HomeMy WebLinkAboutPermit Sidewalk 2013-7-3 Gt'ofS pdngfield t
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• Driveway/Sidewalk Permit A Iica�tion
Application Date:I 6 Ill 6 L2_013 SPRINGFIELD
L 225 Fifth Street,Springfield,Oregon 97477
Transportation&Engineering Section,Public Works Department a.
Permit Number �.n..
d tL 2C11�J_cov 9 Phone: 541 726-3753 C�o
3 OREGON
SITE INFORMATION c Z !�,�� +-=�
Issue Date: 1 60/210� 0∎ ,
91-. 1/1r I
Location of Work: 1-1 IQ- (� rte. cJ U
Applicant N L OLD l Phone: I. ti"
71 OG Ex+. 1-13
Address: 2(Z Mcc&.,, 7 • Tax Map
City: 9d= r vt J State: Of' ZIP: Q��f?1
Tax Lot
Subdivision
Owner:
Phone:
Address:
City: State: ZIP:
REQUESTED PERMITS:
Fees
CI Sidewalk Amount of sidewalk in excess of 90 feet $102.00 @$0.09 SF
El Sidewalk Repair $18.00
IRCurb Cut/Driveway: Number of Driveways X$102.00 1st Cut X$54 2nd Cut
r Multiple Permit Discount each:(Maximum 2) �QProa�h
$35
Multi permit discount good for one site and one site inspection only
applies to 2nd and 3rd permits only. Not sidewalk repairs
C 5%Technology fee
r Proof of Insurance: $500,000 Minimum if work is done by property owner. Total due with permit$ I 0 7. (0
CONTRACTOR'S INFORMATION
Name: 1ki pSLr • Act p Lc,QA" Phone: Szt t - `ZzG • on-
Address: Pb Ror V-kbO
City: ucr.L.- State: l /v ZIP: 5-7c(U7
Contractor Registration# ¶-7799 y Expiration date:
Project Supervisor L,pr; \..10or w I k3E "x Phone: _ 3rf5_ 7t O(o
cx4- Z13
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: '1e-