HomeMy WebLinkAboutBuilding Curb Cut 2013-12-17 City of Springfield
Driveway/Sidewalk Permit Application
Application Date:l SPRINGFIELD
225 Fifth Street,Springfield,Oregon 97477
Permit Number I Transportation&Engineering Section,Public Works Department
Phone: 541 726-3753
Issue Date: I OREGON
SITE INFORMATION
Location of Work: ` '� V 474
Applicant: e,Ulr�r,. i,S ti-L4 e .L,L
k' c Phone: 1 ---ii ( 54/53 02�
Address: 5(J �-c) » f
Tax Map
City: State: (;i� ZIP: C 7 4v / 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
E Sidewalk Repair $18.00
P-Curb Cut/Driveway: Number of Driveways ( X$102.00 1st Cut X$54 2nd Cut
r; 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
✓ °lo Technology fee
Proof of Insurance: $500,000 Minimum if work is done by property owner. Total due with permit$
CONTRACTOR'S INFORMATION
Name: ?c Z-4-- Cc1,1 -57 Phone: 31/( 3y 3L7-7
Address: 54/ ( /Olt-
City: l:i State: ZIP: ci 74.-o (
Contractor Registration# 5 G 404 \ Expiration date:
Project Supervisor ,S a 144,g S ?c0/4 en- Phone:5r(( y5 3277
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: