HomeMy WebLinkAboutPermit Sidewalk 1999-10-8
l. . City of Springfield ' ./
DRIVEWAY/SIDEWALK PERMIT APPLICATION
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PERMIT NUMBER:
DATE ISSUED:
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225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726.3753
APPLICATION DATE: /0.- 7~ '7'1
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APPLICANT '/f.,J (J.J 1Zr VT'lt (./U 1M /u /Vb PHONE
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9 STATE: O(~ ZIP: tJ7<-f71
ADDRESS:
TAX MAP:
CITY:
TAX LOT:
SUBDIVISION:
OWNER:
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PHONE: ~9~~ 6..,
ADDRESS: '300" fie6/) tetGK5 e.u~~: a.t.c 0';;<; 1;..
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STATE: ~L--l ~
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REQUESTED PERMITS:
o DRIVEWAY/CURB-CUT/SIDEWALK: ..................,......................................,...........$ 60.00
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/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
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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
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Date / () / 9' / epf'
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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.
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