
-JJ
Ar
70 13/
I
I
I
I
I [acaticn:
SPFT',VGFIEL.O
14
(,k'lo\\\\\\
\
,N$u'tssorc I'lap #
ditsision:
meft:
ddtess:
:ity:
Ict lat #
-I,leJ
ldditicn
RenoCel
-1 ,,^urr - u^------------J---: :Y''"
Describe h'ork:
Value
CE
Date of App q- tq-Kb
Aac:"ess uLSC. 3
Phone:
.)etzercl C tt;n-en)
?1 ^^?-:^-7
't--i-.: ^-1
Ccnstrtcticn Lentiet
:: is'-he resconstbility of tie pemit hol^d.et'to see that aLL inspectiorrs ate nad.e a+, the p"oper tin., thet ezch.-;;ress is psa)r'ri;
'rom xhe at?eet, anC tlwt the pentrit eard is_ Loeated at the frcnt of ti,e orooerty'Ju!1a24 D;-uicior- aeprou*ed pl'an siclL yena--n ot; xiz; Euilitnl iitc at aL[times.-
'''C::r';?t Fa!? f:iSP:CfI1ll .P1StEST;CALL 726-3769 (reeorier) state uou? Ci.tu desiotzated job nanber, job cii:.ess, t-lte a: :-rscec=icn
':.cuesJea a-e' et':ien gou -uiLL be ready fct'inscccxion, Cont?ccvc?s cr G;neis rc.me cr.d;rnt:e nunbcr. ieq,ues;s recei;ei celcte 7:t, c=:til be nede the sone dcg, ?eouescs nctie cfter 7:00 @na'iLL be maie xne nast ro?kiri: ia;.
Zbc,<b?Ycu? City Desiora.ted iob iiunber Is:a..Ft.'na-l f?.^aI
l
l
l
l
x.:--: -..Ji:--_-.,'.' -O Ce nAAe : ; ; s L' L ;.: I C ;; / V.r -Dn.i F.1.i.?:'f .l :."::ll: I :.'.')a;:3Lt: :C :: :P. -' :3t/=:ezca,taticn, cut pricr tc sei up of
ll.la??ef r) cf trtattra ,r=^rDf at f ?
t'-:ir:,,- -^-: t O D2 nCO.€ Def O?e Cnu
uork is eoucred.
P02!.t:;C , FAU:D,1TIC\\: ?o be raCe
-
alie:. xrencnes are eseauated and
farm; ate enecled., cux prior xa
pourlr,a ccnerete.
llt:naneaat,,\ Df tPnTt,a qal|p Lt^r=D
D3AIilLCI: ?o be nnie prior to fil-Lir4 crenches.
fi p?.\'.t';Ll _IiiP!:!r1!t: rc
lfl cI-ccr cli ctuuali is .inDut pr1o71 tO cna tapL7|9.
To be rr,aie a;'te? aLL insulexicrt cyi
rcquzred uqoor barriers are in pLace
but before oty Laxiz, W?stxn bcayd or
ua.LL eouering is cp'olied., arti before
atg insulation is concealed.
a
DLace,
Scnitatl seser cqcei ct otccera:;: Line
Sepxic totk p'"r=ea a* fJlied. uith :rc:ei
ltnci - [.,hen ebctse itens ote ec-cletei
and. titer iencl:.tion is cc==Le=e o, .::--r-
r,,-- ^^,,^; *; --*- -^- ^- ^--^; .,^
UilD9RFLOCR ?LUI,EilG & ilEC!|AI:ICAL:
To be naie pricz' ta installation of
floon insulaxion or aeekina.
1 Pcsl lto atm: To be naric prior to
) T;;tai.i.";lc" of floot insulation or
deckirtg.
f,q-. -urtil these it*pee!.iot:s heue been
nade arui aoproued,.
1 fn*ucti Wton to plceirn faeina) icierials anr) before froning inspel-tion.
f fPt:fi:c: t4ust be nequested aftez,
\ app"ouat of rough plttxbing, e'Lectri-,, cal d mecianical. ALI rooiin4' braein4 E chinmcys, etc. nilst be
cornpleted. llo ucrk is to be con-
. cecled until this insoeetion has' 'been mad.e anC apptooe'd.
tlAS0llPll: Steel Location, bonC
bears, arouting or uerxiccls -in
aeeoyci.otee vLth U.B.C. Seetion
I,/OODSTO"IE:
ccmp Let€d.
After installation is
CUFB & APPRCACq A.PP)N: Aftet fornsave ereetei but prion to pourLng
conc?ete.
STDEWALX ,P' DRf',EI,lAy: For aLL eon-
erete pauirq uithin street right-
of-txq, to be naCe aftet, aLL ecea-
vating cornplete & forn usork & sub-
base mcterial in place.
