HomeMy WebLinkAboutPermit Easement 2004-7-22
Community Services Div, Building Safety .Job Address i-o-r Ib I ~
cut OF SPRINGFIELD, OREGON . CityJob# C- ff'-t9/!'1- '5!;; .
225 5th Street. Springfield, OR 97477 Ph. 726-3759 ;553 ~
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Affidavit
For Site Investigation Questionnaire
Foundation:: SulrGrade: Approval. for
Residentia 1 R~ding:Sitejn- ArnblesideMeadows---l st Addition
SiIbdiVision~.
~e:undersignf"1i.hf"J'ebpffirmcth~t1:he:Cl.4v4Lio~.5trlictmauiILandmoistme. .
stabilization:methods:.iliLLhe:bni1rlin&:sitP"~t-tbe;~nnress-shuw .u:.above~was:observed by
me~0r.an:authorized:employee:of..LU.1:fL.lL4Wi-tb.cLi.Leof611owffig:is:tme::
..1. ... .The:fonndatiorr~grade:is:~abIe:ofsupporting:.amjnjmnm:ofJ500.psf;. and is .
- adequate~to~ snpport1he:biriIdiIi5: X'.1uyosed.IuL.Jris:site..:-
2. .Th~ moisture content. of the excavation was adequately maintained during the site
preparation process and was adequately. covered to stabilized moisture content.
. priOr to any significant chaIige in moisture content of the sub-~e. .
3. The site is adequately graded and drained to prevent the collection. of water in the
excavated area during construction. .
4. The accompanying report title(L"Site Investigation Questionn3iIefor-ConsUlting
Design f\uf~ona1s" cOntaiiring field observations and instrpctio~.made on . .
1-' ~ ...4 l ~ , - t..z..-tP4- (date) fei the building site wasoCvUJfJleted either by
myself or by an employee of my firm under my supetvision. To the best of my
. knowledge, the information contained in that u"yuu is ~u.q.tlete and ~w.ate.
Name of Licensed Professional (print) l. €t.l.d
Date 'l-"ZL-of
..,,~'
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Signature ~ S)
I EXPIRATION DATE:/t.-l'-CIS'
Community Services Div, BU..lg Safety
CITY OF SPRINGFIELD, OREGON.
225 5th Street, Springfield, OR 9.7477 Ph. 726-3759
Job Address ~ l~
City Job #,
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AMBLEsruEJ.\1EADOWS SUBDIVIsION-1ST ADDITiON
SiteInvestigation. Questionnaire for Consulting.DesigrrProfessionals
fOllnrl~ tion: requirements. - new. structures. onTesidentiallots
This.fornI.ULclJ'.bansed:as.a~~rary'vt.l..ii:ication:to.allow ~~ "ction.to. continue
on. thejob:sfie..u.utilthe:.con~I~'~'ctampec:bimdavit:on:the:site:soil....~action .
and:smhm7'mmd~'l;llhtnittPrl,.fo1he=City;'::"'I'JiiS:L.~completedby a
licensed:dP!clL'~-l'J..uI~~...;nnal~(enemP.E'r..'''''' hitect):or--bi~f'~antborized' ... "t-1oyee,
. anrl:~lnnitiPIiio:the:bnt1n:~~. :"~~p~~~il~~ons:or
P1':",.n.., ..~.~ t -~.... I '.'~n-1pleSti be ered...
. 1a~..~on.COJ1'lr' c. ~t -u.at!U' .....1....,. 7. ODS: ~ :'.
l.Ul.llplete11.~udhe:fonnif~tion-mp'~O.:~~'prov.~or.:co~uCtiO~~--::H'_. _
. .
OwneI?aridlor~~ntra~r-.L~M ~. ~~~~~ ..t~~p~t:..: .... . .
..L ... ~:of_th~:design:pl.~f~J~~~I~:~~~~a~~~?t~d./r":i1L+.J':''-I.~ ~ .bL..
. . . : - . .... . ." :'; . - . . '.
2. . Has the design professional reviewed a copy of the geotechnical information :
fo~~subdivision that was provided ~th.the-bnilding p~nnit? . YesLNo_.
Ii not, please contact this office for a copy'ofthe report. . The design professiorial
must~familiar with the geote~ information before completing this form.
3. What was the size and depth of the excavation and lor fill? .
EXc.AVkr"loil Cor? N.t,ll;t'l, () f; ? ~~ ~A l..-~ . b~T\JC: b&= ~~IJ.t,.l\o c..1<\ M.
~. ~.. ~ 7~~. , .
.t.J '" l;<:KI&'Ti"-l/-r P" .IJ ~ ~~~}, ~'~rA"UN~"-'" A.T 11\.,'-; SI re
,..
. vias ~g non-stmctura1 fill or expansive soil encountered on the lot?
Yes~No~ If "yes", what types, depths and locations?
~o ~Pt.l~STf1.~CTIA~ .;::"''..1..;. l~( ffo.J~-t'IoI".ln1l.l1:b ~- n4l'!"
(I)
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L1.) NI\n~'1 \^loJ)'\~~~ <'''I'.:~ ~"Lf~!tr ,?r= r.)(pAN~l\J~ Goll-!..
~PAN~l\r~ c"O\'.ff~ ~l~n p1-T ~....?!~ FIL.t'w.~ ~tJl[ -f'L70r g U-OlU ~6 SI^,').IAt..~
JtJ ~: ~\.(Tl'/l.l:' Dt.~ C!" A->..d. ~ t..~,n~,-1 M.kle'lM ukA. 8')
. What measures were tlllrpn to remedy the soil condition (include type of
engineered fill used to stabilize the soil)? ':I:r-J 1,1-A I.' . , 2.. tyf '3 ~ - ~ c.Jl,l{~tfb)\ 12PcJ.(...,
11\)<::'7)41.:\: A-:Dl>l~\l)lIMl ~ '% -. - lr< D/2.u~t+t...~ 1L~c.J'.. ~ At:LtMl &A-Il~e 51".Af3
'fILL. ~ Q(~.tl.~ ..:.(,," l$"1cAJtc. ~~T1.:,Yl t.b~ DFFtJ'r1tY.f~ 0") ~b t,iM,~
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. Community Services Div, B, .Ig Safety Job Address L-e~ I ~
CITY OF SPRINGFIELD, OREGON . City Job #
225 5lh Street, Springfield, OR 97477 Ph. 726-3759
e't.cr.;PT.-rrI:E' \.{ ,",SL.oPE "? (/'H>: AT IA..04 t..or?l?; oS I 0 ~. ICX.~D '\i1l)
I " .. . -.r .
(!)l..\.~ f..DI9.l;;:" of ~'1"'A\N.U\c., W~\.'.! ~_ r=i>o<nNf,\_
COM(i}Ac"'T Lh.L S'Nl..V\A-1lAVLA-\. J==.II I _. To 92.~", lLa,...~\^~
t .. ,- _ ...~
c.. D Mo A-vY'H to> f\...1 0 i"\ I iF1 r;i\\ .? a.o c. TI?R.-.
. ., ..
Is the site as prepared. adequate rsr" inadequate 0 to maintain constantmoisture
contentiILthe.sub:g:rade? Note: Verification ofmoisiUrestabilization in the sub
grade is a requirement of the geotechnical report; and must be affirmed before
consrruction can: conrinue.
Ifinadeqnate;. wh atlDeasllres:are: needed. to:provide. constantmoisnIre:content:in
. the:snb:grade? .. . ..
..., :..~.... . ;....>~...:~.. . ... -:;'-..'.. 0..:::-:;'..'...>:". ~,.:
.l!;.the'~:as-~~!I,~~~~~.i!u~4eqJ#l!e~ D;;to:~ul'~~~~~~";;..
: S~7~~izffi,-~~-;'f.!ivXi:fii#Wei:ifie~i.~o:p'r~i#ig;~:~~~~. .
. If ma~:'i~~iidditiol1al:work:iS;'neededto.p~'; f;de;adeqimteil: ..
r. .:1':'-=.:.. . ..... . . . - -e.. .
~\!_UllWUilUnsnpport?:".. . .
4. Did ~ design professional witness placement and ~~action of the
engiD....lL'l;.J fili; or is there a special inspection report forthco~ 1i. UUA.a .
qna1ified agency? J witneSsed PIacimzent 0 Specii.d Insp/compaction report ~
5. The design p~:~onaI ~ten~ to use the. foIL Il:"'g ~od fo~ installation.
of .per~oLal perimeter footing dI-afus: .....:
The design on the attached drawing provided by the design professional ...~.. ~
The mdbod shown on the original constmction drawings................ ~. ~...... 0
. The i.J}I~ 'Foundation pram' dci.wing attached to permit..... ....... ~........ 0
.Perfu~cJ.;J'perimeter drains are not required,' ..... .... ..... .~...... .......... ....... 0
Com~
Note: City Inspectors will inspeciinstalled drainsprior to cover upon request...
Call.: 726-3769 to schedule inspection.
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Community Services Div, J.. .ling Safety .
CITY OF SPRmGFIELD, OREGON
225 Sill Street, Springfield, OR 97477 Ph. 726-3759
Job Address u-~r J
City Job #
Low-point ~4nl space drains are required to prevent the build-up of.excess
moisture inside the foundations during (and after) coristtuction._ This drain
may be installed after foundation placement onlv with the exnress oermission
of the desim orofessional
a. The design professionaI.has determined the following:
The crawl space drain is required when thefoundaIion is i:nstal1ed..... 0
The. low-point drain- can be. installed-after foun.dationplacement without a
signifit:an!moisture-build""upproblem within thefowidation............. ~.
(TJie-Iow:..point:dr~~.lUay:be:installed.:auhe .. ... ~. stage
,.;:. . ....,.;~) past &:berzm,)._._.g.~1fK1JUlg.. ac._
0~~~~- . ... . .
b._ Hizs:the:desilS~~~,.vJessional:obser.ved:and:approveti~~ofthe.
refprired- T ~point:drO.iizL............~............. .....~.._y es;~ N 0-0 V-
. . il"yes':;: w1iereis:the;low.point::drain:locatettunder:t1iiJJili1diiig;and:.~ ...
