HomeMy WebLinkAboutPermit Sidewalk 1994-10-25
II~
-WIDENT1'~;ALK I ~~~~CI~,L,
AFFLlCA TION I PERMIT '
SPRINGFIELD
22" NORTI-l FIFTI-l STREET
SPRINGFIELD, OREGON <;\1411
ENGINEERING DIVISION
OFFICE NO. 126-'1,,'
INSPECTION LINE, 126,';6<;\
Joe ADDREe5. l\q Cj 1==/1 iY v( ew 1) v
ASSES50Re. MAP NO.*' 11 O??.7 Lj ]
5UBDIVISION, M~2..\E VIL.LA6E'
~R, t-Irru. <;)v\~ A.A':hI\l)v; ~
t.DDRESS, '::500 W \- a. ~ If \.h e.u...> ~
STAlE'~ ZIP, c; -Jl.n7
UJO!;!K. DESCRIPTION,
SIDEWALK, u:::::...
'*
T AX LOT NO. ()() to I
RECEIPT NO, \02.I..<-
CA5I-l
CI-lECK L
CITY, Spfel
PrlONE NO. ton - ::E7S
'*
CI-lECKED FOR DELlNQJENCIES _
CURS SIDE _
SETSACK
CURS-CUT, RESIDENTIAL _ CO:1MERICAL _
SECOND DRlvEWA T r SEE TRAfTIC )
REaJlRES AFFLICATION FOR A 5ECOND DRlvEWATr'T,4.1.)
OR A COUNTY APPLICATION FOR FACILITT PERMIT rc <;\&-2"')
IF IN TI-IE U.G.9.
DAlE OF AFFLlCATION )1) ,7Jo -q4
SIGNED,
-a,^^ArJ-~-
'11-7;:'-'1~ .'
DAiE:
UJOI':!< TO BE FE~"", IcD BY, OUNER'/ CONTRACTOR
CONTRACTOR '*' "')IA~)\J (' u.\..\ '\Te.1A.. m 0)0. I tJ~GISTRATION NO.'*' ~~ 7 J
t.DDRES5 2.'1 '::AL\l":> A,12...'VCII2--i ?-D
EXPlRE5, ~ -21 ... 15
P;..!ONE, tHo I oc,lJ:>,
...........c......URE FOR IN$F5CTION REQUEeT.
CALL 126-'16<;\ (RECORPER ) STATE TOUR CITY DESIGNATED Joe NUM9ER Joe ADDRES5,TTf'E OF
INSPECTION REQJE5lED AND ~ TOU WILL SE READT FOR INSPECTION. CONTRACTORS OR OUNER5 NAME A'ID
P;.IONE NUMSER REQUESTS RECEIvED e,,,rvr= 1,= AM WILL BE MADE TI~= SA"1E DAT. REQJESTS AFlER 1,=
AM WILL BE MADE THE NEXT ='~<.1NG DAT
'* SEE 6001<
EXISTING SUILDING PERMIT NO. ( IF APPLICA9LE )
TOUR CITY DESIGNA lED Joe NO. Isf q q \ 10 Lj 0
REQUIRED lNePECTIONe
[]
51DEWALK I DRlvEWAT
FOR ALL CONCRElE PAVING WITI-lIN
TI-lE STREET RIG!-IT OF WAT, TO SE
MADE AFTER ALL EXCAVATING
IS COMPLETE A'ID FORM WORK
A'ID 5UB,SA5E MAlERIAL IS
IN PLACE
D
CURS I APPROACH APRON,
AFTER FORMS ARE EREClE!
SUT PRIOR TO POURING
CONCRETE.
FEEe.
SIDEWALKS
.10.00 . .0.15/LF. ( X )
OF WALK
CURB-CUT
J/() .10.00 . ~.1:;/LF. ( X )
TOTAL PERMIT FEE.
~
1~.OO
COMMERICAL DRlvEWATS SHALL
HAvE ,,' TO e' FLAIRS
"- 0" STA'IDARD
WALK x'
/ "'"
I, x' I,
., 'I
..
",1!l./J7'J{L)d/
SIGNED
I rlAvE CAR:~LL T EXA'1INED THE COMPLETED APPLICATION FOR PERMIT, .=.'1D DO HEREBT CERTIFT TI-I.l.T ALL
1N'"..oRMATION HEREON IS TRJE A'ID'CORRECT. A'ID I FURTf.lER CERTIFT TI-I.l.T A'IT ':>''1D ALL UDR;< PER'O!'<l'1ED
Sl-IALL BE DONE IN ACCORDA'ICE WITH THE ORDINA'ICES OF THE CITY OF SPRINGFIELD, A'ID TI-IE LAW5 OF THE
STATE OF OREGON PERTAINING TO THE WORK DE5CRI9ED I-IEREIN, t.'1D TrlAT NO =CUPA'ICT WILL 9E Mt.DE
OF ,""NT STRUCTURE Wln40JT :='EI<:'1IS5ION OF THE 9UILDING DIVISION. I Ft;RTl-IER CERTIF'I' THAT ONL T CONTRACTOR5
AND EMPLOTEES UJl.<O ARE IN COMPLIA'ICE WITI-l ORe. 101~" WILL 9E USED ON TI-IIS PROJECT.
, /()/10/~~
DATE I
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