HomeMy WebLinkAboutPermit Building 2002-11-13
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: 02-00998-01
ISSUED: 09/25/2002
APPLIED: 08/19/2002
EXPIRES: 05/12/2003
VALUE: $ 176,409.00
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1200 R St 1202
ASSESSOR'S PARCEL NO.: 1703261402703
Spr
TYPE OF Duplex
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Land Use: Duplex or 2-Family Hs, Zoning: MDR,
Owner: J M Brandt Drury
Address: PO Box 1473 Springfield OR 97477
Contractor Type
General
Electrical
Mechanical
Owner
Plumbing
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy
P'rimary Construction Type
Secondary Construction
# of Bedrooms:
SETBACKS
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street
Storm Sewer Available:
Special Instruction:
Notes:
# of Stories: 1
Height of 24.00
Type of Heat: I'orced Air Electric
",0
Water ~a'\
Rang~~p~' ~~
1<\.\'" ",,(!\ '" 1\0 f\'
0\$ne~g..y P~h:~~ ...\
~ ~ 0,,0 ... ~e f.>'V '0'"
~0.\'O- ,,\(\0 'D~ 1>... c... OJ .. ~er:, ^
, .....
~0\0j~)E~rEiO~Mi:Na'~i>~TION I
0' . oo~ .\' N1. ~ \.~ '5.\.'" REQUJRED PARKING
/~\~ 0C:J~ ~\.e"\~~()..:s'~o~\.0.~e .~o\.~ ~\C\~'~
:\"""V ~~ (1~ f\'(S ~'\'~tSf.I~Y~l>is~' ~l'8f:~<;)
i('-~o~ #o~ fJ:()~ ...\ o'O'\! e~tf-..'S~~~;:glJes 3 ~ '\iian{jiCapped:
~ ~\v <'J..C?J~ ~0-\0~~O~e~ty~jJive Rqd: 'y o..~ ~ o..~1no~
~o ~'4.o\). 0'" 0 ~\J ~-e.1Q~' -v.<9' &,<\)"\
.~O ~~p' ,~~..:s' o"..:s' i\~'OfLot Coverage: 4ttljJ'~S ~~
()~ ~"0"~ ~\.0 ~~\; ~"' "f?-~<;:j
v,.4\.'O (',0 . f c.; &Vx~ ~ ~
<J.<J IPUBLIC IMPROVE~'Q,~~ '0~~ "" i:l'\>-
" . ~ ~~~~ ik~
Partially Improved '\'0~'\'0~~~~~31 ype:
Yes ~ \0~ ~Wnspouts/Drains
\..) ~ '\
~~
I CONTRACTOR INFORMATION I
Contractor
Blue Pool Construction Inc
GLEN A CAMPBELL
Marshalls Inc
J M Brandt Drury
Eugene Excavation & Plumbing Inc
License
73995
BUILDING INFORMATION I
2
R-3
V-I
VN
Electric
Electric
Path 1
4
1 of 4
Phone Number: (541) 746-1751
Expiration Date Phone
(541) 729-2583
05/24/2004 541-744-0705
(541) 747-7445
(541) 746-1751
(541) 988-0868
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Gar.age/Carport
Sq Ft Other:
Impervious Surface Area:
2,226
528
Setback 5'
To Storm Sewer
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: 02-00998-01
ISSUED: 09/25/2002
APPLIED: 08/19/2002
EXPIRES: 05/1212003
VALUE: $ 176,409.00
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
Square Footage
Value
Date Calculated
Total Value of Project
I Fees Paid'
Fee Description Amount Paid Date Receipt Number Received By
Residential Plan Check $530.34 8/19/02 10330 djb
Multiple Permit Discount - 2nd $-30.00 9/25/02 10712 djb
State Surcharge - Mechanical $3.78 9/25/02 10712 djb
8% Administrative Fee - Mechan $4.32 9/25/02 10712 djb
MWMC Administrative Fee $10.00 9/25/02 10712 djb
Dryer Vent $12.00 9/25/02 10712 djb
Address Assignment $16.00 9/25/02 10712 djb
State Surcharge - Electrical $16.24 9/25/02 10712 djb
Hood and Exhaust $18.00 9/25/02 10712 djb
8% Admin Fee - Electrical $18.56 9/25/02 10712 djb
Vent Fan to One Duct $24.00 9/25/02 10712 djb
State Surcharge - Plumbing $35.56 9/25/02 10712 djb
8% Administrative Fee - Plumbi $40.64 9/25/02 10712 djb
Temporary: 200 Amps or Less $50.00 9/25/02 10712 djb
Planning Plan Review $55.00 9/25/02 10712 djb
State Surcharge For Building P $57.11 9/25/02 10712 djb
