HomeMy WebLinkAboutPermit Sidewalk 2014-08-19SPRINGFIELD 225 Fifth St
' CITY OF SPRINGFIELD Springfield,OR97477
Phone: 541-726-3753
Building / Public Works Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-PW2014,00125
w .spnngfieldor-gov permito nter@spdngfield-ocgov
PROJECT STATUS: Issued ISSUED: 08/19/2014 EXPIRES: 0211412015
STATUS DATE: 08/19/2014 APPLIED: 08/19/2014
SITE ADDRESS: 3823 WINSLOW AVE, Springfield, OR 97477 SCOPE:
ASSESOR'S PARCEL NO: 1702194101900 TYPE OF STRUCTURE:
-PROJECT -DESCRIPTION: New Approach
OWNER: JORGENSON MATTHEW L Phone Number:
ADDRESS: 3823 WINSLOW AVE
SPRINGFIELD OR 97477
OWNER: JORGENSON TAMI Phone Number:
ADDRESS: 3823 WINSLOW AVE
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lie No Lie Exp Phone
WALTER A DREWS III CCB 124842 09/09/2015 541-513-8241
INSPECTIONS REQUIRED
Inspections
9504 Curbcut — Standard
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 Safely. 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.
i
Owner Date
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I'RhINT SHALL EXPIRE IF THE WORK
I'IZED UNDER THIS PERMIT IS NOT
["('LD OR IS ABANDONED FOR
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Springfield Building Permit 8/19/2014 9:01:18AM Page 1 of 1
Application Date:
SITE INFORMATION
Location of Work: _
Applicant: W4A`N
Address: '
City:
--------------------------
Subdivision
Owner: MA
225 Fifth Street, Springfield, Oregon 97477
Transportation & Engineering Section, Public Works Department
Phone: 541 726-3753
Address:
City: SSP nd\\r�Q\9 State:(*, ZIP:f
REQUESTED PERMITS:
sidewalk Amount of sidewalk in excess of 90 feet
Sidewalk Repair
W,urbCut/Driveway: Number of Driveways
E] Multiple Permit Discount each: (Maximum 2)
Multi permit discount good for one site and one site Inspection only
applies to 2nd and 3rd permits only. Not sidewalk repairs
S%Technology fee
D Proof of Insurance: $500,000 Minimum if work is done by property owner.
Phone: <�u I, <;67 L(
Tax Lot
Phone: I Go (I4q ^ �a
04.00
9.00
$104.00 1st Gut
Total due with permit $
Fees
@$0.09 SF
X $67 2nd Cut
CONTRACTOR'S INFORMATION
'� n
Name: ��1ti\� �1J-C>lrS \IJI���YyC�6h Phone:
Address: n le) `T\r %rte A nr PNinA 0 \0
City: �-V kt-, State: OQ ZIP: !�r) C I -t
Contractor Registration f k 3 -LI 7) )-19 Expiration date:
Project Supervisor
INSPECTIONS:
q.°I, (
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 Cityjob 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.
are required to
SIGNATURE:
48 hours before before digging.
-800-332-2344,