HomeMy WebLinkAboutSpecial Inspection Electrical 1995-10-6
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COURTESY INSPECTION APPLICATION
(RENTER REQUEST)
CITY OF SPRINGFIELD
BUILDING DIVISION
OWNER: ..:QP. ~ PHONE NUMBER: f
OWNER'S A;DRESS:. ,'J'fd ~ ~
RENTER: ~~ M ~~ PHONE NUM~~5, '7</0--0S~O
SIGNATURE OF OCCUPANT (RENT~): cs- ~ . m I ''-"'')~ ~p
FOR AC. CESS TO PROPERTy - TELEPHONE Nm BER: . An..' ~~ ,,~j:t/fo. 6#f8 @3~/~~'
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TYPE OF DWELLING: SINGLE FAMILY tIf- DUPLEX I I MULTIPLE I I '
'"BRIEF DESCRIPT~ON OF MAJO~ PROBL~MS: ~/ ~,' u.Jcvd ~-J ~~P(
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FOR OFFICE USE ONLY
DATE OF INSPECTION:
COURTESY LETTER SENT:
NOTICE AND ORDER ISSUED TO OWNER:
DATE FOR COMPLIANCE:
COMPLIANCE OBTAINED - DATE:
,YOU WILL BE CALLED TO SCHEDULE AN INSPECTION
WITHIN 5 WORKING DAYS
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~ SENDER:
o -Complete items 1 and/or 2 for additional services. /BUILDING I 'also wish to receive the
Iii -Complete items 3, 4a. and 4b. following services (for an
Gl - Print your name and address on the reverse of this form so that we can return this extra fee):
l!! card to you. ' ai
~ -Attach this form to the front of the mailpiece. or on the back if space does not 1. 0 Addressee's Address .~
l!! permit. ...
Gl -Write 'Return Receipt Requested' on the mailpiece below the article number. 2. 0 Restricted Delivery ~
5 -The Return Receipt will show to whom the article was delivered and the date _Q.
c delivered. . ' / . , Consult postmaster for fee.
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c 3. Article Addressed to:~> 4a. Article Number g
~ '>i- Z 7-30 054 0 12. ~
~ L(lQ., ~ '60 VI 4b. Service Type.. \. ?
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\) 2..(10 Q "5 . 0 Registered & '., LV"vertified r;,
~ J 0 ji I j 7 0 Express Mail I, o Insured .~
~. 5pt1 't\()1 OK q"fL{1 T (-"",n RetumRe~iP.t4orM4rChandise D CgD :
~ e. 7. Date of Del7:;rr . [
: 5~d~;; NjY a~ 8. :~~r:~s~e~~~~driss (Only if requested ~
5 ';. S~ (ifddresstM or Agentj
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-: PS Form 3811, December 1994 Domestic Return Receipt
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UNITED STATES POSTAL SE _ICE P'~ '1~g~ ' :J . r:!\S E MA II F~ge-&-F-ees Paid
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DEVELOPM ENT SERVICES
225 FI FTH STREET
SPRINGFIELD_ OR 9'74.77
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