8% Building Administrative Fee $65.27 9/25/02 10712 djb
Residential Improvement MWMC $69.66 9/25/02 10712 djb
New Curbcut $75.00 9/25/02 10712 djb
Wiring Footage Each Add'l 500 $76.00 9/25/02 10712 djb
Wiring Footage 1,000 Sq Ft or $106.00 9/25/02 10712 djb
SDC Administrative Fee $274.35 9/25/02 10712 djb
Residential- Reimbursement $321.74 9/25/02 10712 djb
Two Bathrooms $508.00 9/25/02 10712 djb
Residential Sanitary MWMC $665.72 9/25/02 10712 djb
Sanitary Sewer SDC Improvement $671.60 9/25/02 10712 djb
Building Permit $815.90 9/25/02 10712 djb
Sanitary Sewer SDC Reimburseme $883.60 9/25/02 10712 djb
Residential - Improvement $1,419.61 9/25/02 10712 djb
Residential - Duplex - Storm $1,444.97 9/25/02 10712 djb
Duplex - Willamalane $1,848.00 9/25/02 10712 djb
+ 7% State Surcharge $4.41 11/13/02 1200200000000000229 djb
+ 8% Administrative Fee $5.04 11/13/02 1200200000000000229 djb
Perm Serv/Fdr 200 amps or less $63.00 11/13/02 1200200000000000229 djb
Total Amount $10,179.42
Building Permit $815.90 09/25/2002 10712
2 of 4
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Address Assignment
Residential Plan Check
State Surcharge For Building P
8% Building Administrative Fee
New Sidewalk
New Curbcut
Wiring Footage Each Add'l 500
Temporary: 200 Amps or Less
Wiring Footage 1,000 Sq Ft or
8% Admin Fee - Electrical
Two Bathrooms
State Surcharge - Electrical
State Surcharge - Plumbing
Vent Fan to One Duct
8% Administrative Fee - Mechan
Mechanical Issuance
Residential - Improvement
Residential Improvement MWMC
Planning Plan Review
8% Administrative Fee - Plumbi
Hood and Exhaust
State Surcharge - Mechanical
Dryer Vent
Residential - Duplex - Storm
Duplex - Willamalane
Sanitary Sewer SDC Reimburseme
Sanitary Sewer SDC Improvement
Residential Sanitary MWMC
SDC Administrative Fee
MWMC Administrative Fee
Residential - Reimbursement
Total Fees Paid Prior to 9/30/02
En2ineeriDl!-Res
Initial Review-Res
Initial Review-Res
Plannin2-Res
Structural-Res
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: 02-00998-01
ISSUED: 09/25/2002
APPLIED: 08/19/2002
EXPIRES: 05/1212003
VALUE: $ 176,409.00
$16.00 09/25/2002
$530.34 08/19/2002
$57.11 09/25/2002
$65.27 09/25/2002
$75.00 09/25/2002
$75.00 09/25/2002
$76.00 09/25/2002
$50.00 09/25/2002
$106.00 09/25/2002
$18.56 09/25/2002
$508.00 09/25/2002
$16.24 09/25/2002
$35.56 09/25/2002
$24.00 09/25/2002
$4.32 09/25/2002
$10.00 09/25/2002
$1,419.61 09/25/2002
$69.66 09/25/2002
$55.00 09/25/2002
$40.64 09/25/2002
$18.00 09/25/2002
$3.78 09/25/2002
$12.00 09/25/2002
$1,444.97 09/25/2002
$1,848.00 09/25/2002
$883.60 09/25/2002
$671.60 09/25/2002
$665.72 09/25/2002
$274.35 09/25/2002
$10.00 09/25/2002
$321.74 09/25/2002
$10,221.97
I Plan Reviews ,
09/05/2002 Appr VJ
08/20/2002 Wait LH
08/29/2002
Appr LH
08/30/2002
09/24/2002
Appr AD
Appr BB
3 of 4
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10712
10712
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10712
10712
10712
10712
10712
10712
10712
10712
10712
10712
10712
10712
10712
10712
10712
10712
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10712
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10712
10712
10712
10712
10712
No elevation drawings submitted
with plans. Requested Don Moore
to request from applicant. On hold
until received.
Elevations received Friday August
23rd. Remained in "In Box" while I
was out ill until I returned on 8/29.
Please process with a received date
of 8/26 - Ih
REQUIRES NEW DESIGN FOR
3RD BEDROOM WHICH HAS NO
EGRESS WINDOW, CALLED
CONTRACTER
Status:
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: 02-00998-01
ISSUED: 09/25/2002
APPLIED: 08/19/2002
EXPIRES: 05/12/2003
VALUE: $ 176,409.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
To Request an inspection call the 24 hour recording at 726-3769. All inspection 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 work
day.
LReouired Insoections I
1 Rough Electric: Prior to Cover
2 Electric Service: Approval required prior to utility company energizing service.
3 Final Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefuUy 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 701.005 wiD 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.
Owner or Contractors Signature
Date
4 of 4
~. 225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
ELECTRICAL PERMIT APPLICATION
City Job Number 0 Z -d 0 7'7 % -= 0 I
3. CO:MPLETE FEE SCHEDULE BELOW
1. LOC.A TION OF INATALLK{'ION
l'2 00 1<- s"r
LEGAL DESCRIPTION
170's Zb/ i.f
D Z70~
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
\ ~lo'l'li(\9
"'80
"as \\ '.....d use
JOB DESCRIPTION .... ~ c S\)r-"'\\\€'o eC.\\lc If{'JOO sq. ft. or less
fr~ 0 7.. S (2.lIr lee' a. teC\c1.'d s? Each ad . . nal500
>tJ\~~\"I~' .
"e \01\0 ;. ooe~ . or po n
Permits are non-transferabl~~N:lxfrre tl
if work is not started within k8.1Yffi~ys 7..0(\\\"19 \ ~ ,. 0 Each Home or
of issuance or if work is suspended for J\~-"""'- oClular Dwelling
180 days. rV\~) --' >'1.>,<-- Service or Feeder
,,<, . S,\,llw-'
,O{lt-13Cl
2. CONTRACTORINSTALLNr'tt)N ONLY B. Sel-vices or Feeders
/' , . j ~.1 Installation, Alterations or
Electrical COIl tractor ...;,; ""r~ i I ~'L Relocation
Address p) D.- tf:u) -i.. ? l..R ~ 200 amps or less
~_ 201 amps to 400 amps
CityfA Mikw,lk Phone 744-otioS 401 amps to 600. a~p~iotHO
. / I -$ r. 3' ~ G2ddVnltj,rfQ'a~~r!lm~\]\iWi.'J
Supervisor License Number S (P \R ~ ~\ I ct~1" J.~ ~tr~'~tl ~~~l~r~~ se\~or(t~
Expiration Date . Ie. I 10/0# ~O\~O'i~~~~ri:~~~~~~~~~~~~:~ 952~OO~~
. . \.'~O\\t\~ 452..:oont~Q:I~l~Cl:ple'S'~t~ll~\~S
ConstrContr. Number 7 3q~ r- l!P.n OAt1vou gJU!~lu'ffifbm r;~BI{fr1<<~~~(a~~~ion
\}:)90. . tne ceflte~. {\MO ~~~mw Noti~icat~O\(1\
Expiration Date '(1 I, b I () y ca\hnG iOi" the({!)ia~~<<"b~r~s~~344).
I I' 'Ilumhercen~e?~ lli\~flf~a66amps
Signatlli-e of Supervising Electrician Over 401 to 600 amps
At ~w Over 600 amps or 1000 volts see
o . ',t,'" "B" above
ute
... D. Branch Circuits
Owners Name. "S'fl// ~{2./f}VOl tJ~ New Alteration or Extension Per Panel
Items Cost
S Ul~l
$106.00
$ 19.00
$ 50.0'0
I $ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
6.3
$50.00
$69.00
$100.00
Address
po JS.by
sf' p- ~ Phone
/473 Wl]u~(clE:
T~S PERMIT ~M.~~~?IR~ ,IF; bHE, WRJil~ .
AUTHORIZED ~mJ~~ffi~~At1 is 'Nrtrervlce
COMMENCED OR IS ABANDONED fOR
ANY 18(it.o~s~tBf$JGQ).!S (Service/feeder not included)
-Each installation
Pump 'or irrigation
Sign/Outline Lighting
Limited Ellergy/Res
Limited Energy/Comm
One Circuit
$43.00
City
$ 3.00
OWNER INSTALLATION
The installation is being made on
property I o\vn which is not intended
for sale, lease or rent.
