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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 Jl.. .? 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}- >< 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:" ~~~- > 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