HomeMy WebLinkAboutSpecial Inspection Correspondence 5-12-23
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hcCEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PRoVIDEo-
NOT FOR INTERNATIONAL MAIL
(See Reverse)
SENT TO
Roy Gray
STRi~ '~D ~i1 n ny Drive
P.O'8TATEANDZIPB~DE 404
ugene, 97
POSTAGE $ a.
CERTIFIED FEE /'::J ~
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W w SPECIAL DELIVERY ~
U ~ RESTRICTED DELIVERY
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fr 70
a: '" w SHOW TO WHOM ANO ~
w W <.:l OA TE OELlVEREO
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::E 2 c W OELlVERY
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0 '" C> :z OELlVERY
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<.:l li:i SHOW TO WHOM, OATEANO
a: AOORESS OF OELlVERY WITH ~
RESTRICTEO OELlVERY
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STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE,
CERTIFIED MAIL FEE, AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES. (see front)
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1. If you want this receipt postmarked, stick the gummed stub on the left portion of the address side of
the article, leaving the receipt attached, and present the article at a post office service window or
hand it to your rural carrier. (no extra charge)
2. If you do not want this receipt postmarked, stick the gummed stub on the left portion of the address _
side of the article, date, detach and retain the receipt, and mail the article. .<.;' '-'-,
3. If you want a return receipt, write the certified-mail number and your name and address o'n a return .' ,
receipt card, Form 3811, and attach it to the front of the article by means of the gU(l1rTled ends if space I".
permits. Otherwise, affix to back of article. Endorse front of article RETURN RECEIp'T REQUESTED'" I '.-
adjacent to the number. (. - /' ~;~
4. If you want delivery restricted to the addressee, or to an authorized agent of the addre?see, -: .... _ - -. 'f" /
endorse RESTRICTED DELIVERY on the front of the article. ':. '
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If retu.rn....
receipt is requested, check the applicable blocks in Item 1 of Form 3811.
6. Save this receipt and present it if you make inquiry.
"'GPO: 1980331-003
~ ClTY O~ SPRINGFIELD
DEPARTMENT OF PUBLIC WORKS
(N~~ffi 5th ::; I Ktt I
C::OP1"'~rIFII,) nRF~nN 97477
(No. end Street. Apt., Suite, P.O~ Box or R.D. No.)
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UNITED STATES PO;)~~EmC::E ~.
OFflClAL BUSIIVESS ! r:- "~:
SENDER INSTRU..!'t.,.. Ja. . /
PrInt your neme, address, end ZIP~lh' .
epace bolow. .'
41 Complete Item. 1, 2, 3t and 4 on the reverse.
. Attach to front of III'tIClG If apace pennlta,
otherwIH efk to bact of article.
. Endorae artlcla "Retum Receipt Req1illltod"
adJacent to number.
RETURN
TO
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Don Moore
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PENALTY FOR PRIVATE
USE.t3llO
(City, State, and ZI....Code)
~ 'ISENDER: Complete item, 1. 2, 3 and 4.
~ your addreu in the "RETURN TO" spIKe on the .
3 ers8 .ide. Failure to do this will prllY8f1t this card from
W being returned to you. Th.. return receiot 18<1 ....ill provide'
~ '(00 the name 01 the person dlIlivet'ed to and the date ot
.~ delivery. For addltlonaI1_,~e following servicet are .
lIVailable. Consult postmllStW 10r 1_ and check bo.(etl
10r aenlcelsl requested. '
1. ~how to whom. d918and address 01 delivery.
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2. 0 Restricted Delivery.
3, Article AddrllUed to;
Roy Gray
1379 Sunny
Eugene, OR
Drive
97404
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Article Number
..o,,Reginered 0 Insured
xe9"'Certified 0 COD
o Express Mail
P329964107
AlwaYI obtain lignaturll olltddressell.Q!.lIgenlllnd
DATE DELIVERED.
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8. Address8e'~ Addrea (ONL Y if requested and fee paid)
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STRUCTURAL INSPECTION REPORT
JOB ADDRESS
OWNER
ADDRESS
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./L-<.s-?'?? f_ r .. ) /
DATE
PHONE
TENANT OR OCCUPANT
TYPE OF INSPECTION: HOUSING OCCUPANCY _ COMPLAINT FIRE DAMAGE
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FIRE DAMAGE REPORT
OR _
ELECTRICAL HAZARD
DATE: .l..Q-r;}.] -,1:)'
TO: Su; 1 ding Depa rtment
FROM: Spri ngfi e 1 d Fi re Department
SUBJECT: Structural Damage to Buil di ng
Address, or' location of building
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Name of o'tmer
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Type of building '()/)PLE'i.-,:-; '\TIIRV
(Dwelling, Store, Warehouse, etc.)
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Estimated value of building $ &.s:(){)(J.(X)
Estimated loss to building
Da te of fi re 1(2 -c.:;3 -~J
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Location of damage. in building .RnrJF. fOALLC, ;:t.(}o/, /'.~~Tf1JI".r;.
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1/}-1lt"/O f!' INr,c r.IOf' ,(]/}/11 )~(...r:..
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire PI"Y)F b)/1tISJ ro"rr/I!.f'<orAu'S,
l1J.!bJFf1 ,Inl <;7<;, .. qUi)S} Tlf'u S'5_
. ~ . (Burned rafters, Beams, Joists:, etc.)
Additi ana 1 perti nent i nforma ti an
Electrical' Hazard /~J///~J(;: /HP/)I}f'..:HI'.V},' O/'lll/., ,cII'F /J/J.rrl /1~;E/J.
(Wiring, Outlets~ etc.)
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