Owners Signature:
$50.00
$50.00
$25.00
$45.00
Minimum Electric Permit Inspection Fee is S45.00 + Surcharges
4. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee
b)
TOTAL
"...-
72 ..,;,--
........
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: 02-00998-01
ISSUED: 09/25/2002
APPLIED: 08/19/2002
EXPIRES: 05/14/2003
VALUE: $ 176,409.00
SITE ADDRESS: 1200 R St 1202
ASSESSOR'S PARCEL NO.: 1703261402703
Spr
TYPE OF
Duplex
TYPE OF USE: New Residential
PROJECT DESCRIPTION: Land Use: Duplex or 2-Family Hs, Zoning: MDR,>> This permit includes sanitary,
storm and water line improvements for parcell and parcel 3 also. DB 111802
Owner: J M Brandt Drury
Address: PO Box 1473 Springfield OR 97477
Phone Number: (541) 746-1751
I CONTRACTOR INFORMATION.
Contractor Type
General
Electrical
Mechanical
Owner
Plumbing
Contractor
Blue Pool Construction Inc
GLEN A CAMPBELL 73995 OS/24/2004
MarshaUs Inc ~~
J M Brandt Drury ~\) ~"\
Eugene Excavation & Plumbing Inc 'r "\'<'-~ \S ~
BUILDING INFORMATIQg.~'(.<?x.~~~ ~\:j~
~\..~ " "\~S ~~
# oas . s: ~ S~ ~<.:.,.~ ~'?-~\S 1 Lot Size:
!{f ~~ ~ ~~ ,S ~ 24.00 Sq Ft 1st Floor:
1\YJl~ ~~ I~~~~ectric Sq Ft 2nd Floor:
WMi~ir.~~~~\J~ ~ <?~ Electric Sq Ft Basement:
Ran~ ~~~ <v~ Electric Sq Ft Garage/Carport
Energ;! Nh"i Path 1 Sq Ft Other:
'?-~ Impervious Surface Area:
License
Expiration Date
Phone
(541) 729-2583
541-744-0705
(541) 747-7445
(541) 746-1751
(541) 988-0868
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy
P"rimary Construction Type
Secondary Construction
# of Bedrooms:
2
R-3
U-l
VN
2,226
528
4
SETBACKS
I DEVELOPMENT INFORMATION I 0C21"\0~~~\,,\
~~\'\ 0'(\ 'IJ \Q<ID:QUIRED PARKING
. ~"{0 e~ C210\ (\'\..
Overlay Dlst: 0~,\'lJ. ~00'\ 5'().'(.0 1O'2:~T~tl:
# Street Trees.0"\~i~ o'O"\~ '(.J.0 O~((.g ,\~\0Handicapped:
. Paved Drive .f!.'c:)(j':OO"Q\0 ~"(\ose ~~"(\y,,~0 ~~~~{lact:
. ~~\ t:>C21'lJ. 0'\' <<,to ',~':l~s\ ~0~, ~O
% ofEot"Co~etag~'t\\! ~(\'\~ l"o\4'5.0Qa \00,;*,\v
r ~'~'V ..,jv '~v .'\.\, ~ \\;
\O~~\c'Q.\~(",.?:~~~ O'O\'().~ \~0\~~\~{\'Ln.~".
IPUBLIC IMPR6lVc -E~NTSf~'"O'" :\0~~';...P,)~t:v
.~, - '~"'.~. 0 ~\J\.)
,,\)~V \\\~ . :\ <'i J'C:S""d Ik T .
P . 11 I d v . C0.\ .,\0 ~~, '\. I ewa ype.
artla y mprove :00\ '0'(\\."'"
