HomeMy WebLinkAboutPermit Sidewalk 1999-10-11
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
(0//1/1 q
~ji
PERMIT NUMBER:
DATE ISSUED:
C{C(1387
(o/ttj 1cr
APPLICATION DATE:
SITE INFORMATION:
lOCATION OF WORK: &/,(q 731 U6?JE,l,t.,.
APPLICANT 6'k.tfJ 01/ ~.9C4~~Y 'COJ..9<,'T'_
ADDRESS:B9'311 61..D CO'"BlLK6 l(ll,
CITY: t,f.Jc.1b.")JC STATE: Ot<
(
SUBDIVISION:
()...}AV
PHONE
6r31-0~J9 / /f()/-'11/S-
TAX MAP: /702 33 3 "5
ZIP: 0/110 f3
TAX LOT:
0170~
OWNER:
elrr of ~f//<.I)..J&:>F(ELO
f.t..,i T,
C!oJ;JTRAqoR PER..
I
r<-<iPAJ' SA- Tl+cR
STATE:
PHONE:
ADDRESS:
CITY:
ZIP:
~
REOUESTED PERMITS:
D DRIVEWAY ICURS.CUT /SIDEWALK: ..........................;..........................................$ 60.00
AMMOUNT OF SIDEWALK IN EXCESS OF 90FT. @$O.06 SF. $
ft1 SIDEWA~/~~~Rt':-.~~~Al.~~~%...~~.TY................$ 10.00.
(( I<!.E~ jQ.POT t>A--I'W A.::...c) .
D ADDITIONAL DRIVEWAY: ..................:.......................:........................$ 30.00
16,00
D f.BQ.OF OF INSURANCE: $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
TOTAL DUE WITH PERMIT $
10,00
CONTRACTOR INFORMATION:
CONTRACTOR:
ADDRESS:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERVISOR:
PHONE:
EXPIRATION DATE:
PHONE:
INSPECTIONS:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WORK HAS BEEN FORMED
AND MADE READY TO POUR.
CURB CUT AND SIDEWALK INSPECTIONS CAll726.37~9 (RECORDER) STATE YOUR DESIGINATED CITY JOB NUMBER/PERMIT
NUMBER, JOB ADDRESS, TYPE OF INSPECTION REQUESTED, AND WHEN YOU WILL BE READY FOR INSPECTION, CONTRACTOR'S
OR OWNER'S NAME AND PHONE NUMBER. REQUESTS RECEIVED BEFORE 7:00 A.M. WILL BE MADE THE
SAME DAY, REQUESTS AFTER 7:00 A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE CALLED IN
AFTER EXCAVATIONS ARE MADE AND FORM WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE.
YOU ARE REQUIRED TO CAll
THE LANE UTiliTIES .COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1.800.332.2344
48 HOURS BEFORE DIGGING
SIGNATURE:
AMOUNT RECEIVED:
RECEIPT NO:
?,/ tC// 00
DATE PAID:
RECEIVED BY:
oc:r; /1, f 9~ q
B.o/8 TA-'r-LO,12.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information herein
is true and correctr and I further certify that any and all work performed shall be done in accordance with the Ordinances of
the City of Springfield, applicable Cit'( Standard specifications and Drawings, and the laws of the State of Oreiton p'ertaining to the work
descr,ioed ~erein. I furth~r certify tha only contractors and employees who are in compliance with ORS 701.055 will be used
on this proJect.
The City mpy inspect the work site described ifl this permjt <;It any time duril')g a one year period followjng the receipt by. the City of notic!
of completion of the deSCribed work and speclfv, at the City s sole descresslon, any additional restoration work re~uireo to return the site
to a standard acceptable to the City. The permit~ee will be notified in writing of any work required and will have thirty days (30) from the
date 9f the notice to cO'T!plete the work. Work I')ot completed at the end of the thirty days Will be performed by
the City and the costs wIU be billed to the permittee. .
I furthor agree to ensure that all required inspections are requested at the proper time, that project address is readable from the
street, ana the approvep set o~ans w;U remain on the. site at all times during construction.
Signature 7 l' <{{) NA7f . . Date 1~/1'l
I',
...
City of Sp~ingfield
225 Fifth St~eet
Sp~ingfield, OR 97477
(503) 726-3753
T~ansaction nUffibe~ 035832
Octobp.~ ii, i999 12:07 PM
Rece i ved fr'OITl:
Contr'act/Ol~n :
Addr'ess: 89317
City: EUGENE
OREGON COUNTRY CONSTRUCT I
CONTRACTOR
OLD COBURG ROAD
St: OR Zip: 97408
-Bljilding-
Job =1:: 991387
DesC'~iption
Fe.;?
SidelNalk
10.00
Total:
Amt Received:
Check :1=: 628
10 . 00
10.00 Cheel:
Thank you, Bob T.