HomeMy WebLinkAboutPermit Sidewalk 2013-9-18 Driveway/Sidewalk Permit Application
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Application Date:l /sy, 0J3' SPRINGFIELD
-(-l/ 225 Fifth Street,Springfield,Oregon 97477 i
Transportation&Engineering Section,Public Works Department I
Permit Number I - Phone: 541 726-3753
Issue Date:
OREGON
SITE INFORMATION //� n
Location of Work: /co� [Yehawk iv c). �ringft'e(d c 9—ivn-1
Applicant: (X S ga\ ['1 o h c.� otc.J Nor-W AI-t �JJ
Q I Phone: 5yj-72 ,--n05
Address: )�p ZD o{1c..wk W L✓). •
/ J :r■a�..ji�._:�i�. Tax Map
City: S r i;vac?'
va I r`cL State: QQ ZIP: nj -1 LI 11
✓ Tax Lot
Subdivision
Owner: �A.,I C� \Acunnines us Rath_
E (ar orlc Ltd (s
Phone:l 503-;7C-5o89
Address: 0.19D Wah a j-irn
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City: °DrFjLiv4( State: O2 ZIP: R.7 2/[p
REQUESTED PERMITS:
Fees
r Sidewalk Amount of sidewalk in excess of 90 feet $102.00 @$0.09 SF
k 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
CI 5%Technology fee
fl Proof of Insurance: $500,000 Minimum if work is done by property owner. Total due with permit$
CONTRACTOR'S INFORMATION
Name: (_Jol4-a 1 • u efl ont-Jruc.-h'ok, Phone: sj'4/_ gg—O33I
Address: 9. 19. ,4O v g3
City: ?Ni1R,Pe.(4 State: f)2 ZIP: ! '797
Contractor Registration# J Cc p
,B 1 p / 92 QI Expiration date: g—aV,2o r
Project Supervisor /,'Ja i}-e - BcI) /N, )C-i 51e ;/) Phone: 591_55 y-0 29�r
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
'4.
TRANSACTION RECEIPT SpnngfieldtOR 97477
hi8i :C C 541-726-3753
OREGON 811_PW2013-00180
www.springfield-or.gov 1620 MOHAWK BLVD permitcenter @spnngfield-or gov
RECEIPT NO: 2013002061 RECORD NO:811-PW2013-00180 DATE:09/18/2013
IP1dc3o ill.hllIoi)i ' _lci9Pa ter ak' r :ACCOUNT CODEFI BANS CODE arialigtAMOUNT DUE!",i'_'■.
Sidewalk Repair - 201-00000-428060 1142 102.00
Technology fee(5%of permit total) 100-00000-425605 2099 5.10
TOTAL DUE: 107.10
PAYMENWPE PAYOR caSHtER:;eGle`soN _COMMENTS _ AMOUN P,AIDa"
--Select-- Walter Bell Construction 1620 Mohawk blvd 107.10
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4219 Sidewalk repair
811-pw2013-00180
TOTAL PAID: 107.10
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