HomeMy WebLinkAboutPermit Sidewalk 2014-5-30 SPRINGFIELD - • • 225 Fifth St
• CITY OF SPRINGFIELD Phone:eld OR 3757
OREGON Building / Public Works Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-PW2014-00068
www.springfeld-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 05/30/2014 EXPIRES: 11/25/2014
STATUS DATE: 05/30/2014 APPLIED: 05/30/2014
SITE ADDRESS: 2727 GATEWAY ST,Springfield,OR 97477 SCOPE:
ASSESOR'S PARCEL NO: 1703223402400 TYPE OF STRUCTURE: •
PROJECT DESCRIPTION: 2 panel sidewalk repair.
OWNER: DRIFTWOOD VILLA HOMEOWNERS ASSOCIATION Phone Number:
ADDRESS: 2727 GATEWAY
SPRINGFIELD OR 97477 •
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CONTRACTOR INFORMATION
Contractor Type Contractor Name - Lic Type Lic No Lic Exp Phone
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INSPECTIONS REQUIRED
Inspections
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.
c/717
Owner r Contractor Signature Date
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Springfield Building Permit 5/30/2014 8:11:58AM Page 1 of 1
City of Springfield
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Driveway/Sidewalk -Permit Application
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Application Date: 5-/. o7/ti SPRINGFIELD
225 Fifth Street,Springfield,Oregon 97477
Permit Number SS.zt r,66068 Transportation&Engineering Section,Public Works Department
V Phone: 541 726-3753 7.7( else
Issue Date: 5/30/ 10 OREGON
SITE INFORMATION /
Location of Work: - 7 7 2 G Q -e J7 ,91/1 -
Applicant: C o, r. ,.p C,•e /
Phone: 3
9/,
2 -3S7-7
Address: r Q o C P/rr se_.—1 I/9 l l Tax Map
City: State: ZIP:
Tax Lot
Subdivision
Owner: Phone:
Address:
City: State: ZIP:
REQUESTED PERMITS:
Fees
• Sidewalk Amount of sidewalk in excess of 90 feet $104.00 @$0.09 SF
Sidewalk Repair $19.00
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▪ Curb Cut/Driveway: Number of Driveways X$104.00 1st Cut X$67 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
[� 5%Technology fee
0 Proof of Insurance: $500,000 Minimum if work is done by property owner. Total due with permit$
CONTRACTOR'S INFORMATION
Name: (a>llde e/rty � Phone: 51/— 7 2 9-3 S 77
Address: fo 405 DX c- 'Y / L $ t",7�
City: State: O/e ZIP: .j74Lff
Contractor Registration# Expiration date:
Project Supervisor N 6 Gr f ' ��1 Phone/90 7 2.9- 35
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: •