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HomeMy WebLinkAboutPermit Sidewalk 2014-10-03L' IELD "- 1 pts C OREGON v .spdngfieldor.gov CITY OF SPRINGFIELD Building / Public Works Permit PERMIT NO: 811-PW2014-00165 PROJECT STATUS: Issued ISSUED: STATUS DATE: 10/03/2014 APPLIED: SITE ADDRESS: 437 MAIN ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703353111200 10/03/2014 10/03/2014 PROJECT DESCRIPTION: Sidewalk repair at several locations on site. OWNER: OF PORTLAND ADDRESS: LAKE0012 MINNEAPOLIS MN 55406 OWNER: U S NATIONAL BANK ADDRESS: LAKE0012 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 Permitcenter@springfield-ocgov EXPIRES: 04/01/2015 SCOPE: TYPE OF STRUCTURE: Phone Number: Phone Number: MINNEAPOLIS MN 55406 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone 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. Owner or Contractor Signature Dale Springfield Building Permit 10/3/2014 2:16:44PM Page 1 of 1 Application Date: �b(� (Z d la 225 Fifth Street, Springfield, Oregon 97477 SPRINGFIELD Permit Number Transportation & Engineering Section, Public Works Department Phone: 541 726-3753 iaOREGON Issue Date: 1 b (� % ?_0 (t( SITE INFORMATION Location of Work: Applicant: Address: S/' Phone:I 5, Q r City: Iff 6T VState: /'lam ZIP: Tax Lot Subdivision` - Owner: _ Address: _ City: REQUESTED PERMITS: State: I�ISidewalk Amount of sidewalk in excess of 90 feet Sidewalk Repair r-1 Curb Cut/Driveway: Number of Driveways ZIP: 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% Technology fee © Proof of Insurance: $500,000 Minimum if work is done by property owner. $104.00 $19.00 X$104.00 1st Cut Phone: Fees @$0.09 SF X $67 2nd Cut Total due with permit $ -A i b q , 20 CONTRACTOR'S INFORMATION Name: Address: City: State: Q/Y_ ZIP: 7 7 Contractor Registra ion It CC ® Expiration date: Project Supervisor WA6,cP ff INSPECTIONS: Phone: 45r7 1 ! W4& D.3151 Phone: .S ,Sf�'Uz I b 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. are required to call: The Lane SIGNATURE: 48 hours before before digging.