. _ _ _. _ }J!.lzere:dtJ~:~~-f1:t:~?.;(n;ustbe:an.:':"t'Y.:!. u !eA.:IiJc:atjp~i.e.~.
. street:~r;::sto~:sewer;:sump.pz.anp~tirid:diScharg~tO:tlie:siTeet,::~: .
.e~). .. .
...- ..
The design.professional must determine whether the approved permit.drawings have. ..
adequate. foundation steeL Is any additional foundation steel required that is not
shown on the fotindationdrawings for the building? .. -... . . . . .
Yes No /. If "yes", describe. additional steel required (or provide drawing).
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The following statement mUst be signed by the iruIividua1 dlJing the observations and
providing direction for the eJ:CllVatWn and site preparation work on the property..
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Community Sc:rvic::s Div, Building Safety
CITY OF SPRlNGr It:.LD, OREGON
225 Sib St:re:t, Springfield, OR l[l477 Ph. 726-3759
Job Address kT 1$'
City Job t: .
'. .1'
The laZfIersiglled design professional (or authorized employee) izttests that heJshe
observed required moisture stabiiiiy procetiures on this site, and that su.ch procedures
were CU?CDmplished before any cJuu;,ces 0.........., .A in the moistui-e content of the Sub.
grade. under and around tJze building (where expansive soils were encountered). The
ll1Ulersigned j~ Sd!T- attesJs that the sub-grade, as 1" .:.:'~ is adequate to ~""1:'1'ort the
building P' u!lDSed for this site.
Additional Willi' ,pn~:
. . ~ote)::A::copy:of:thiS:repa&~t:.n. ~lr'n:~~proved:pbn:,:."'( all~2_ .
. : - t.imes;_ . . ...
. . .'
. _.._Thic:~u- ~ll0e:f611~~~bymr:ffi1rl~ \';; j~eriffi'mlfi~ .J",..~..:~by:tD.C:~in:-:':.'.
.'~pro~--'. .:... ,... ..- d. . ...~cOnfl;.ted;~~.::"a.tbe:mformation
- . ~hCrei~~;. .Lhe~~~P.di;~~ffi~~ido~.witfi.r.~!lJ oftbis.report:sbaIlbe-
snb~:t;01his:or:n~'Prior~~~~ ~~ inspection. for. the.bUilding.-:~ .
Sien:l~ ~);) .~ f.e- _ <;.\>~ .
Name~.....~ FAI!>Llc..AfoLr Pit..c;.~ rnfe P#l.\~C.,PItt-
Comp3ny ~^t4C4 ~r~NE.ei.~liaJ ,'.I:NC_ .
Phone 1+" otoY1 ..
.Licei1see 'E.€..a. -i- ~ILJU\",r
. ~cense#~4015l~ r..; .
~..s /'1. - ~r': o~
.The gcoteclmicaI Icpart foitbe ). mh~~ Meadows - 1st Addition.Snbdivision .
ds . .. . '-'iI" of ~ . ~~":;"":and:. ..t..___
...~~"..iP:Il II11Tnf"rt1~mrn......u~mm .,,,I.no. ~~. ..~......Il:TVC..____~- .WAl.
expansive soils be ~1.....-eL.4..u...J and~l~f"l"t:i "~atleast12inchcs offill ~
to at least95% of ASTM D698 fur 11 H ...rlmlon u.....~..... d. :nn The ...';'U\JJ.i. also J.~" .... ''''TIQs
that~_..~l...) betaken to preVent "'4LIo..4. ~UllLcclL.~in or .....u...:o. the .zuuudarion ar-..zs
during and ~ the consirnction tlJ.L' -', and that ~YL. site drainage be :n-uv.i.ded to .
reduce the ~~on or ~uuAce VI cw.... into thC ~WJSivcsoiis.
Tne 5~Lf:Chnical reoort fw~ emorrnc:i7t"<: that the :finish grade or landsca:oe soil
. adjacent to the founrlanon should be at least 24" above the ~<WSive b~ soils, fumlv
S:OIJ:lnacted to rerince the infilmtion of warer at the sm:fi!ce. The adeqnacy of fill soil
m.aterial ~uWJd the bnilriina mnst be \~ed to the ~..-facrion of tbedesi2n
~ -
professional.
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file
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SEE I<ETAINING WAll. telGNS
FOR ~AOO:ILlI<ECllIr<EM:NTS
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EXISTING -..J ENGI~ ~TIVE:aM'ACTI()J
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ICElATlVE:aM'ACTI()J
MOOIMCZ/PI<OI..I t:K
J EXPIRATION DATE: I"-'I-.,J
eJGI~ 'FILL. J<EaJ11<EMENT5:
CONSTl<UCT FILL O~ENTIRE FOOT ~INT OF BUILDING
. EXTEND FILL ?h'. BEYoo ClJIt::J<.EDGE OF FOOTING ()J
ALL.SIDESEXCtt"1 1HE UPSLOPE SIDE.
. EXTEND FILL It BEYoo 00f8( EDGE OF FOOTING ()J THE UPSLOPE SIt\:
ENGINEER Fill REQUIREMENTS