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HomeMy WebLinkAboutPermit Sidewalk 2014-10-03SPRINGFIELD Q 610REGON w .spvngfieldncgov CITY OF SPRINGFIELD Building / Public Works Permit 1;14;MIYi►WWI IE,hrEME91I111.11 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769. Fax: 541-726-3676 permitcenter@sp6ngfield-orgov PROJECT STATUS: Issued ISSUED: 10/03/2014 EXPIRES: 0 4101 /2 01 5 STATUS DATE: 10/03/2014 APPLIED: 10/03/2014 SITE ADDRESS: 1620 MOHAWK BLVD, Springfield, OR 97477 SCOPE: ASSESOR'S PARCEL NO: 1703253105900 - TYPE OF STRUCTURE: PROJECT DESCRIPTION: Sidewalk repair. OWNER: BANK OF OREGON ADDRESS: LAKE0012 MINNEAPOLIS MN 55406 OWNER: UNITED STATES NATIONAL ADDRESS: LAKE0012 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. caner or Contractor Signature Dale Springfield Building Permit 10/3/2014 2:26:53PM Page 1 of 1 Application Date: Permit Number b^lt-pw261q-0e( o SITE INFORMATION Location of Work: Applicant: //11,i Address: City: 225 Fifth Street, Springfield, Oregon 97477 Transportation & Engineering Section, Public Works Department Phone: 541 726-3753 SPRINGFIELD � AVA AI Phone:IS// 1P8g=4331 Tax Map 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 Name: Address: City: Contractor Reg Project Supervi 101697xi1111161B l $104.00 $19.00 X $104.00 1 st Cut $35 Total due with permit $ Fees @$0.09 SF X $67 2nd Cut Phone:�jl ��g Q331 Phone:,s y/ -,ss/( -62 Y 6 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. You are required to call: The Lane Utilities Coordinating Council's "One Call Number" 1-800-332-2344, 48 hours before before digging. SIGNATURE: