HomeMy WebLinkAboutPermit Sidewalk 1999-4-15
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
~
4S/~~9f
PERMIT NUMBER:
DATE ISSUED:
6 9~Q qp;r
q-/~9cTj
APPLICATION DATE:
SITE INFORMATION:
LOCATION OF WORK: '7('~- A- Sf.~e.1--
APPLICANT RI'l 1-0 R I1U \-ef'
ADDRESS: Lf5~1 nr<:>r IiUe,
PHONE
b X' q (71(
TAX MAP:
CITY: [uc,p",-e
v
STATE:
[')(.).
ZIP:
<1' ? tfo Cf
TAX LOT:
SUBDIVISION:
o,WNER:
w; II CW7~Lb.IH' MeV'or,'c.. {
I (p f.)~ f-J < S'h~-e f
,
PHONE:
7 Y'G I folo '(
ADDRESS:
CITY:
<;pr/rt'; f"'e Ie),
STATE:
off<.
ZIP:
REQUESTED PERMITS:
l290RIVEWA Y ICURB-CUT/SIDEWALK: .",.....................,...,.,........................"...,.."..".."".,.,."" $ 60.00
AMMOUNT OF SIDEWALK IN EXCESS OF 90FT. @$0.06 SF, $
o SIDEWALK REPAIR: ....................................................................,$ 10.00..........
I
o ADDITIONAL DRIVEWAY:
"..".",.",.",.",..",.".,..".." ...",.",."" $ 30.00, ..., ...,
[il PROOF OF INSURANCE: $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
TOTAL DUE WITH PERMIT $
~()~
CONTRACTOR INFORMATION:
CONTRACTOR: . ~ (')+0 R ()(){.er
ADDRESS: 4~7 Q,'tRr lJu€...
CONTRACTOR REGISTRATION NO: 7 II C;;:2
PROJECT SUPERVISOR: ,IC<M....... (''7~;''tar\
PHONE: rbfSr (7((
EXPIRATION DATE: 00
PHONE: ~ ~q (7 ((
INSPECTIONS:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WORK HAS BEEN FORMED
IXND MADE READY TO POUR.
CURB CUT AND SIDEWALK INSPECTIONS CALL 726-3769 (RECORDER) STATE YOUR DESIGINA TED CITY JOB NUMBER/PERMIT
NUMBER, JOB ADDRESS, TYPE OF INSPECTION REQUESTED, AND WHEN YOU WILL BE READY FOR INSPECTION, CONTRACTOR'~
OR OWNER'S NAME AND PHONE NUMBER. REOUESTS 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: .d/Y#w
AMOUNyREcEI'JED:
REC~ NO: ·
Yf) ()U
-?:A 00
DATE PAID:
RECEIVED BY:
~ -/<<; -.-ClJ" ~
hB /<;vo/
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify 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 Drawlngshand the laws of the State of Ore.llon pertaining to the work
described herein. I further certify that only contractors and employees w 0 are in compliance with ORS 7Ul.055 will be used on this
project. ' .
The City may insRect the work' site described in this Hermit at any time during a one year period following the receipt by the City of
notice of completion of the described work and speCify, at the City's sole descression, any additional restoration work required to
return the site to a standard acceptable to the City. The permittee will be notified in writing of any work required and will have thirty
days 1301 from the date of the notice to complete the work, Work not completed at the end of the thirty days will be performed by thE
City and the costs will 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 approved set of plans will remain on the site at all times during construction. . .
I . ,'.
Signatur~Al?7.J?A ..v~AIr<:-,_
/' '. ..,
Date
Y' /.J: 9'9'
j"