HomeMy WebLinkAboutPermit Electrical 1988-3-15 (2)
I INSPECTION LINE. .' CITY Uf SPRINGfIELD
726-3769 -,'1 Y COMBINATION APPLICATION/PERMIT
-;J n EilERGY SOURCES:
Job Address (~ T"\flvI+LD,,;L lANli .Srfl.l>. Heat
.
Legal De'cription ~~ ~4- /4I ~l,.T' . Hater Heater
~ '19 Range
I fJO.3 ;;Z3dO n ~ ValUE of Hork:
Owner A'~~I() JJJ:t~ l)lS 74lcJ
dd IS'.'~o'/ II.., 'IAJ_ ~.... Phone7,1l.lh,. Buil<iino Pennit Info: Describe Hork(i.e.. Build Single
A ress ~ ~ ~ ~ ~ I~tl/tr~ Familv nesidence With Attached Garaael
c;.,p (\.{ .vr; '" ~U). {J"K..
Construction lender
Address
UESlliN TEAM
Primary
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
. .-
.
INfORHATlON UNt
726-3753
Sq. Ftq. '.Iain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other - -
~
~
C),
I~
~
(name)
Phone
(address)
'-1/2Lu/ -4-buJ?LP .I
~ ~~tku 987J
(l ir'~. no,)
(exoi res)
(ohonp no
I~ \-{ ~o(..~il ~N~BhCrl
:i' I' \ '~'.Hu..b
(name I
(address. )
llir:s.no.)
(pxnirpc:)
(ohonp nn. \
Plumbino
Y/hLPAtL/!d ~~L;fl ;:'fuE;.
I
'l,/')\
Electrical
~1echanical
NO.1
Each single fixture
PLUIIB I NG
ELECTRICAL
MECHANICAL
I FEE I CHARt;F Nn I
Residence of
I HI=' I r~AB.G.E Nn I
IJ:'~J:' Ir~~
furnace/burner to
SQ. FT. BTU's
Relocated building
(new fix. additional)
IS.F. Residence
(j bath 1
I Duplex (1 bath)
IAdditional bath
1 ~Iater service
Sewer
Storm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
;7I!. I '6J.
Recessed wall
~n~r.p hp~tpr ~nrl vpnt
each
Temporary Construction
Change in existing
rpc;.i qp':nr.~
multifamily, corrm. or
Tnnuc;trial
Appl iance vent
c;~oaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust
hood and dud.
Of
amps.
ut \
COffi~./IND. FEEDERS
Install/alter/relocate
dic;tr;h fpprlpr~
Wood stove/heater
Of
amps.
"
~7~~
3?3!
I J}..
ISSUANCE OF PFR!1IT
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerformed 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 UO OCCUPA[~CY will be made_
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that~,
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project. ~.
llAI-lE (p I ease
print)E:meR~P :z:..1>If$'T.w14Ll9's.?'Mc.. SIGrlATUR~ ~ j-Ilz~ ..,...
FOr. OFF I CE USE OI~L Y
DATE 3 -IS'-8&
Zone
Fi re Zone
Flood Plain
BUILDING PER~lIT
Charges and
Surcharges
PLU!~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERlnT
Cha rges and ~ \
Surcharges V\
HECHANICAL PERMIT
Charges and
SurCharges
:
Type/Const.
Bed rooms
Stories
Units
Occy Load
Occy Group
Sq. Ftg. riain x Value
Sq. Ft!]. Access x Value
Sq. Ftg. Other x Value
TOTAL VALUATION
Shstems Development
C aroe (1. 5~)
Plan Ck. Comm/Ind
____________~/Bldo Ppr J:'",~
Plan Ck. Res
30%/8Ido Per Fee
Fence
Demo
_ _ ____":J_C:~~S1dewalk
1.1'1S A/C Paving
ITotal Comb. Permit
J
Curb Cut
I
I TOTAL
31,38
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
,. ,......
1. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample- Tax Lot 100, lane County Map Reference
II 03 43
2. examole- Lot I. Block 3, 2nd Addition to
springtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceili~Q/or forced air Qas
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
.chee k. add. ete.
F. Building permit information:
1. .example - construct single family house with an
a ttached garage
2. examole - remodel existing garage into family room
3. example - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAfI AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections. etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules.
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is .not authorized
to sign the electrical label. ---
Ill. Applicant to sign and date
Whenever possible. the initial application will be used as
a worksheet only. Where possible. Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
;: '\~
'y ['5-~
V. FOR OFFICE USE ONLY
Permit Cl erk
CL
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
,
~. .
M E M 0 RAN DUM CITY OF SPRINGFIELD
September 3, 1999
TO:
Springfield Police Department
Springfield Fire and Life Safety Department
9 I I Dispalch, Depamnent of Public Safety
Springfield Utility Board
Rainbow Water Districl
Sanipac
NW Natural Gas
US West Communications
Lane County Elections
US Postal Service
TCI
Springfield News
Regisler Guard
FROM:
Lome Pleger, Plans Examiner
Community Services Division
Development Services Depamnent
SUBJECT:
Address assignment for proposed Land Partition Plat Number 99-P1278
The property in queslion is currenlly Tax Lot 00907 of Lane County Assessors Map Number 17032300.
Allhe request of Rodney & Jacqulein Chase, we have assigned an address 10 Parcel 2 of Land Partition Plat
Number 99-PI278. The Chase home is currently localed on Tax Lot 02102 of Lane County Assessors Map
17032343, and is on property being developed as lhe River Glen Subdivision Third Addition. A pennil
request is being processed, City Job #991176, which will involve moving the house 10 Parcel 2 of the
subject Partition Plat. The house is currently addressed 798 Royaldel Lane. The new address once the
house is moved will be 708 Blackstone Street.
A house currenlly exists on Parcel I, and is addressed 705 Mansfield Slreet. ThaI address will remain
unchanged. If you have any questions, please feel free to phone me at 726-3669.
Ip
.
.-
G PARCEL A
2B5 SQ. FT.
SEE DEED RESTRICTION
ON SHEET 2
~- ~
MCKENZIE RIVEF.
~
,
,
,
\
F I
L E
NOTE
TRUCTURE. TREES, SHRUBBERY OR
OON SHALL SE PLACED OR LOCATED
IBLlC UTILITY EASEMENT.
DATE 17 A_ I'"~
LANE COUN1Y CLERK I
OF CONVEYANCES
DEPUTY fl... (.).,L
D STREET' g . FOUND PK
S B9'5B'45" W (3) d ~ NAIL (/)13)
. S B9'26'33" E (/).... ,
. ~ -99.00 (/)(3ji --;;- -([~
,E 0 · CJ -J. .
3) cS a 0)':;) .1": ~s
1 ... · ",'!>"'~'!>'"
~
25.00' 25.00 1
. (3). I (3).
PAR
RIVEE
S,W, 1/4. SF.
SPRINGFIELL
J
,\
\DETAlL "A"
\ f'EE SHEET 2
i
.
"
.
~
"'~
~
~ ......
It')iO...'.....
.....-
",.
-:CI)
~Cl
~
~ ----' Ii!
\' ~
\ ~ACATEO RIGHT-OF-WAY
WITH 7' P.U.E. RESER V A TlON
1 RECORDED M.A~C." "Z '999,
I REEL .1?~("'!. 1l:
RECEPTION No. _qqO? 25:.L.
~ LC.O.R.
.;
~
" "'
...... "!
,,~
'"
'--
PARCELS I Af'
COMPL Y WITH
DEVELOPMEN
THE OVERALL
DESIGN ST ANI
SPRINGFIELD Dc
!.,
~
"
O";l
l%1
~
~~
2 n!
0\O~ ~ ~
p90 , "'~
& ~I
7 ~-ml
00-' ~
~
~
%
~
6 ~
~'" ii1
70'5 M"'Jy~FIB-t>
(c/(/~TJIY4)
g
'"
en
""
PARTITIO.
PARCEL
1
20.5BB SQ. FT.
h
1!Ol
:~I ~
aWl
, .
0"
oN
...
~:>
o
o
;z, !!:
!j)
RIVER GLEN L.I
C/O FUTURE B
P.O. BOX 7425
EUGENE. OR 9"
~
m
f:; a
t\11f
\Q
Q
l>.1 '
te~
~~
~
Z(
:-( J>-'-'
?>O
7.00 P.U.E.
DEDICA TED
HEREON
3
LDI
j
-+-
I. SURVEY ^
AS COUN'j
2. SURVEY ^
IN lANE I
3. SECOND I
RECORDEl
L.C.O.P.R.
4. UNRECORl
THOMAS 1
5. WARRANT
CHASE RI
RECEPTlO,
6. BARGAIN
TRUSTEE
NOVEMBEI
1996 IN I
IN L.C.O.R
3:k~ :t
to ~ ii1 '"
"=1:' ii1 PARCEL 0 ~
i?o:a 2 ":~
00 r-u La.i 0 co 0
o <: 51 :i ~ 10.389 SQ. FT. 2 8
<6::li' ;z..1 0: '" is CJ)
\JINITlAL POINT ~ ~ g!l II!
FOUND 5/B" REBAR gj" l!l!l! 7"'8 I
WITH CAP MARKED ::::::? J
't.81301" (4) ~....-"?'_.. , .,,,,. ",'"". u':: I
."""'.~~~~~~,,~~~~~~~.,
. o. \' "NfS9.Z6ij. v/ i07.i90'"
~ 0 1/07.79) (4). . q
11").0 .....10
135.00(3). ~'" _ ...!07.6B -q: "'''' ;
~- N B9"26'33" W Iii. .0 I 242.6B 1/). .0
/' (N 89058'45" EJ (3) .....0 .....q
FOUND RAILROAD BLACKSTONE ~:\iJ STREET ~
~SPIKE WITH PUNCH
MARK (J}13) I '" jO
FOUND 5/B" REBAR.! . lit. 7~ I
WITH CAP MARKED ~ ~ 10 ~ ~
"LS 1301" (4) ;;.,g5~ ;ZCJ'I7:57
tf,1"l ~dO W-I'AyRa"
0",0
;z i';
4
7a.:;
I
"
'"
"',
,0(1)
~~Ci3
0)0-_
"0';::
, 0'"
g;z
;z-
PUBLIC RIGHT-OF-WAY
DEOICA TlON PER OEED
RECORDED
DCTOBER 6, 19B3
~ ~ft30 ~~~~p~~~RN~ B335954.
'" L.C.O,R.
~":t'
'"' EAST LINE OF
<0
<0
1
~a~
OREGON ..' J
.u.y 20. 1993
REX A. 8ETZ
.2606
EXPflE9 DEe. 31. 1999
REGI8TERED
PROFESSIONAL
LAND SURVEYOR
~
Sp
(5.
JACOB HALSTEAD
DlC No. 47
Tl7S. R3W. WM.
(2) (3)
I
/
lBRi,; //
BRIDGE ROAD
20
HAYDEN
DWG. No. E'
III
; (1.1
t ,.,.\
\ \
. -' I
l~
~
>>< CD
0ii1; ',,,,"_
~~ ~ ~
.......1"'1 ~l.. ~
~o 'S~.s>
~~ i ~
;2) I
Ul .~.
if "
. .
;t
d
..
.
III
~
II
. Ult
. I.
f,' ),: I:
,.
~,
.,.
"
~
.,
"
',.1
,J ~J.'
~,
'"
o
(II
N
C7l
....~
~ '
.
.
.
.
-
o
-
W
I
o
01
~
o
~'l(A,I\~~
8 ,or
o~,()
" ~\\
o
(jI .
~ :it
I ~
(jI
I
'"
~ l'H
~
.~
"
:J>
-I
1 ~T
-.....
~
6
\lII
.
.
~
<:>
s:.
-\
-
;
J>
'V
:::;
0 :3- ...
(jI
Ii) :>
(jI ,
~- ~ ~
o
-
W __",
-~- ~.
-
-
-
-
-
-
...... '_C':.
" .:::;."
~.oo.l";a' ~
lane cou..nty
..
AGRICUL.URAL. PLACEME~
AUTHORIZATION
FOR OFFICE USE ONLY
~~~~~IZA~~~__~~
o TWO COPIES OF PLOT PLANS
'I\J\1NSHIP
STATE DEFINITION: AGRICULTURAL BUILDING is a structure located on a farm and used in the operation of such farm for the
storage. maintenance, or repair of farm machinery and cquipm:::nt or for the raising, harvesting, and selling of crops or in the
feeding, breeding, rnanagcrront. and sale of, or the produce of, livestock, poultry, furbearing animals or honeybees or for
dairying and sale of dairy products or any combination thereof including the preparation and storage of products raised on
such farm for human use and animal use and disposal by marketing or otherwise.
AGRICULTURAL BUILDING DOES NOT INCLUDE: (a) a dwelling; (b) a structure used for a purpose other than gro..ring plants in
....'hich persons perform more than "'i4'4 hours of labor a week; (c) a structure regulated by tho.:! State Fire Marshall pursuant to
ORS O1.apter 4761 (dl a place used by the public; or (el a structure subject to Sections 4001 to 4127, Title 42, United Statos
Code (the National Flood Insurance Act of 1968) as amended, and regulations promulgated thereunder. (ORS 456.758)
I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION, and do hereby certify that all information herein is true and correct
a:1d I further certify that any and all work performed shall be done in accordance wi th the Ordinances of Lane County and the
Laws of the State of Oregon pertaining to the work described herein, and that NO CiANGE OF USE will be made of any structure
~ithout first obtaining the proper permit(s) from the Building Division.
