HomeMy WebLinkAboutPermit Sidewalk 1995-9-15
II~
---lrIDENT~I~;ALK I :~~.<:::IAL
AF'PLlCATION I FE~IT .
225 NORTH FIFTH STREET
SPRINGFIELD. OREGON ';\1411
ENGINEERING DIVISION
cr.FICE NO. 126-3153
IN5FECTION LINE, 126-316';\
JOB ADDRE55, /516 C:;.
ASSESSOR5 Mt.F NO'*/7 03 ~(;.
S""t'4.ed
2- TAX LOT NO: '* O~ $"0 I
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5UBDIVISION,
O..:..NER: JA\l\A.fC..s'
/ C~€.. Kl'..""TV\L~
CITY, <; ?F \)
FHONE NO. 72-10 - I $"\ I
..4.DDR::55:
1M. eilw......O~
S;"lA.'T'j A <;;7
1'>70
5TATE, at<-
~ DEecRIPTIOI',j,
ZIF, <11'+"
5!O::uJ.4.LK:
CURS-CUT: ~
CU5'95IDE._
~5IDENTJAL _
5=TeAC~
CO:-1l1: R1CAL
5:::COND DRIYEWAY (SEE iR.t.,.;,..]C )
REQUIRES AF'PLlCATlo.--l FOR A 5:COND DRIVEWA':'I'T.4.1.)
OR A COJNTY t.FPLICA.ION FOR FACILITY FE~IT IC "l8,2"'3)
IF IN THE UC.5.
DATE 0.= t.F'PLlCATlo.--l
t?-r,~
WORK. TO BE FE~l"<J II::D BY,
CONTRACTOR*"~.u.i~",I\l'" ~.v\')-\ G,~,l.-\J'-'-
'An, V?I:;{I}-
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CONTRACTOR
Oi.!..N:R
SPRINGFIELD
RECE IFT:;....---' 'I 0 ~
CASH _
CHECK _
*
.-
Cr-lECKED FOR D=LINQ:J~Cl:::S
. SIGNED,
DAlE:
*"
REGI5TRATlON NO. '1'1'2 'f
APPR:55
~6
~UJ:"
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EXPIRES, ::zIUlf1
P,-,O"E, ~8}~o
r-1'<V'-'I::I.AJRE FOR IN5A:CTION REGlUE5T,
c.4LL 126-316';\ lRECo.<:DEfo1) STATE YOUR CITY DESIG"-'-TED JOB NtJ:";BER. JOB ADDRESS.TYFE 0.=
INSPECTION F?EaU:::5TED A"lD ~EN "(OU WILL 5::: R:ADY FOR INSFECTI~, CONTRACTO% O~ Ot.:..N:~ NAM::: t..."lD
FI-loNE NUMBER. REQ~ESTS RECEIVED ;:=;-~r= 1,"'0 .'-11 WILL 5E MADE THE SA.ME DAY. REQ~E5TS :"'=TER 1,=
A"1 WILL BE MADE THE NEXT \ll:>R(.ING DAY
*" SEE BC::>oi<:.
YOUR CITl D:SIGNATED JOB NO. Isf
EXI5TI~ BtlILDING PER'MIT NO. ( IF AFPL1CABLE )
REGlUIRED 1N5F;CTION5
D
SIDEWALK I DRIYEWA Y
FOR ALL CONCRETE FAVING Wm..IIN
THE STREET RIC.4T OF WAY. TO 5E
M.4DE .t.FTER ALL EXCAVATING:
15 COl"iFLETE AND FON1 WO~
AND SUB, Bt.5E Mt. TERIAL 15
IN PLt.CE
FEES,
SIDEWALKS
~10.00 + ~0.15/LF. ( X )
Of WALK I".GIJ -/- t;.'i'O
CURB-CUT
~10.00 + 10.1!?ILF. ( X )
9</Lj91
04- CURB I APPROACH AFRO.
AFTER FOR'M5 ARE EREcn
BUT PRIOR TO FO:JRING
CONCRETE.
TOT AL F;~IT FEE,
s
,..
J~, C/O
CO;1MERICAL DRIVEWAYS SHALL
HAVE 5' TO 8' FLAIRS
3'- "''' ST-'-NDARD
Wt.L< x'
/ ~
t X' I.
., "
I ;..lAVE ,CAR.:::.-i=uLL Y EXA~INED TJ-JE COMPLETED APPLICATiON FOR PERMIT, ,.:.."~D DO t-lEREBY CERTIFY 71-1.L.T ALL
lNFO~ATlON I-!EREON 15 TRUE A"lD CORRECT, A~D I FURTf-.;ER CERTIFY Tt-l4T o4"IY ,j."ID ALL WO~ PEFiFOR7iED
5;...lALL BE DONE IN t..CCORDA"'JCE WIT~ n-lE ORDIN":'''-lCE5 OF TI-lE CITY or 5PRINGFIElD, AND THE L.AW5 0:= Tl-lE
5TATE OF OREGON FERTAINING TO T4E Il.lOR!<: DESCRI5ED HEREIN. "ND THAT NO OCCUFANCY WILL 5E MADE
or .4.SY 5TP.JCTU~ UJlT;-!OJT PER:"11551O':'J or TI-lE !31J1LD!NG PIV1510tt I FUR71-l5.R CERTIFY 7i-1~T ONL j COSTRACTOR5
t.ND EMPLOYEES UJI-IO ARE IN COMFLIANCE WITI-I 0R5 101_5 WILL BE USED ON THIS PROJECT.
~ / z.:- CfE. R f:Aln:<<:- (; .
SIGNED
'1/7 / 9~
DATE