HomeMy WebLinkAboutPermit Sidewalk 2014-10-03SPRINGFIELD Q
610REGON
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CITY OF SPRINGFIELD
Building / Public Works Permit
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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
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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: