HomeMy WebLinkAboutPermit Sidewalk 2001-1-29
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
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APPLICATION DATE: J I>r/v. 2.'1. 2...00 I
PERMIT NUMBER:
DATE ISSUED:
Q(PO(Co2-c) \
SITE INFORMATION:
LOCATION OF WORK:
APPLiCANT BlYlc. (Iv 'h
ADDRESS:
/ 'i 7
ASSt~~Q'-i CJ.J!. G ",,\),
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STATE: C::XW,Qy{)1--
PHONE
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TAX MAP:
CITY: ~P'UJ*f)cAl
SUBDIVISION:
ZIP:
C{1<{7Y
TAX LOT:
OWNER:
PHONE:
ADDRESS:
CITY~
STATE:
ZIP:
REQUESTED PERMITS:
tsY DRIVEWAY ICURB.CUT ISIDEWALK: ....................:................................................$ 60.00
AMMOUNT OF SIDEWALK IN EXCESS OF 90FT. @$0.06 SF. $
o SIDEWALK REPAIR: .............."..............................,',..............,..............,....$10.00.
o ADDITIONAL DRIVEWAY: ...................................................................$ 30.00
o fBQOF OF INSURANCE' $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
TOTAL DUE WITH PERMIT $
fro 0 .0'0
CONTRACTOR INFORMATION:
CONTRACTOR:
ADDRESS:
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p () -f2,O'f.. .i...CJ3Qtn VO.0'1\o.."",O
CONTRACTOR REGISTRATION NO: I L\ J:; 3~ q
PROJECT SUPERVISOR: ~U'p./ .,,-h<uUlI-c\.
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I\'W> q 11 '1' l{ PHONE~-7d1-1117/
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EXPIRATION DATE: ,'\lJ.M~ :1..00 'l
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 726.3769 (RECORDER) ST ATE YOUR DESIGINA TED 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. REQUESTS RECEIVED BEFORE 7:00 A.M. WILL BE MADE THE .
SAME DAY. REQUESTS AFTER 7:00 A.M. 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" '.800.332.2344
. .' ("'\ 48 HOURS BEFORE DIGGING
SIGNATURE: 2~.J ()J ?tkD....JI;;:>., X .
AMOUNT RECEIVED: ~ - '"
RECEIPT NO: DI-DOD4~28
DATE PAID: JAN. 2<=J.2.=/
RECEIVED 8Y:vL. ~f-u
By signature. I state and agree, that I have carefully examined the completed application and do hereby certify that all information herein
is true and correct and I further certify that any and all work performed shall be done in accordance with the Drdinancqs of
the City of Springfield, applicable City Standara specifications and Drawings, and the laws of the State of Ore~g.on p'ertalning to the work
descr}oed herein. I further certify that only contractors and employees who are In compliance with ORS 701.055 will be used
on this proJect.
The City may inspect the work site described in this permit at any time durin9 a one year period following the receipl by. the City of notic'
of completion of the described work and specify, at the City's sole descression, any additional restoration work regUlrec to return the site
to a standard acceptable to the City. The permitlee will be notified in writing of any work reqUired and will have thirty days (30) from the
date of the notice to comrlete the work. Work not completed at the end of the thirty days will be performed by
Ihe City and Ihe cesls wI' be billed Ie the permillee.. .
I furthor aQ.ree to ensure that all required inspeqtions are requested at the proper time. that project address is readable from the
str et, ano the approved set of plans will remaID on the site al all times during construction.
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Signature
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Dale
I ~21-- 01
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CITY OF SPRINGFIELD
225 FIFTH STREET
SPRINGFIELD. OR 97477
(541)726-3753
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WELCOME TO DEVELOPMENT
SERVICES AND PUBLIC WORKS
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REG-RECEIPT:Ol-000432B C:JAN 29 2001
CASHIER ID:001 11:03 am A:JAN 29 2001
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1012 CURB CUT PERMIT
JOB#:96-01612-01
$60.00
TOTAL DUE
RECEIVED FROM:
BEREAN ASSEMBLY OF GOD
CHECK:
$60,00
$60,00
TOTAL TENDERED $60,00
CHANGE DUE $0,00
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*Pay Name :BEREAN ASSEMBLY OF GDD
*Mail Addr :147 N 75TH STREET
*Cty/st/Z :SPRINGFIELD OREGON 9747B
*Site Addr :147 75TH STREET
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THANK VOU!!!!!!
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