HomeMy WebLinkAboutPermit Building 2010-10-4
CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: COM201 0-01 022
IVR Number: 210183083589
www.ci.springfield.or.us
PROJECT STATUS: Issued
ISSUED: 10/4/10
APPLIED: 7/30/10
EXPIRES: 4/2/2011
VALUE: $400,000.00
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
. Fax: 541-726-3676
permitcenter@ci.springfield.OLU5
SITE ADDRESS: 3333 RIVERBEND Springfield
ASSESOR'S PARCEL NO: 1703220004101
SCOPE: Hospital
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Hyperbaric Chambers
Phone Number:
OWNER:
ADDRESS:
PEACEHEAlTH
PO BOX 1479
EUGENE OR 97440
Contractor Type
Contractor Name
CONTRACTOR INFORMATION ~
Lie Type
Lie No
Lie Exp
Phone
BUilDING INFORMATION ~
Site Information I
ATTENTION' Oregon law requires you.t.o
. t d by the Oregon Utility
;~gl~:~~~~~~~~'~ 6~~:oeur~~e~~~e ~;~_fg~~~
In a obtain copies of the rules y
0090.. You m c~nter. (Note: the telephone
calling tfhe the Oregon U\ility Notification
number or . 4)
Center is 1-800-332-234 .
# of Units: 0
Construction Type
Occupancy Type
Occupancy Comments
# of Stories:
IA Height of Structure:
1-2 Type of Heat:
New Hyperbaric C Water Type:
Range Type:
Hazmat:
# of Bedrooms:
Sprinkled Building: Y
Fire Alarms:
Yes
Electrical Specialty Code Edition:
Springfield Fire Code Edition:
Mechanical Specialty Code Edition:
Municipal I Development Code:
Plumbing Specialty Code Edition:
Residential Specialty Code Edition:
Structural Specialty Code Edition:
Energy Path:
Engineered Fill:
Fill Volume:
Flood Hazard Area:
Land Hazard Area:
Retaining Wall:
Soils Report Required:
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
.',[jTHORIZED UNDER THIS PERMIT IS NOT
,:')MMnJCED OR IS ABANDONED FOR
I" :\. ~ P,Q DilY PERIOD.
Springfield Building Permit
10/4/2010 B:17:3BAM
Lot Size:
Sq Ft 1 st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:.
Sq Ft Garage:
Sq Ft Carport:
. Sq Ft Other:
Occupancy Load:
2007
2007
2007.
Page 1 of 10
S.P~N.G.....FI.E. L~
~'~-'
.~~ ,"'-.
~~
:':S;?\.. OREGON
www.ci.springfield.or.us
CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: COM2010-01022
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenler@ci,springfield.or.us
,
IVR Number: 210183083589
PROJECT STATUS: Issued
ISSUED: 10/4/10
APPLIED: 7/30/10
EXPIRES: 4/2/2011
VALUE: $400,000.00
SITE ADDRESS: 3333 RIVERBEND Springfield
ASSES OR'S PARCEL NO: 1703220004101
SCOPE: Hospital
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Hyperbaric Chambers
DEVELOPMENT INFORMATION ~
Frontyard Setback:
Interior Setback:
Sideyard Setback:
Rearyard Setback:
Solar Setback:
Overlay Dist:
# Street Trees Reqd:
Paved Drive Reqd:
% of Lot Coverage:
Highest point on structure to
north property line:
REQUIRED PARKING
Total:
Handicapped:
Compact:
PUBLIC IMPROVEMENTS
~
Street Improvements:
Storm Sewer:
Storm Sewer Available:
Speciallnstructon:
Subdivision Accepted:
Notes:
Sidewalk Type:
Downspout/Drains:
. Valuation Description
~
Description
Tvpe of Construction
Unit Amount Unit Tyoe
Unit Cost
Value
Springfield Building Permit
10/4/2010 8:17:3BAM
Page 2 of 10
www.cLspringfield.or.us
CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: COM2010-01022
IVR Number: 210183083589
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permilcenter@ci.springfield.or.us
PROJECT STATUS: Issued
ISSUED: 10/4/10
APPLIED: 7/30/10
EXPIRES: 4/2/2011
VALUE: $400,000.00
SITE ADDRESS: 3333 RIVERBEND Springfield
ASSESOR'S PARCEL NO: 1703220004101
SCOPE: Hospital
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Hyperbaric Chambers
[-~~; _:~ ."':~0'~" 0S<-;;~'V.:>q4-,~ ~':
..,:~-~:'~:;T~-;t;JfJ:~;'f;f;~:~:~TtEE~PA(P.M:2;,~i;;}."~;,.i-'"J:~\'d O1'~'i.' ~~" z:: :':';,7~:?;'S:Y0:,'jIr' 'ff~: f/;}1c;~*~:0'},!:~
Amount Paid Date Paid Receipt #
$771.90 10/04/2010 374467
$1900 10/04/2010 374467
-,~~~..-..
$0.75 10/04/2010 374467
----,---
$1900 10/04/2010 374467
_."~"--'~---.
$152.00 10/04/2010 374467
$38.00 10/04/2010 374467
$19.00 10/04/2010 374467
$35.50 10/04/2010 374467
$1,929.75 10/04/2010 374467
$342.00 10/04/2010 374467
$3420 10/04/2010 374467
$916.32 10/04/2010 374467
$326.17 10/04/2010 374467
---~,_..._-----~
$97.85 10/04/2010 374467
$410.31 10/04/2010 374467
$188.06 10/04/2010 374467
$1,254.34 09/08/2010 299460
$6,554.15
Description
Fire, Life, Safety Plan Review
Fixture cap
First copy
Floor drain/fl9m sink/hub,
Sink/basin/lavatory
Water closet
Sanitary Waste or Portable Water Supply not listed
Each additional copy
Building Permit Fee
Deferred Submittal
Admin fee (10% of applicable fees)
Mechanical Permit fee (based on value of work)
Medical Gas Permit fee (based on value of work)
Medical Gas Plan Review (30% of medical gas fee)
~~ate of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit totaIL.
Structural Plan Review Fee Commercial
Total Amount Paid
Springfield Building Permil
10f4/2010 8:17:3BAM
Page 3of10
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: COM2010-01022
IVR Number: 210183083589
www.ci.springfield.or.us
permitcenler@cLspringfield.or.us
PROJECT STATUS: Issued
EXPIRES: 4/2/2011
VALUE: $400,000.00
ISSUED: 10/4/10
APPLIED: 7/30/10
SITE ADDRESS: 3333 RIVERBEND Springfield
ASSESOR'S PARCEL NO: 1703220004101
SCOPE: Hospital
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Hyperbaric Chambers
r~:::':~'-~~~,;-?,-':;'~:~.".~. '/~~~"'~PJ~'~evi~~~;::;,~::J~::::,T;;:::-,:--<i ~'~i"":.-;:::~'~';,~~~-:~~~~:-'"::;~~j
Department Received Due Date Complete Result Reviewer
Plumbing Review 1 0/01/201 0 08/09/2010 08/09/2010 Approved Steve Graham
Permi11ssuance 10/04/2010 10/01/2010 10/01/2010 Issued Nancy Machado
Electrical Review 09/08/2010 08/09/2010 08/09/2010 Add'llnfo Required Bryan Richardson
Electrical Review 09/09/2010 08/09/2010 08/09/2010 Approved Bryan Richardson
Structural Review 10/01/2010 08/09/2010 08/09/2010 Approved Kip Kaufman
Public Works Review 10/01/2010 08/09/2010 08/09/2010 Approved Kaye Wilson
Plumbing Review 08/26/2010 08/09/2010 08/09/2010 Add'llnfo Required Steve Graham
Plumbing Review 08/26/2010 08/09/2010 08/09/2010 Add'llnfo Required Kip Kaufman
Structural Review 08/26/2010 08/09/2010 08/09/2010 Add'llnfo Required Kip Kaufman
Plumbing Review 08/27/2010 08/09/2010 08/09/2010 Add'llnfo Required Steve Graham
Plumbing Review 08/25/2010 08/09/2010 08/09/2010 Add'llnfo Required Steve Graham
Planning Review 08/16/2010 . 08/09/2010 08/09/2010 Approved Liz Miller
Plumbing Review. 08/13/2010 08/09/2010 08/09/2010 Review Steve Graham
Initial Review 07/23/2010 08/09/2010 08/09/2010 Approved Chris Carpenter
Application Acceptance 07/30/2010 08/09/2010 Application Accepted Chris Carpenter
Fire Review 09/22/2010 08/09/2010 08/09/2010 Add'llnfo Required Gilbert Gordon
Plumbing Review 09/14/2010 08/09/2010 08/09/2010 Review Steve Graham
Fire Review 09/24/2010 08/09/2010 08/09/2010 Information Only Kip Kaufman
,Plumbing Review 09/16/2010 08/09/2010 08/09/2010 Not Required Kip Kaufman
Energy Code Review 09/16/2010 08/09/2010 08/09/2010 Not Required Kip Kaufman
Fire Review 09/30/2010 08/09/2010 08/09/2010 Approved Gilbert Gordon
Structural Review 09/10/2010 08/09/2010 08/09/2010 Information Only Kip Kaufman
Structural Review 09/24/2010 08/09/2010 08/09/2010 Informatlon Only Kip Kaufman
Springfield Building Permit
10f4/2010 8:17:38AM
Comments
Med Gas: Modify existing Le
Sent E-mail to Mike VVhite wit
Ok to issue electrical permits
Received and reviewed on 9-
Need Hyperbaric Chamber rJ.
Interior Only - Not leased par
E-mail sent on 9/22/10 reque
Med Gas
Received architect's correctie
Info. routed to SUB, OK to is~
See attached document for F
Received architect's respons'
Received architect's correctie
Page 4 of 10
sr~~..~~~
~~~
~O'REGON
www.cLspringfield.or.us
CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: COM201 0-01 022
IVR Number: 210183083589
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@cLspringfield.or.us
PROJECT STATUS: Issued
ISSUED: 10/4/10
APPLIED: 7/30/10
EXPIRES: 4/2/2011
VALUE: $400,000.00
SITE ADDRESS: 3333 RIVERBEND Springfield
ASSESOR'S PARCEL NO: 1703220004101
SCOPE: Hospital
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Hyperbaric Chambers
INSPECTIONS REQUIRED ~
Inspections
1260 Framing
1540 Gypsum Board/LathlDrywall
1550 Firewall
1560 Firestop Assemblies
1600 Ceiling Grid
1710 Fire Sprinklers
1740 Fire Alarm Final
1800 Emergency Egr~ss Lighting
1999 Final Building
2180 Fire/Smoke Damper
2220 Underfloor Medical Gas
2300 Rough Mechanical
2997 Final Medical Gas
2999 Final Mechanical
3500 Rough Plumbing
3800 Medical Gas Piping
3999 Final Plumbing
4500 Rough Electrical
4999 Final Electrical
8690 Fire Sprinkler Final
8790 Fire Alarm Final
8999 Final Fire
OWNER:
ADDRESS:
PEACEHEALTH
PO BOX 1479
EUGENE OR 97440
Phone Number:
Contractor Type
Contractor Name
CONTRACTOR INFORMATION ~
Lie Type
Lie No
Lie Exp
Phone
Springfield Building Permit
10/4/2010 8:17:38AM
Page 5 ot 10
CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: COM2010-01022
IVR Number: 210183083589
www.ci.springfield.OLUS
225 Fifth ,St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
pennilcenter@cLspringfield.or.us
PROJECT STATUS: Issued
ISSUED: 10/4/10
APPLIED: 7/30/10
EXPIRES: 4/2/2011
VALUE: $400,000.00
SITE AODRESS: 3333 RIVERBEND Springfield
ASSESOR'S PARCEL NO: 1703220004102
SCOPE: Hospital
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Hyperbaric Chambers
BUilDING INFORMATION ~
# of Units: 0
Construction Type
Occupancy Type
Occupancy Comments
# of Stories:
IA Height of Structure:
1-2 Type of Heat:
New Hyperbaric ( Water Type:
Range Type:
# of Bedrooms:
Hazmat:
Sprinkled Building: Y
Fire Alarms:
Yes
Electrical Specialty Code Edition:
Springfield Fii"e Code Edition:
Mechanical Specialty Code Edition:
Municipal I Development Code:
Plumbing Specialty Code Edition:
Residential Specialty Code Edition:
Structural Specialty Code Edition:
Energy Path:
Site Information
Engineered Fill:
Fill Volume:
Flood Hazard Area:
Land Hazard Area:
Retaining Wall:
Soils Report Required:
lot Size:
Sq Ft 1 st Floor: .
