HomeMy WebLinkAboutPermit Sidewalk 2013-6-28 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
;;� Phone: 541-726-3753
'OREGON Building / Public Works Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-PW2013-00137
www.springfield-or.gov permitcenter @springfield-or.gov
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PROJECT STATUS: Issued • ISSUED: 06/28/2013 EXPIRES: 12/24/2013
STATUS DATE: 06/28/2013 APPLIED: 06/28/2013
SITE ADDRESS: 1690 S A ST,Springfield,OR 97477 SCOPE:
ASSESOR'S PARCEL NO: 1703363106000 TYPE OF STRUCTURE:
PROJECT DESCRIPTION: Sidewalk Repair
OWNER: CHURCH OF J C OF LDS Phone Number:
ADDRESS: 50 EAST N TEMPLE ST
SALT LAKE CITY UT 84150
OWNER: CORP OF PRESIDING BISHOP OF Phone Number:
ADDRESS: 50 EAST N TEMPLE ST .
SALT LAKE CITY UT 84150
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
EMPIRE CONCRETE CUTTING INC CCB 51754 10/16/2013 541-746-8818
INSPECTIONS REQUIRED `
Inspections
9508 Sidewalk
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
constructio//n.
Owner or Contractor Signature Date
ATTENTION. Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
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if 3 T 10E; in OAR 952_001.0010 through,
MS PERMIT SHALL EXPIRE IF THE WORK 0090. You may obtain copies ofAR 9 2-0 by
UTHORIZED UNDER THIS PERMIT IS NOT °alling the center. (Note: the telepl:i.,rr-
number for the 0regon Utitity Notificauon
OMMENCED OR IS ABANDONED FOR
Center is 1-8 0-334-2344).
NY 180 DAY PERIOD.
Springfield Building Permit 6/28/2013 10:18:15AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
< 225 Fifth St
,,��. y TRANSACTION RECEIPT Springfield,OR 97477
'r�`OREGON 541-726-3753
811-PW2013-00137
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wwvi.spdngfield-or.gov 1690 S A ST permitcenter@springfeld-or.gov
RECEIPT NO: . 2013001380 RECORD NO: 811-PW2013-00137 DATE:06/28/2013
10 .YC11:d1i[o]?Lile"iu;. >r„ai...-. " _?k.-.::a. -i__sn—ACCOUNT'rCODE/TRANS CODE ,1 ,.Ea •o
Sidewalk Repair 201-00000-428060 1142 17.00
Technology fee(5%of permit total) 100-00000-425605 2099 0.85
TOTAL DUE: 17.85
z PAYMENT.TYPE :_"•:,,PAYOR.T.-CASHIER:KWILSON 1111: 1_: COMMENTS e"' 4...,4;1,57. AMOUNT'PAID ,, ,„. ;;r ;_;j
Cash Bill Weeks Sidewalk repair 17.85
TOTAL PAID: 17.85
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City'of Sp-ring field . - : 2— n {• , . ..., • ' : , : ,
Driveway/Sidew,alkk Permit Ap,p,l'ication .
,..,.... .,_ i.. •- ui.,f uj s,•.i .....,:'gym .�, :., ..r. .k.;r3,_,..0$rxi�u.•.. ¢ ,4. !., ti aW1?_.•:, k ,.,` .. �
Application Date:IL/ZB/� SPRINGFIELD
/ 225 Fifth Street,Springfield,Oregon 97477
Transportation&Engineering Section,Public Works Department E ,1,•
Permit Number Phone: 541726-3753 ,!ri ®j..1/4 G•}. !,0" ,s+.• OREGON
Issue Date:
SITE INFORMATION
Location of Work: /6 9O
Applicant ytv0fletcl %cskbp5 S1o(nel^oc&se S�(j ZZj 7/3h
l II Phone:
Address: 115A6 S A nn
p v�, ci7� �7 Tax Map
City: 51 �c J—le�� State: U` ZIP:
J 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
p 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
[I 5%Technology fee
El Proof of Insurance: $500,000 Minimum if work is done by property owner. Total due with permit$
CONTRACTORS INFORMATION },
Name: K:Miiit Cohefe-te CA-n-1 1'1Gt Phone:
Address: J
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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: