HomeMy WebLinkAboutPermit Sidewalk 2014-09-18SPRINGFIELD
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w .springfield-or.gov
CITY OF SPRINGFIELD
Building / Public Works Permit
PERMIT NO: 811-PW2014-00151
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitmnter@spdngfield-ocgov
PROJECT STATUS: Issued ISSUED: 09/18/2014 EXPIRES: 03/17/2015
STATUS DATE: 09/18/2014 APPLIED: 09/18/2014
SITE ADDRESS: 6449 A ST, Springfield, OR 97478 SCOPE:
ASSESOR'S PARCEL NO: 1702344204201 TYPE OF STRUCTURE:
PROJECT DESCRIPTION: Repair of sidewalk
OWNER: MINIERJAMES Phone Number:
ADDRESS: 6447 A ST
SPRINGFIELD OR 97478
OWNER: TRAVESS GEORGE T Phone Number:
ADDRESS: 1495 CHEEK ST
SPRINGFIELD OR 97477
OWNER: WOODALL BARBARA ANN Phone Number:
ADDRESS: 6449 N A ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone
INSPECTIONS REQUIRED
Inspections
9506 Sidewalk - Setback Sidewalk - Setback: After forms are erected but prior to placement of concrete.
By signature, I stale 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 al,the front of the property, and the approved set of plans will remain on the site at all times during
Owner 4 Contractor Signature
'iflS ITS IIAU EXPIRE IFTHE WORK
" ' 1 HORIZED UNDER I -HIS PE_RN41T IS NOT
" HCH) OR IS ABANDONED FOR
0 I)AY HIJOD.
Springfield Building Permit
'rTPPI1*IG) .,.
wl I requires you to
t$3tgow 1`14108 adopted by the Oregon Utility
Notification Center. Thoso rules are se( forth
in OAR 952-001-0010 through OAF; 952-001-
0090. You Inay obtain copies of the rules by
calling the center, (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332-234,1).
9/18/2014 8:33:12AM
Page 1 of 1
225 Fifth Street, Springfield, Oregon 97477
Transportation & Engineering Section, Public Works Department
Phone: 541 726-3753
SITE INFORMATION
Location of Work:�9S
Applicant: /A. G& vt,✓VS f- S O 1-5 CG NS %
Phone: f_ `I S � 8�0
Address: PC). Ox �tai!
City: r^— � State: Ole ZIP: �(? y % % Tax Map
Tax Lot
Subdivision
Owner:
Phone:
Address:
City: State: ZIP:
REQUESTED PERMITS:
Sidewalk Amount of sidewalk in excess of 90 feet
❑ Sidewalk Repair
❑ Curb Cut/Driveway: Number of Driveways
❑ 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
❑ 5%Technologyfee
❑ Proof of Insurance: $500,000 Minimum if work is done by property owner
CONTRACTOR'S INFORMATION
Name: GL/1J rt
Address:
104.00
19.00
$104.00 1st Cut
due with permit $
City: 5;-99 r r\ State:p Jam' _ ZIP: C( 2 y 7
Contractor Registration # L- 6j `} a r C p Expiration date:
Project Supervisor
11011-19011110101K
Fees
@$0.09 SF
X $67 2nd Cut
Phone: �7—r/-! 53 6��- 9
Phone:
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.