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HomeMy WebLinkAboutPermit Sidewalk 1999-10-8 l. . City of Springfield ' ./ DRIVEWAY/SIDEWALK PERMIT APPLICATION ~:,~ PERMIT NUMBER: DATE ISSUED: q.q l~l4- (0 If> (&fC( 225 FIFTH STREET SPRINGFIELD, OREGON 97477 ENGINEERING DIVISION OFFICE TELEPHONE (503) 726.3753 APPLICATION DATE: /0.- 7~ '7'1 ~~:~~::OO~:~:~N: ~ .,~ _ 1111"". - APPLICANT '/f.,J (J.J 1Zr VT'lt (./U 1M /u /Vb PHONE .~ Ie d/f i (?oST tJ,;ckL1E.J /l $r. 9 STATE: O(~ ZIP: tJ7<-f71 ADDRESS: TAX MAP: CITY: TAX LOT: SUBDIVISION: OWNER: 70S'! ()~hc...'L- r os. ') '- , PHONE: ~9~~ 6.., ADDRESS: '300" fie6/) tetGK5 e.u~~: a.t.c 0';;<; 1;.. Vt~(,- WL-Vt~ STATE: ~L--l ~ ZJp:q~ REQUESTED PERMITS: o DRIVEWAY/CURB-CUT/SIDEWALK: ..................,......................................,...........$ 60.00 6~~~:: O:E~~::~~~.I.N,.E.~~~~~.~.~.~~~~:.."......,.,.".....,.,."........~~.O:~: ~:..OO,$ /0.00 o ADDITIONAL DRIVEWAY: ,......,..........,.".,..,...,..",.,.,..,.,.,....,.".."".,.., ,$ 30.00 o fROOF OF INSURANCE' $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER TOTAL DUE WITH PERMIT $ /0,00 , CONTRACTOR INFORMATION: CONTRACTOR: --r(y/;V 1?-({/f"6&l115//'-<;'? ADDRESS: / ~ ? > / I<-UI .All..':? f?...cjl CONTRACTOR REGISTRATION NO: ! 7 rf.J'l~ PROJECT SUPERVISOR: /)1/ /?e.-- INSPECTIONS: /d.-u & PHONE: 0).iV -/'-1<9 EXPIRATION DATE: PHONE: qL;Z/ -/0<1S- 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 726-3769 (RECORDER) STATE YOUR DESIGINATED 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. REQUESTS RECEIVED BEFORE 7:00 A.M. WILL BE MADE THE SAME DAY, REQUESTS AFTER 7:00 A.M, 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 DIGGING SIGNATURE: AMOUNT RECEIVED: ~/o. 06 DATE PAID: 10/8'/"1'1 RECEIPT NO: o3S-tB/S RECEIVED BY: Bee- /~ By signature, I state and agree, that I have carefully exa';'ined the completed application and do hereby c~rtifv that all information herein 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, applicable City Standard specifications and Drawings, and the laws of the State of Oregon p'ertaining to the work descriOed herein. I further certify that only contractors and employees who are in compliance with ORS 701,055 will be used on this project. ' The City may inspect the work site described in this permit at any time during a one year period following the receipt by the Ci~ of noflc{ of completion of the described work and specify, at the City's sole descr~ssion, any additional re,toratlofi work re~u retj to retu n the s t€_ to a standard acceptable to the City. The permittee will be notified in writing of any work requireo and will have thirty days (30) rom the date of the notice to cO'T]plete the work. Work not completed at the end of the thirty days will be performed by the City and the costs w!1I be billed to the permittee, . I furthor agree to ensure that all required inspections are requested at the proper time, that project address is readable from the street. and the approvep set of plans will remain on the site at all times during construction. Signature ~~ "l}:f'-wt ., . ) Date / () / 9' / epf' / I ~ . " / . City of Springfield 225 Fifth Street Sp~ingfield, OR 97477 (503) 7210,-3753 Transaction number 035815 October 08, 1999 1:13 PM Received fron.: TWIN RIVERS PLUMBING, INC Contract/O~n : CONTRACTOR Address: 1525 IRVING ROAD City: EUGENE St: OR Zip: 97404 -Bllilding- Job t: 991374 Descr.ipt ion Fee Side~alk 10.00 Total: Amt. Received: Check t: 21154 10.00 10.00 Checl, Thank YOIl, Bob T. . o