HomeMy WebLinkAboutPermit Sidewalk 1993-4-19
22S NORTH FIFTH 5TREET
5PRINGFIELD, OREGON ~1411
ENGINEERING DIVI510N
OFFICE NO. 121:>-31S3
IN5PECTION LINE, 121:>-311:>~
f"""\~6IDENTIAL - COMM' ~CIAL
51DEWALK I CURBCUT
APPLICATIoN I PERMIT
1I/~'"
SPRINGFIELD
Joe ADDF:EOO:, 49 -::sa -& ~(e.'~ L L. ~
A55E550R5 MAP NO'*l '7-0 Z -:- :s'3 - ~5"3 TAX LOT N.O. "* i 78 I
5UBDIYI510N:
OUNER: "SIC-i) f3-J() S M I T ['-I..
ADDRE55:. I r"Z- J. Ie 4- ?N--f CITY: =!5PF L l ~
5T ATE: 0 ~ 'ZIP: 97478 PHONE NO. r146 - bGC.l
~ DEecRIPTION:
5IDEwALK: '>C CUR6 51DE 5ETBACK
CUR6-CUT. ,RE5IDENTIAL. COMMERICAL
5ECOND DRIVEWAY (5EE TRAFFIC)
REaUlRE5 APPLiCATION FOR A 5ECOND DRIVEWAY("'.4.1a)
OR A COUNTY APPLICATION FOR FACILITY PERMIT (C~-2"'3)
IF IN THE U.GI.6.
DATE OF AFPLlCATIONC:!J.>-/9 -93
RECEIPT NO: . 810 Co
CASH .~
CHECK
* (,......--
CHECKED FOR DELINQUENCIE5
5IGNED:
DATE:
/~tAI) ~)UJt~
4-/9;:-9 -;;:;
WORK. TO BE PE~D ey,
CONTRACTOR *, ~ 6. H/f.. 6. S
ADDRE55
OUNER yo CONTRACTOR
0<' CALZR-REGI5TRATION NO.* 8b9Z{ EXPIRE5:!O-Z.3-73
PHONE:
~cvLJF;:S FOR IN&FECTION ~QUEeT,
CALL 121:>-311:>~ (RECl.oo'~ER) 5TATE YOUR CITY DE51GNATED JOB NUMBER, JOB ADDRE55,TYPE OF
IN5PECTION REQUE5TED AND WHEN YOU WILL BE READY FOR IN5PECTION, CONTRACTOR5 OR OUNER5 NAME AND
PHONE NUMBER REQUE5T5 RECEIVED BEFORE 1:"'''' AM WILL BE MADE THE 5AME DAY, REQUE5T5 AFTER 1:"""
AM WILL BE MADE THE NEXT WORKING DAY
* 5EE 600K
EXI5TING 6UILDING PERMIT NO. ( IF APPLICABLE)
YOUR CITYDE51GNATED J06NO. 15f . if:? =? 0_')/ 2...-
F:EQUIFli!ED 1N6FECTIONS'
Ire'
51DEWALK I DRIVEWAY
FOR ALL CONCRETE PAVING WITHIN
THE 5TREET RIGHT OF WAY, TOBE
MADE AFTER ALL EXCAVATING
15 COMPLETE AND FORM WORK
AND 5UB-BA5E MATERIAL 15
IN PLACE
CUR6 I APPROACH APRON:
AFTER FORM5 ARE ERECTED
BUT PRIOR TO POURING
CONCRETE.
FEE6:
SIDEWALKS CURB-CUT
.10.00 + .0.15/LF. ( X) /5 / .1e>.00 +' ~.15/L.F. ( X ) .
. OF WALK
WALK X'
/ ~
TOTAL FE~IT n:Cs
~ I z. 2.5
COMMERICAL DRIVEWA Y5 5HALL
HAVE S' TO 8' FLAIR5
3'- "," 5T ANDARD'
/
'X'
,
,
I HAVE .CAREFULL Y 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 PERFORMED .
SHALL BE DONE IN ACCORDANCE WITH THE ORDINANCES OF THE CITY OF SPRINGFIELD, AND THE LAW5 OF THE
STATE OF OREGON PERTA,.INING to THE WORK DESCRIBED HEREIN, AND THAT NO OCCUPANCY WILL BE MADE
OF ANY STRUCTURE WITHOuT PERMISSION OF T~E BUILDING DIVISION. I FURTHER CERTIFY THAT ONLY CONTRACTORS
AND EMPLOYEES WHO ARE IN COMPLIANCE WITH ORS 1"'I:tZlSS WILL BE USED ON THIS PROJECT.
~Mr1/i11~f/J~ .. ... .11-/1'-1'-;'
r SIGNED . i ~ c..
DATE