I HAVE READ AND QiEQ(ED THIS APPLICATION THOROUGHLY AND I FURTHER CERTIFY THAT I HAVE READ nlE STATE DEFINITION FOR
AGRICULTURAL BUILDING.
I understand this application in only for the purpose of locating the structure to assure proper setbacks from roads,
property lines, and related facilities.
fi',.In ~ (~C~ ~r~n~
-a~~~c2~fi(
"1-2.4 - $.1.
DATE
THIS IS NOT A BUILDING PERMIT. Call for a placement inspection prior to
pouring concrete, setting poles, or frama.ng V8~' ocation of th~Jroposed
structure on the site.8ntL:iJC:,rj~I//1l P.~T ~-r.3 9~
t7~:PIl-\J&l\, / IA
MINIMUM SETBACKS: I' rjt()~{ \14 ~ ~~~_~~
Road center line, front c5(O t'f2.DP &rJ1f center line, side /0 _
Property line, interior ~~1S7 rear ~~,
FACILITIES:
Proposed construction will not increase sewage flow.
field.
MINIMUM SETBACKS:
Do not park on or drive over drain-
existing and replacement sewage
DATE l' ~ 1f.JY'
& COMMUNITY DEVELOPM~T'/ (5/82)
Eugene, Oregon 97401
TRS, TT
Plat
Subdivision
Lot
.
.
./
!
Plan
Block
C74-150
Vicinity Map
Job Location
Permit {j
Permit (j
Permit fJ
.
N
(Address)
For
For
For
Permit {j
Permit {j
Permit {j
Me l<el'l"Zt't!:' l?/t/~r
/"
l./3; 9 (
Aotd il. 1m I a
~ ~.9i><./ l~ ~- (/&--
~7~ ~rt)-/ /ttI&~/;~
R(Jyalcl.j 1-",---
Q
fl,M
7 fl1
:J I. '6
Hddt'n p /,dyo R d
For
For
For
--.,
l.
, )5:1
') "
\
1
'. ""
,
.
S.
.
-!..
10
.
12
J.!..
16
.
10
1!..
"
.
"
..!!..
..!!.
.
"
T \
2!..
"
.
"
....(
- <'
..
."'1
48 .-
;....-)
.:::'..,. '1-' i;":::S:
f"'-">
C_,-, -
S'I'"
SO. ..
- '-,/,,'
,~ ..-
1\--.,
"
B;-'
" ,,3082 ,'\G
,;-'
c-.....
.
"
Tl I
2!..~ ','__
-. ..'
~1 ..:-1.:',
"
- r'r^"/i:~I" B'
_...-"~' "
u
"
.- ,~,
..
E..
..
-.
.
.
, ,,30'L2
','C'>'
:~~\. ~~c;-;- ;=-\C..... ~~~: '.,"
'''/! .
. ._~ ,-,. - ,
'.~J~'
I="""C"' I::.
...,-'
"V .. ," -.--
., .",:.,-
- C~.\~ C,~ASE, ~~T\:'.
38 .-;i_~.:. . :(:): '23000.' '::)00
- NE~ B~DG ~YPE NR
o;l;'\r:'~' ~~:-j.:-
40 ^,I._.,
- ... ~:n'lt. ,-'I='f-..... i;I~' f~C1 :':Cr~ D:::S;:;:-~J" ":'"':1(;:<
42 :r:
- ,.
...1..1-',.
~C-:~D:\'
dS:::~ F~ BJ.j~~f"~S (i
,.-,
(.;
.- ._. N,~
'.'0.., J.
'..IN:;:-;'S (';'0~
,~IDJ;:~
~ r: ':+...-
0,)'" I
NO. CCN~i:::CTCmS:
.";::""C:~'-f\IIr9j._ ',':::-
S-rt-ITE Sl1;:;:CHt)':;'G~
~-~_.AN Cl-~EC:: cc::
,:;:C'::' ..: .~
~'~N . '~~.: l::"!" 'r (: i'~ D?~ .~. :::
S':Dr-:~: ES
\_F<::T
',,...,."
.. .....,
:~:f.;:",:)GS {.\O',
':23',' \..':~:...,.;r-",-IOt:
; 5 . 00 EACH ..
J1 .,~
T;.,
t,:3 i~
';"0.1',,'
J
-- ll'~ ~:. 1,._ ::~::~ 'L .~.
, .