?EilCE: Lhen conplete -- PtouiCe
aates o? nouable sections through
P,U.E.
ALL pro,jeet eonditions, such as the i.nstallaxion of street tt,ees, co-oletion oi t;E
nequired LanCsccping, etc., ntust be satisficd before the BUfLDI\:C FMAL can be reqttested.
PINAL BUILDfNC: The Final Building fnapection nast be requesteC cftet the linel Plunbirq
Electnical, od ileciay:ical fnspectiotw naoe been norie arui aoorovei.
l
l
{
l
FTilAL PLUI|BIIIG
FIIIAL I.IECIIAiIICAL
FIIIAL ELEC?RICAL F
Plunbing connecxions -- sa)e? al ucter
Electriccl Ccnnection - Blockir4, aet-u.
an:i plwnbing ccttnections r;st be c?>rc::'e:
before request)ng elec:rtcal inspe'c'=io-
Aecessor; BuilCing
pcrekes, skirting, decks,
Bloeking ad Sex-:tp
Firnl - After
etc. aPe comp
?4e1o!2.ALL I,AI]HCLES AND CLEANOUTS IIUST BE ACCESSIBLE, ADJI,JS?:11|I To 3E I.ITDE I.? I:o c!S? To CI?y
ec.-
tr
I tr
L-co d
JOB NO.sb q SOLAR AG<E S S R'EQ.-
Be.:r'od'ls:
Gtot -3
z cf Lct Ccoenage 4i4
! of Stories ?-
:otat Y.eight 2C'
:opography Zb{
/ rnterior
heac
Cor.nef
Panhandle
Cul-de-sac
toDe
Lat Faees -
P. L.House
I'lotth
Fns t
Sot:th
Uest
Building Vqlue & Permit
?OTAL VALUE
This permLt is granted on the ezp"ess condition tLat the satd.constmtetionshall, in all respeets, eonform to the }rdirnnce edopteC by the City ofspringfi-e7.d, i.ne-L.uding the zoning cydinance, regulcting the ccnsttu-cticny.r"n of buildings,. ord may b,e_ suspend.ed or reuokeC at cny t;.ne upon vic-Lataon of oty ptcuisions of said Oydinances.
lD:.D.C. 7.5 s
Euilding PenrrLt
State
?otal Chatgea
{?L -lb,ZS = ,=;93
gfre
a Ult
SC
Sig:teti:
FET
x Valuc'5.1'345 /o sy'5o
345a
PLan Cheek Fee: I .Z
-rl+Cuate yaad: r
Reeeipt #: ts
^Iaa-l
44r*
iesi.zrttial (1 bath)
Seuer
:-t/Z=terui Ctret:-ts
Plumbing Pernrit
No person slwLl constz'uct, instaL!, aLter or ciunge cn! neu cr e:istir:c
.lt*1,* or drainage systen in uhoie or in part, unlesi "".n "ni"o"'i"'tinLegal.possessor of a ualid pluntber's License, esceDt tl.a.t a ielscn naz cc
Z:#r."*
uork to proDertu anieh is ormeci, Leased. on operaxeci. t -;i. ;rrl;_
Electricol Permit
I{nere state Lan reouires tiu.t the electrical aoyk be dote b,t an zlectri.eaicontracxct, tite eleerriccl coyxion of titis "";n; "Li1-1""'i t;ci.zi ut::-Jitize la.bel ius been aignei by the Electrieal' Jontycctor..
?I zz- €o
,?o
?3,1o
.';a | '-;J,',--t IViechonicol Permit
'i,:ast HooC
cnt Fot
coasto:se
Pet'nrLt Issuqnee
Meciunietl Perrrit
\
-- Ei,)CRCACHI.IE!IT --
- cfaoe
...n
J.reua
ia.salk
Total Chc'racs
f HAW CAREEALLy IXAI|INED the corqoleted aoplication for permit, cnd d.ahereby eertify that alt it:,fo:nati'on hereon'is ttue ani e'ot.eex', cz,C ffunther .eertif"- that any ard aLL uork perfor-ned. sLaZL be d.one ;.n n""or_<iancetLth the ordinances of the city-ofbpr.ingfietd, and thc L"^;s of thestate of oregon pcrtaininc to the uotk cescribcd herern, cnd tict I:o occu-Pr'.ilCy Ditt b-e nade of aru.r structure uithout permissiott of the Suit.d.Lna pi_uzsion. f furthen certif.ri thet o:zly cont?ae'tors a;;d enplcyees ako aie inco:rpliance uith CRS Z01.0SS uiLL be used on this projec't
n3e
L
bile Hane
8- ts -&b
I
?,20
,12,Gts
TAL Ainu|ff DUE:.l?-b Signed Date
4
-