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage:
Sq Ft Carport:
Sq Ft Other:
O~cupancy Load:
2007
2007
2007
~
DEVELOPMENT INFORMATION ~
Frontyard Setback:
Interior Setback:
Sideyard Setback:
Rearyard Setback:
Solar Setback:
Overlay Dist:
# Street Trees Reqd:
Paved Drive Reqd:
% of Lot Coverage:
Highest point on structure to
north property line:
Springfield Building Permit
10/4/2010 8:17:38AM
REQUIRED PARKING
Total:
Handicapped:
Compact:
Page 6 of 10
www.ci.springfield.or.us
CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: COM2010-01022
IVR Number: 210183083589
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
S~4IiN~~.I<~
.~~~
~:,1Eh OREGON
permitcenter@ci.springfie\d,or.us
PROJECT STATUS: Issued
ISSUED: 10/4/10
APPLIED: 7/30/10
EXPIRES: 4/2/2011
VALUE: $400,000.00
SITE ADDRESS: 3333 RIVERBEND Springfield
ASSESOR'S PARCEL NO: 1703220004102
SCOPE: Hospital
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Hyperbaric Chambers
PUBLIC IMPROVEMENTS
~
Street Improvements:
Storm Sewer:
Storm Sewer Available:
Speciallnstructon:
Subdivision Accepted:
Notes:
Sidewalk Type:
Downspout/Drains:
Valuation Description
~
Descriotion
Tvpe of Construction
Unit Amount Unit Tvoe
Unit Cost"
Value
.'
r':~;;.;r~~:;:+~:T">~;:;'~JR.iZ~~~:r::~'iI:'.4 ':~J:t.i::)':~~~i€gl;~~~~IJi:~?:s;;~3:~~~-2t:!:i:r~;' :_-::,. ~".-:--__;';~0:~~L:'7;'_--,~:,.~~:~ __~~j
Description
Fire, Life, Safety Plan Review
fixture cap
:irs~ copy
Floor drain/floor sink/hub
Sink/~asin/lavatory
Water closet
Sanitary Waste or Portable Water Supply not listed
Each additional copy
Building Permit Fee
Deferred Submittal
Admin f~: (10% ~_~pJ:~icable f:.:~____
Mechanical Permit fee (based on value of work)
Medical Gas P:rmit fee (based on value of work)
Medical Gas Plan Review (30% of medical gas fee)
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
Structural Plan Review Fee Commercial
Total Amount Paid
Amount Paid Date Paid
$771.90 10/04/2010
$19.00 10/04/2010
$0.75 10/04/2010
------._,
$19.00 10/04/2010
$152.00 10/04/2010
$38.00 10/04/2010
$19.00 10/04/2010
$35.50 10/04/2010
$1,929.75 10/04/2010
.-._--'"-"~"'---..._---
$342.00 10/04/2010
~--~--,~--,---"-,~
$34.20 10/04/2010
~~ -,,-----~ ._---~~.-
$916.32 10/04/2010
~_._-----.'--"-_._.----------_.~..-
$326.17 10/04/2010
$97.85 10/04/2010
$410.31 10/04/2010
$188.06 10/04/2010
$1,254.34 09/08/2010
$6.554,15
Receipt #
374467
-,----
374467
"-"-"---,,---,-
374467
374467
374467
374467
374467
374467
374467
374467
374467
,,---"._--,,-
374467
----------
374467
374467
374467
374467
299460
Springfield Building Perm,it
10/4/2010 8:17:38AM
Page 7 of 10
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: COM201 0-01 022
IVR Number: 210183083589
www.ci.springfield.or.us
PROJECT STATUS: Issued
ISSUED: 10/4/10
APPLIED: 7/30/10
EXPIRES: 4/2/2011
VALUE: $400,000.00
permitcenler@ci.springfield.or.us
SITE ADDRESS: 3333 RIVERBEND Springfield SCOPE: Hospital
ASSES OR'S PARCEL NO: 1703220004102 WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Hyperbaric Chambers
Deoartment Received Due Date Comolete Result Reviewer
Plumbing Review 10101/2010 08/0912010 08/0912010 Approved Steve Graham
Permit Issuance 10/04/2010 10/0112010 10101/2010 Issued Nancy Machado
Electrical Review 09108/2010 08/0912010 08/0912010 Add'llnfo Required Bryan Richardson
Electrical Review 09/09/2010 08/0912010 08/09/2010 Approved Bryan Richardson
Structural Review 10101/2010 08/0912010 08/0912010 Approved Kip Kaufman
Public Works Review 10101/2010 08/0912010 08/0912010 Approved Kaye Wilson
