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HomeMy WebLinkAboutPermit Sidewalk 1995-7-10 2150 NORTI-l FIFTI-l STR:ET SPRINGFIELD, OR:GON <;\,4" ENGINEERING DIVISION OFFICE NO. ,26-3,503 INSPECTION LINE, ,26-3'6<;\ RESIDENTIAL - . COMMERCIAL ll~~ SIDEWALK I CURBCUT . APPLICATION I PE~IT ? SPRINGFIELD JOB ADDRESS, '?-? ~<7 * ASSESSORS MAP NO. .. /7 D 3 0AMEP-JAen/) ed. TAX lOT NO: +. -:J;,7CJO rc;- RECEIPT NO, /'{Zf(b CA5I-l CHECK ~- 5U:3DIVISION, 57 ATE: M AfJ r+)-/ B~ ~535"" (;~{)lda.em N CITY, L.,f~[) bfl ZIP, 97417 P;.!QNE NO. * / C~=CK.:D FOR DELINQ:';~C:=5 ~ O.l.NER: .L.DDR::55: UJC>R< DE5CRIFTION, S!DE!'l,t.! K: CURS-On: CUSS SOE 5:::ieAC< ~ ~5rDa-.;iJ~ _ co, n ER1CAL S:COND DRIV=WAY (S:: TRAiTIC ) R:aulR:S APPLICATION FOR A 5:C= DRIV=WA,('T-4.1.i OR A COJNrr .L.PPLJCATION FOR FACILITY P:~IT (C '?8-203) I~ IN TH: U65. DA1"E a= APFLlCATla-./ '7 -I/) -'1..( 5h:::::!'ED: Pi,/- d;li/ _ '- /~i~--?5 DA.."i"E: lXIRl<: TO BE FERf'v"", Il:D BY,_ O<:N:R CON"RACTOR CONTRACTOR*" f1t!f:;?N,'J.!':- 61,1\1rfIiCI/l.L. REGISTRATION NO.* CI"5"<;?,<f =DRE'SS 8~ )A! :?.ftZ' h}~r- ,Q-?4tfl....- , /" /' ' EXPIRES,7-2/-9b P'-'ON:, ..:~6:~~- 7}7t~ r,"",-,,-,c..URE FOR IN&FECTION REQUEST. CALL 12b~3l&~ (R::CORDER ) STATE YOUR CITY D=5rC::~TED J05 N'.f.""j==R. J09 t:.DDR.::55.Ti'PE 0:= INSPECT1~ REQUESTED A""-lD Wi-lEN YOU UJILL 9= FC:.ADY FOR IN5PECTIC1.'-l, CONTRACTORS OR Ol..:J'.2R5 NA:--;:: .L..'lD Pl-tONE NUM5ER REa'J::5T5 RECEIVED 6=.......~ ':o~ 4'1 WILL 5: MADE Tl-4E SAME DAy. REa~::5IS ~=TER 1:00 .4.'1 WILL 6: MAD: T!;E N:XT WOR<.ING DAY * ~"" ~~~ ;;1__~ EXISTING: ~IL;::'ING FE~lT NO. ( rr= AFPL1CA9LE ) YOU<< CITY DESIGNA",D JOE> NO. Isf 991LfC1 REQUIRED INSFt:CTIONS D SIDEWALK I DRIVE;WAY FOR ALL CONCRETE PAVING WJT;-lIN TH: STR::T RIG!;T or WAY, TO :3: M.4.DE ..l..CTER ALL EXCAYATfNG: 15 COMPLETE AND FORS1 WO~ A~D SUB-BASE Mt..TERrAL [5 IN PLACe ~_CUR5 I APPRCACI-l APRO A=TER FO~S A~ ER.:Ci: BUT PRIOR TO PO~RING CONCRETE. FEES. SIDEWALKS .10,00 + .0.15/LF. ( X ) or WALK CURB-CUT TOT AL FE~IT FEE. ~ /~joD COMM:RICAL DRIV=WAYS SI-lALL I-lAVE; !;' TO 8' FLAIRS 3'. O. 5T A""DAR!:> W.t..L< X' / ~ l x' I. ., " .10.00 + ~.15/LF. ( X ) r ~A\IE ,C.L.REf:ulL Y EXA"'1I~D TJ-!E COMPLETED APPLICATION FOR PERMIT, ,j.'JD DO ~EREBY CERTIFY 7l-l.L..T ALL 1N"".-o~ATlON H:R:ON IS T1<1J: A'ID CORRECT, A'ID I FURTl-'ER C:RTIFY TI-lAT "''11' A'ID ALL ILOR<: PE~R.'1ED SHALL 6: DON!: IN t.CCORDANC: WITI-l TI-lE ORDIN-'-'JC:S or TI-l: Cln- or SPRINGFIELD, AND TH: lAUJ5 or TI-l: 5TATE or 0R:60N PERTAINING TO THE =1'>< DE5CRI5ED HEREIN, AND TI-lAT NO OCCUPA'JCY WilL 5E M-'-D: OF t..SY STF1JCTU~ UJln-lOUT PER:'1ISSlo:-.! OF T~E SU1LD!NG DIVISIOt..f.. I FuR7l--1=:R CERTIFY 7/-l..1T ONL Y COSTRACTO~5 AND :MPLOYEES WHO AR: IN COMPLIA'lCE WITI-l ORS ,01.00.50 Will B: USED ON TI-lIS PROJECT. -~"''V) ~bV\vt,k. ~~D \ :;2-[D-qs- DAT: