HomeMy WebLinkAboutPermit Sidewalk 1994-10-26
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-=W' IDENT11~;ALK I C~~TIAL
APPLICATION I PERMIT
225 NORTH FIFTH STREET
SPRINGFIELD, OREGON <;\1411
ENGINEERING DIVISION
OM'ICE NO. 126-3153
INSPECTION LINE, 126-316<;\
JOB ADDREe5, Y'irCj
ASSESSORS MAP NO.*'
F(!.'l V I/i -t,W \) oj
110??..7Y]
5UBDIVISION, MlW\2iE VIL.L.A6E:'
Hrru. <;)y\~ A., -t\" il'v; ~
hDDRESS, ?JOD IN \- tl. ~ V III eu.J ~
ZIP, C, I Lj 77
OilNER,
STATE,OC-
l1JOf'!l<. DEe.cRIFTION,
SI!:>EUJALK, ..IL::...
CURS SIDE
TAX LOT NO~ '* M 101
RECE IPT NO, t t7 Z "Z--1..-
CA&H
CHECK
"./
CITY'Spfe1
P",ONE NO. (on - ::875
'*
CHECKED FOR DELINaJENCIES _
SET9ACK _
CO:1MERICAL ~..
SIGNED,
DAiEl
WORK TO BE FERF,.,,..,. Il:::D 6.,..., OUNER v CONTRACTOR
CONTRACTOR *' <:::;1A-1~,\l (' 1)")\"\ ~,rT1 O)V. J NGcGISTRATION NO.*' -:;)?J 7 J
ADDRESS 2.CJ=:H-c..11'1 AIe...'i'?rI2.-, ~])
CURS-CUT, RESIDENTIAL _
SECOND DRIYEWA Y (SEE TRt.I'T'IC )
REaJIRES APPLICATION FOR A SECOND DRIYEWAY('T,4.1.)
OR A COUNTY APPLICATION FOR FACILITY PEF<:'1iT (C ~-2"'3)
IF IN TH: U.G:.5.
DATE OF APPLICATION )0, LIo . Cf4
- a /'v\ ArJ- t4-u-.
II1-7J-i ..q~
EXPIRES, ::5 -2) ,,15
P",ONE, t/lnl ()Cj1J:J,
'-~"'l:::""URE FOR IN&Fl:CTION REGlUEST,
CALL 126-31&<;\ (R:CORDER) STATE YOUR CITY DESIGNA>:D JOB NU:'1B:R. JOB ADDRESS.TYPE OF
INSPECTION R:QUESTED A"ID IIIrIEN YOU WILL B: REA!:>Y FOR INSPECTION, CONTRACTORS OR OIlNERS NAME A"ID
PI4ON: NUMBER R:QUESTS RECEIYED B"rv...: 1,ClO Al1 WILL BE MAD: n-lE SA'"1J: DAY, REaJESTS t.FTER 1,ClO
AM WILL ElE MADE THE NEXT UJORll(ING DAY
*' S:E ElOOK
EXISTING ElUILDING PEF<:'1IT NO. ( IF APPLICAElLE )
YOU"! CITY DESIGNATED JOB NO. 1St q L( 110 4 to
SIDEWALK I DRIYEWAY
FOR ALL CONCRETE PAVING WITHIN
THE STREET RIGHT OF WAY, TO El:
MADE AFTER ALL EXCAVATING
IS co:1PLETE A"lD FOF<:'1 UJORll(
A"lD 5UEl-ElASE MATERIAL IS
IN PLACE
REQUIRED INSA:CTIONS
[]
FEES,
SIDEWALKS
110.00 + 10.15/LF. ( X )~t)
OF WALK
TOTAL A:RMIT FEE,
,~ .
1 q,oa
D
CURB-CUT
110.00 + 10.15/LF. ( X )
COMMERICAL DRIYEWAYS 5J-IALL
HAYE :,' TO 8' FLAIRS
3'- 0" 5TA"I!:>ARD
CURS I APPROACH APRON
AFTER FORMS ARE ERECTE:
ElUT PRIOR TO POURING
CONCRETE.
.
WALK x'
/ ""
l x' t
" 'I
I ",AYE CAR;rlJLL Y EXA.."N:D THE COMPLETED APPLICATION FOR PEF<:'1IT, "'''ID DO HEREBY CERTIFY THt. TALL
INFORMATION HEREON IS TRJE A'iD'CORRECT, A"ID I FURTHER CERTIFY THAT A"IY AND ALL UORK PER'ORMED
SHALL ElE DONE IN t.CCORDA'iC: WITH THE ORDIN"'''ICES OF THE Cln- or 5PRINC:FIELD, AND THE LAU15 OF THE
5TATE or OREGON PERTAINING TO THE UJORll( DESCRIBED HEREIN, A"ID THAT NO OCCUPA"ICY WILL ElE MADE
OF "'NY STRUCTURE WITHOJT PEF<:'11551ON or THE ElUILDING DIVI51ON. I FURT}.jER CERTIPT' THAT ONLY COl"RACTORS
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