Plumbing Review 08126/2010 08/0912010 08/0912010 Add'llnfo Required Steve Graham
Plumbing Review 08126/2010 08/09/2010 08/0912010 Add'llnfo Required Kip Kaufman
Structural Review 08126/2010 08/0912010 08/0912010 Add'llnfo Required Kip Kaufman
plumbing Review 08127/2010 08109/2010 08/0912010 Add'llnfo Required Steve Graham
Plumbing Review 08125/2010 08109/2010 0810912010 Add'llnfo Required Steve Graham
Planning Review 08116/2010 08109/2010 08/0912010 Approved Liz Miller
Plumbing Review 08/1312010 08109/2010 0810912010 Review Steve Graham
Initial Review 07/2312010 08109/2010 08/0912010 Approved Chris Carpenter
Application Acceptance 07/3012010 08109/2010 Application Accepted Chris Carpenter
Fire Review 09/2212010 08109/2010 08/09/2010 Add'llnfo Required Gilbert Gordon
Plumbing Review 09/1412010 08109/2010 08109/2010 Review Steve Graham
Fire Review 09/24/2010 08109/2010 08109/2010 Information Only Kip Kaufman
Plumbing Review 09/16/2010 08/0912010 08109/2010 Not Required Kip Kaufman
Energy Code Review 09/16/2010 08/0912010 08109/2010 Not Required Kip Kaufman
Fire Review 09130/2010 08/0912010 08/0912010 Approved Gilbert Gordon
Structural Review 09110/2010 08/09/2010 . 08/0912010 Information Only Kip Kaufman
Structural Review 0912412010 08109/2010 08/0912010 Information Only Kip Kaufman
Springfield Building Permit
10/4/2010 8:17:38AM
Comments
Med Gas: Modify existing Le
Sent E-mail to Mike White wH
Ok to issue electrical permits
Received and reviewed on 9-
Need Hyperbaric Chamber tv.
Interior Only - Not leased par
E+mail sent on 9/22/10 reque
Med Gas
Received architect's correcti(
Info. routed to S.UB, OK to is!
See attached document for F
Received architect's respons,
Received architect's correcti(
Page 8 of 10
~S~~~NaFI~LD
,. .,
"". "
c'~,. .~
'-. .-. .... OREGON
CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: COM201 0-01 022
IVR Number: 210183083589
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
www.ci.springfield.orus
permitcenter@cLspringfield.or.us
PROJECT STATUS: Issued
ISSUED: 10/4/10
APPLIED: 7/30/10
EXPIRES: 4/2/2011
VALUE: $400,000.00
SITE ADDRESS: 3333 RIVERBEND Springfield
ASSESOR'S PARCEL NO: 1703220004102
SCOPE: Hospital
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Hyperbaric Chambers
INSPECTIONS REQUIRED ~
Inspections
1260 Framing
1540 Gypsum Board/Lath/Drywall
1550 Firewall
1560 Firestop Assemblies
1600 Ceiling Grid
1710 Fire Sprinklers
1740 Fire Alarm Final
1800 Emergency Egress Lighting
1999 Final Buildin9
2180 Fire/Smoke Damper
2220 Underfloor Medical Gas
2300 Rough Mechanical
2997 Final Medical Gas
2999 Final Mechanical
3500 Rough Plumbing
3800 Medical Gas Piping
3999 Final Plumbing
4500 Rough Electrical
4999 Final Electrical
8690 Fire Sprinkler Final
8790 Fire Alarm Final
8999 Final Fire
Springfield Building Permit
10/4/2010 8:17:38AM
Page 9 of 10
www.ci.springfield.or.us
CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: COM2010-01022
IVR Number: 210183083589
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726.3676
permitcenler@ci.springfield.or,us
PROJECT STATUS: Issued
ISSUED: 10/4/10
APPLIED: 7/30/10
EXPIRES: 4/2/2011
VALUE: $400,000.00
SITE ADDRESS: 3333 RIVERBEND Springfield
ASSESOR'S PARCEL NO: 1703220004102
SCOPE: Hospital
WORK INVOLVED: Alteration
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Hyperbaric Chambers
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 or 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 701.005 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.
L~I
.,---~.-~
1[;-'-1,-10
Date
Springfield Building Permit
10/4/2010 8:17:38AM
Page 10 of 10