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
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SIDEWALK I CURBCUT .
APPLICATION I PE~IT ?
SPRINGFIELD
JOB ADDRESS, '?-? ~<7
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ASSESSORS MAP NO. .. /7 D 3
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TAX lOT NO: +. -:J;,7CJO
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RECEIPT NO, /'{Zf(b
CA5I-l
CHECK ~-
5U:3DIVISION,
57 ATE:
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~535"" (;~{)lda.em N CITY, L.,f~[)
bfl ZIP, 97417 P;.!QNE NO.
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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....-
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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
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EXISTING: ~IL;::'ING FE~lT NO. ( rr= AFPL1CA9LE )
YOU<< CITY DESIGNA",D JOE> NO. Isf 991LfC1
REQUIRED INSFt:CTIONS
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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.
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