HomeMy WebLinkAboutPermit Sidewalk 1994-11-22
~IDENTIAL - COMMERCIAL
SIDEUJALK I CURBCUT .
APPLICATION I PERMIT
!;/~O
225 NORTI4 FIFTI4 STREET
SPRINGFIELD. OREGON "'1411
ENGINEERING DIVISION
OFFICE NO. 11&-3153
INSPECTION LINE, 11&-31&'"
Joe ADDREee. (tJO& 1-aivl/ieu)
ASSES50R5 MAP NO,* 17 e>:s "Z- 7 4 z...
sueDIVISION.
ou.NER.
H AC.5 A
ADDRESS. .::(00 UJ ~Faii-'v/eUl
STATE. OiE&-otJ ZIP, q7477
U.JORK DE5CRIPTION.
DATE G;' APPLICATION
Id~'J.!qtf
UJORK TO BE PEF<f'v"", I""D BY,
CONTRACTOR* STAToAJ CtJtl.St. TI'lG.
ADDRESS :1'1394 ~R Ai "porL:a.d..
PROCEDUl<S FOR IN5FECTlcN REQUEST.
SPRINGFIEl.D
',*,
TAX LOT NO. IDD
RECEIPT NO. I 5:>"6:''1
CA51-1
CI4ECK ~
CITY Sfl- ;"~rfi..e.LJ
PHONE NO.
CI4ECKED FOR DELINQJENCIES'*' /
5ET9Ac.< _
CO:-t.1ERICAL _
SIGNED:
D.l..i'E:
Ou.N.:R
x.
CONT~CiOR
~ -;r;~"';;
11 -z.:z_~/
EXFIRES..? /J./lq.)-
. .
PMONE. %I-Oo~
C.4.LL '26-~i6~ (RECORPER ) STATE YOUR CITY DESIGNATED Joe NtJ."19ER. J09 A!)DRES5.TYPE OF
INSPECTION REQUESTED AND UJ:..lEN YOU WILL eE READY FOR INSPECTION. CONTRACTORS OR 0\l.NER5 NAME ./-ND
P~E NUM9ER REQUESTS RECEIVED 5EFORE 1,00 A"1 WILL 5E MADE TI4E SA"1E DAY. REQJESTS AFTER 1.00
AM WILL 5E MADE TME NEXT UlOR<ING DAY
SIDEUJALK. CURS SIDE _
CUR3,CUT, ~ RESIDENTIAL _
SECOND DRIVE:;)A Y (SEE TRAFFIC )
REQUIRES APPLICATION FOR A SECOND DRIVEWAn'T-4.1.)
OR A COUNTY APPLICATION FOR FACILITY PERMIT (C ':>3,103)
IF IN TI-lE u.c..9.
REGISTRATION
*
NO. 0337/
'[L4fJ :1
* SEE 500K
EXISTING 5UILDING FERMIT NO. ( IF APPLICA5LE )
YOJR CITY DESIGNATED J09 "0. IS'f 941 711
REQUIRED INSPECTIONS
'0
EUY61P, O~
SIDEWALK I DRIVEWAY
FOR ALL CONCRETE FAVI"G UJITI4IN
TI-1: STREET RIC,!-lT OF WAy. TO 9E
M"-DE ACTER t..LL EXCAYATINC:J
IS co,"1PLETE AND FORM WOR<
t.."-!D 5UB-9A5E Mt..i'ERIAL 15
IN PLACE
FEES,
SIDEWALKS
t10.00 + t:2?.I5/L F. ( X )
0;: WALK
TOTAL PERMIT FEE.
~ . /? ' f..{ 0
~CUR9 I APPROACI4 APRON.
AFTER FORMS ARE ERECTED
BUT PRIOR TO POURING
CONCRETE,
CURB-CUT
tiel.00 + tlZ'.I5/LF. ( X ) I~
co:-1MERICAL DRIVEWAYS S;.!ALL
MAVE 5' TO 8' FLAIRS
3'- 0" STAN"ARD
UJALK X'
/
I.
x'
""
t
1
1 ;-lAVE CAREFULL Y EX~"'N=D TI-lE COMPLETED ":"PPLICAiION FOR PER:11T, ,.:,'''-ID DO r-:ERESY CERTIFY 71-l,t..T ALL
!NCORMATlON MEREON IS TRUE AND COR~CT. AND I FURTMER CERTIFY TI4AT .:.NY "'ND .:.LL t!.OR< PERFORMED
S;'!ALL 5E DONE IN ACCORDANCE UJITI4 T;.!E ORDIN':'NCES G;' TME CITY G;' SFRINGFIEL". .:.ND T;.!E LAWS G;' TI4E
STATE G;' OREGON PERTAINING TO T;.!E WORK DE5CRI5ED HEREN, AND T;.!AT NO OCCUPANCY UJILL 5E M':'DE
G;' ANY STRUCTURE UJIT;'!OJT PERMISSION G;' T;'!E 5UILDING DIVISION. I FU'RT;'!ER CERTIFY TI4AT ONLY CONTRACTORS
.!.ND EMPLOYEES WHO ARE IN Co."1PLIANCE UJITI4 ORS 101.055 UJILL 5E USED ON THIS PROJECT.
,~~ &I:d
SIGNED a
II /? ;:;'/9'-1
DATE I I