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Permit Curb Cut 2013-5-
SPRINGFIELD ' 225 Fifth St CITY OF SPRINGFIELD Springfield,OR97477 Irkst4R- P hone: 541-726-3753 EGON Building / Public Works Permit Inspection Phone: 541-726-3769 • Fax: 541-726-3676 PERMIT NO: 811-PW2013-00065 www.springfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 05/06/2013 EXPIRES: 11/02/2013 STATUS DATE: 05/06/2013 APPLIED: 04/16/2013 • SITE ADDRESS: 788 S 72ND ST,Springfield,OR 97478 SCOPE: ASSESOR'S PARCEL NO: 1802022105400 TYPE OF STRUCTURE: PROJECT DESCRIPTION: Second Driveway . OWNER: TEIGEN CHRIS&AMI Phone Number: ADDRESS: 788 S 72ND ST . SPRINGFIELD OR 97478 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone INSPECTIONS REQUIRED Inspections 9502 Curbcut-Second Curbcut-Second: After forms are erected but prior to placement of concrete. By signature, I state and agree,that I have carefully examined the completed application 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 Laws of the State or Oregon pertaining to the work described herein,and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street,that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. k VC til.E S .L Pc , S/6//± - Owner or Contractor Signature Date Springfield Building Permit 5/6/2013 2:01:25PM Page 1 of 1 Cit9 of Springfield : r • Driveway/Sidewa�I�k ;Permit Application Application Date: ------ 225 Fifth Street,Springfield,Oregon 97477 SPRINGFIELD Transportation&Engineering Section,Public Works Department Permit Number Phone: 541726-3753 _. Issue Date: OREGON SITE INFORMATION Location of Work: 5 M-1-1A-s2 Applicant: .I-Dc?) .S• I 0---)9 Address: 75/D 5. -'afS "th Phone: �" /; �/ Tax Map City: �/(/. State: �.,e_ ZIP: 9791„..c.- Tax Lot Subdivision Owner: Phone: Address: City: State: ZIP: REQUESTED PERMITS: Fees ✓ Sidewalk Amount of sidewalk in excess of 90 feet $102.00 @$0.09 SF • Sidewalk Repair $18.00 • Curb Cut/Driveway: Number of Driveways X$102.00 1st Cut X$54 2nd Cut ✓ Multiple Permit Discount each:(Maximum 2) $35 Multi permit discount good for one site and one site inspection only applies to 2nd and 3rd permits only. Not sidewalk repairs [l 5%Technology fee ✓ Proof of Insurance: $500,000 Minimum if work is done by property owner. Total due with permit$ CONTRACTOR'S INFORMATION Name:' Phone: Address: City: State: ZIP: Contractor Registration# Expiration date: Project Supervisor 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 call: 541 726-3769(recording)State your designated 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. Requested received before 7:00 am will be made the same day,requests after 7:00 am 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 before digging. SIGNATURE: • SPRINGFIELD-- - CITY OF SPRINGFIELD 225 Fifth S : TRANSACTION RECEIPT Spnngfield,OR97477 7' OREGON 541-726-3753 811-PW2013-00065 www.spnngfield-or.gov 788 S 72ND ST permitcenter©spnngtield-or.gov RECEIPT NO: 2013000879 RECORD NO: 811-PW2013-00065 DATE:05/06/2013 {o7 Yo1:71JIdtoltk - --±` ,a _ r_- _,_ .rte u*, ACCOUNTCODEIPRANS?CODE '... ._ AMOUNTiDUE`J Curb Cut/Driveway 1st Cut 201-00000-428060 1141 102.00 Technology fee(5%of permit total) 100-00000-425605 2099 5.10 TOTAL DUE: 107.10 P YMEN T.:TYPE_-o ?`PAYOR 'cns xi 'avit soN 4210. :-COMMETS AMOUNTPD r , ,;1! Credit Card Ami Tiegan Second Driveway 107.10 035816 TOTAL PAID: 107.10