Yes '(\'\).'{\'\ C Downspouts/Drains
Setback 5'
To Storm Sewer
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street
Storm Sewer Available:
Special Instruction:
Notes:
1 of 3
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: 02-00998-01
ISSUED: 09/25/2002
APPLIED: 08/1912002
EXPIRES: 05/1412003
VALUE: $ 176,409.00
I Valuation Descriution I
Desc ription
Type of Construction
$ Per Sq Ft
Square Footage
Value
Date Calculated
Total Value of Project
LFees Paid I
Fee Description Amount Paid Date Receipt Number Received By
Residential Plan Check $530.34 8/19/02 10330 djb
Multiple Permit Discount - 2nd $-30.00 9/25/02 10712 djb
State Surcharge - Mechanical $3.78 9/25/02 10712 djb
8% Administrative Fee - Meehan $4.32 9/25/02 10712 djb
MWMC Administrative Fee $10.00 9/25/02 10712 djb
Dryer Vent $12.00 9/25/02 10712 djb
Address Assignment $16.00 9/25/02 10712 djb
State Surcharge - Electrical $16.24 9/25/02 10712 djb
Hood and Exhaust $18.00 9/25/02 10712 djb
8% Admin Fee - Electrical $18.56 9/25/02 10712 djb
Vent Fan to One Duct $24.00 9/25/02 10712 djb
State Surcharge - Plumbing $35.56 9/25/02 10712 djb
8% Administrative Fee - Plumbi $40.64 9/25/02 10712 djb
Temporary: 200 Amps or Less $50.00 9/25/02 10712 djb
Planning Plan Review $55.00 9/25/02 10712 djb
State Surcharge For Building P $57.11 9/25/02 10712 djb
8% Building Administrative Fee $65.27 9/25/02 10712 djb
Residential Improvement MWMC $69.66 9/25/02 10712 djb
New Curbcut $75.00 9/25/02 10712 djb
Wiring Footage Each Add'l 500 $76.00 9/25/02 10712 djb
Wiring Footage 1,000 Sq Ft or $106.00 9/25/02 10712 djb
SDC Administrative Fee $274.35 9/25/02 10712 djb
Residential - Reimbursement $321.74 9/25/02 10712 djb
Two Bathrooms $508.00 9/25/02 10712 djb
Residential Sanitary MWMC $665.72 9/25/02 10712 djb
Sanitary Sewer SDC Improvement $671.60 9/25/02 10712 djb
Building Permit $815.90 9/25/02 10712 djb
Sanitary Sewer SDC Reimburseme $883.60 9/25/02 10712 djb
Residential - Improvement $1,419.61 9/25/02 10712 djb
Residential - Duplex - Storm $1,444.97 9/25/02 10712 djb
Duplex - WilIamalane $1,848.00 9/25/02 10712 djb
+ 7% State Surcharge $4.41 11/13102 1200200000000000229 djb
+ 8% Administrative Fee $5.04 11/13/02 1200200000000000229 djb
Perm Serv/Fdr 200 amps or less $63.00 11/13/02 1200200000000000229 djb
+ 7% State Surcharge $27.09 11/18/02 2200200000000000194 djb
+ 8% Administrative Fee $30.96 11/18/02 2200200000000000194 djb
Storm Sewer - Ist 50 Feet $45.00 11/18/02 2200200000000000194 djb
Storm Sewer Each Addtll00' $84.00 11/18/02 2200200000000000194 djb
2 of 3
CITY OF SPRINGFIELD
Building/Combination Permit
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO: 02-00998-01
ISSUED: 09/25/2002
APPLIED: 08/19/2002
EXPIRES: 05/14/2003
VALUE: $ 176,409.00
Encroachment Permit
$120.00
11/18/02
2200200000000000194
djb
Total Amount
$10,486.47
I Plan Reviews I
Engineering-Res
Initial Review-Res
09/05/2002
08/20/2002
Appr V J
Wait LH
No elevation drawings submitted
with plans. Requested Don Moore
to request from applicant. On hold
until received.
Elevations received Friday August
23rd. Remained in "In Box" while I
was out ill until I returned on 8/29.
Please process with a received date
of 8/26 - Ih
Initial Review-Res
08/29/2002
Appr LH
Planning-Res
Structural-Res
08/30/2002
09/24/2002
Appr AD
Appr BB
REQUIRES NEW DESIGN FOR
3RD BEDROOM WHICH HAS NO
EGRESS WINDOW, CALLED
CONTRACTER
To Request an inspection call the 24 hour recording at 726-3769. All inspection 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 work
day.
I Reuuired Insnections I
1 Rough Electric: Prior to Cover
2 Electric Service: Approval required prior to utility company energizing service.
3 Final Electric: When all electrical work is complete.
4 Sanitary Sewer Line: Prior to filling trench and including required testing.
5 Storm Sewer Line: Prior to filling trench.
6 Water Line: Prior to filling trench and including required testing.
7 Encroachment: After item(s) have been removed to inspect condition of public right of way.
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 701.005 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 a.Gi~~,(juring construction.
Y~P?5~l29-:~// /f/;Y)?---
/v ~~
/Owner or Contractors Signature Date
/'
3 of 3