M ..,
7-16
FEE.
:: J ,)()
,,,", .. 0:
.
.
i. I
.
.
.
. i
.
.
.
.
.
'".
1')l_:,
,<,,-,'. .
~" I ....
,.. '-'{"'
.Ill'il",}.
.
..
.:
;
~
.~
.
-12 ;;
::.j
J.)
.
5.
4
3
.
-
~LANNING & COMMUNITY DEVELOPMEN~
ACTIVITY INFORMATION SHEET
bne county
~
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
IZ, cl he-V C-.bOS't.""
PEI0"UN MAKINli REQUEST
798 Ro.,cl o;./cI(!> / L Q I? ~
AlAILING ADDRESS
^ rcnn q /Jot:!}c/ c;!)f"('_ ? 7'177
/ 9TY STATE ZIP CODE
7~C. (. r7.1
HOME TELEPHONE #
SOI""7>f!'
PROPERTY OWNER
MAl LI NG ADDRESS
C!TY STATE
ZIP CODE
BUSINESS TELEPHONE #
BUSINESS TELEPHDNE # HOME TELEPHONE #
2.. PROPERTY ADDRESS
(IF DIFFERENT FROM MAILING ADDRESS)
3 MAP & PARCEL NUMBER
(REQUIRED INFORMATION)
(from tax maps in Department of Assessment and Taxation
or from tax statement)
~~ t)j' 2'3
T HIP RANGE SECTION
/'0 () 0
TAX LOT(S) OR PARCEL # ZONING
_~~ \6Nl
V~~
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL # ZONING
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL # ZONING
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
4'7 .'1~
ACRES
4 SUBDIVISION (if applicable) LOT BLOCK
5 REQUEST (state exactly what you plan to do) PI? (; r C /')n ~/"'t';fC! _f!{ /06 .
.-.e.r~ TlM l/f' rlorn.Jt<'~ j?nr f"en r!>rf2 ,,"3 ~~ on</J"'r-';P/dt:'!e
w/I-LnoI/OI.L""j(" r,~v(fr rib,.. !Vot tras~,'''(1 eqb/J:)InL~lIf
. ~ ~ b /'
6 DIRECTIONS TO SITE: be) 1'1'/, IV-M 7.ff, 8-/.(' Cladeh fi;-,~l' /fd.
** FOR STAFF USE ONLY **
--
NUMBER
DATE
.
-f
'"
VI
ZONE/LAND USE:
BY: DATE:
.
-f
r-:
TIME IN:
OUT:
jL
11-03 - 25
ec- lonu
~ LANE COUNTY
OWN~a ~/ce..,.fi ~/L d. .li-L..-;
w~~
EET BACK REQUI ~EMENTS
L, FRONT ~( YL, SlOE
~'JO~~HbR'i~LB~RMIT
DIRE~ONS TO SITg!
/1
71'<6 fAfl/tdJ'dtt&
SITE ADDRESS c:;
.-
-
.
INSPECTION RECORD
.,
PHONE NUMBER
1!-.7
INTERIOR
- REAR
PHONE NUMBER
~~LUMBING FIXTURES
A
;7f~
/
,4 / "
I::,?/;e;;f-A
/l :::;'/) -? ;'
./VP __
PERMIT NUMBER
FOOTING / FOUNDATION INSPECTION OR MOBILE HOME SET UP INSPECTION
Approved Correction Disapproved Date Inspector
CONCRETE SLAB / UNDER-FLOOR INSPECTION
Approved Correction Disapproved Date
Inspector
UNDER SLAB / PLUMBING GROUNDWORK INSPECTION
Approved Correcti on Di sapproved Date
Inspector
ROUGH PLUMBING INSPECTION
Approved Correction Disapproved Date Inspector
FRAMING INSPECTION
Approved Correction Disapproved Date Inspector
INSULATiON / VAPOR BARRIER INSPECTION
Approved Correction Disapproved Date Inspector
LATH ( GYPSUM BOARD INSPECTION
Approved Correction Disapproved Date Inspector
FINAL PLUMBING INSPECTION
Approved Correction Disapproved Date Inspector
FINAL WASTE DISPOSAL SYSTEM INSPECTION
Approved Correction Disapproved Date Inspector
FINAL INSPECTION BUILDING
Approved v/" Correction
MOBILE HOME ~
Disapproved Datell-Iq.-tr.? Inspector- ~A')/
CERTIFICATE OF OCCUPANCY
Approved Correction
Di sapproved .
TEMPORARY CERTIFICATE OF OCCUPANCY
Date Inspector
Form C74-197