HomeMy WebLinkAboutPermit Sidewalk 1992-4-8
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SIDEWALK I CUReCUT
APPLICATIoN I Ff:F<!'1IT
SPRINCFIELD
22S NORTf.I FIFTf.I STREET
SPRlNCSFIELD, OREGON <31411
ENGlNEE~NG DIVISION
OfFICE NO. 126-31S3
INSFf:CTION LINE, 126-316<3
.
, ) I'
JOB ADDFiES&. /0 &., '7 /lU>T""'~,4
ASSESSORS MAP NO.* 1'7- 0'3 -3 '5"'-..4- ( TAX LOT NO. *0 2-7t'O
SUBDfVISION,
OUNERo E( H/) F-/c ,..-;::>Z~{-
ADDRESS, /O/~"] AjofZ'_~rl-i A CITY, <:';PFLr:::::>
STAiE'O~ ZIP, 974--77 P1-lONE NO, "7
UJOf<K oeecRIFTION.
SIDEUlALtG ~ CURB SIDE _
CURB-CUT, ~ RESIDENTIAL _
SECOND DRIVEWAY (SEE TRA'i'IC)
REQUIRE!> APPLICATION FOR A SECOND DRlVElUAYI"T-4,\o)
OR A COUNTY APPLICATION FOR FACILITY Ff:F<!'1IT (C '38-203)
IF IN Tl4E U.G.B,
SETBACK _
COMMERICAL _
DATE OF APPLICATION
.
RECEIPT NO,
4tu4
CA51-1
Cf.lECK 2S..
*
Cf.lECKED FOR DELINQJ:NCIES ~
SIGNED,
DATE,
~~_. L ~JJ1/L
4- k"/<=pZ-
,
WORK TO BE r-"'~ I",D e'T'.
CONTRACTOR* L...b-- e.-e-'-P A,
ADDRESS &., '5 S' A f, /~ T1-f
~.w1' ,w
75P;::r, D
>< CONTRACTOR
REGISTRATION NO,* S i 488
r?R- c?74--'Lr
EXPIR:S, e/u /97:-
PHONE, '74'7-- ~34-3
OUNER
FR..,....=-Ul"S FOR lN5FECTION FiEQUEST.
CALL 126-316<3 (RECORDER) &TATE YOUR CITY DESIGNATED JOB Nu:-15ER. JOB ADDRESS,TYFE OF
INSFf:CTION REQUE&TED AND lI.\-IEN YOU WILL BE READY FOR 1N&Ff:CTION, CONTRACTOR5 OR 0UNER5 NAME .4.'iD
P1-lONE NUMBER. REGlUE&T& RECEIVED BEFORE 1,0'" AM WILL BE MADE Tf.lE &AME DAY, REQJ:ST& AFTER 1,,,,,",
AM WILL BE MADE Tf.lE NEXT ~ING DAY
* SEE ~
EXISTING BUILDING Ff:F<!'1IT NO, ( IF APPLICABLE) "'7"'Z~:::':::;-.-.:
YOUR CITY DE&IGNATED Joe NO, I&f <=J 2-0 5"'50
REQUIRED INSFECTIONS
[ZJ
SIDElUALK I DRIVEWAY
FOR ALL =NCRETE PAViNG WITf.lIN
Tf.lE STREET RIGf.lT OF WAY, TO 5E
MADE AFTER ALL EXCAVATING
IS COMPLETE AND FOF<!'1 ~
AND SUB.BASE MATERIAL IS
IN PLACE
FEES.
SIDEWALKS
WD.00 . ~0.1!:>/LF. ( X )
OF WALK
CURB-CUT
~10.00 . W.1!:>/LF. ( X )
o
CURB I APPRO,<.Cf.I APRON,
Ar"'TER FOF<!'1& ARE ERECTED
5UT PRIOR TO POJRING
=NCRETE.
WALK X'
/ "'"
t X' I,
., '1
TOTAL r->='"' liT FEE.
~ I&. 5C>
COMME!<ICAL DRlVEWAY5 Sl-tALL
f.lAVE S' TO 8' FLAIRS
3'. Oil 5T t...'l.PARD
I HAVE CAR:FULL Y EXA'1INED THE COMPLETED APPLICATION FOR PEF<!'1IT, AND DO HER:5Y CE!<TIFY Tf.I'<'T ALL
INFOF<!'1ATlON f.lEREON 15 TFaJE ,<.'iD =!<!<ECT, A'iD I FURTHER CERTIFY TH'<'T A'iY A'iD ALL WOR< P:R!'O!<MED
S;'!ALL BE DONE IN ACCORDANCE WIT;.! THE ORDIN'<''lCES OF THE CITY OF SPRINGFIELD. ,<.ND TH: LAWS OF THE
5TATE OF OREGON PERTAINING TO TI4E WORK DE5CRISED I4EREN, .L.~D THAT NO OCCUP~'-JCY l:JiLL 5: M~D:
OF ANY STR:JCTU!<E WITHOJT PER:'1ISSlo.-l OF THE 5UILDING DiViSION. I FU"'THE'" CERTIFY 7HAT CNL Y CCNTRACTO",S
""N PLOYEESIIJl-t(r'IN ~~IANCE WITf.I 0R5 lOI-"SS WILL 5E US:D ON THIS PROJECT. .
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