HomeMy WebLinkAboutPermit Sidewalk 1994-10-25
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--WIDENT11~;AL:-1 :~~EjCIAL
APPLICATION I PERMIT
22:' NORTH FIFTH &TREET
&PRINGFIELD, OREGON ~1411
ENGINEERING DIVI&ION
OiTICE NO. 12b-31:.3
IN&PECTION LINE, 12b.31b~
J06 ADDRE58. L\ 1'1
A&&E&&oR& MAP NO.*
f=-r.L iY VI-GuJ \)r'
110?L7LJj
&U6DIVI&ION, N\t)?;c}rz.,\E V\LLA6~
OiLNER, t-\rru <; )y\ 0 A. A ~ (lv ; il:J
t.DDRE&&, '?:;Do IN \- 0. ~ I{ III e.l0 -.r::>r
&TATE'f1e- ZIP, ell Wli
SPRINGFIELD .
TAX LOT NO: *' rJ() 101
RECEIPT NO, 10'Z-z...-z.....
CA&H
CHECK
./'
CITY, Spfd
PHONE NO. ton - ::E7S
*'
CHECKED FOR DELINCl'.JENCIE& _
5ET9ACK _
CO:1MERICAL _
5IGNED,
DA.'iE1
WORK TO BE F'E~l'<.I Il::D BY, O~R V CONTRACTOR
CONTRACTOR *' ~/A"'f7)l\.l r [)J\1 ~ en DN. I,\IGcGI&TRATION NO.*' ~3 7 J
t.DDRE55 2.. '1':A<-l 1':> A I~? "12,:, ~D
llJORK DE5CRIFTION.
il 5IDEWALK, u::::::... CURe 51DE _
CURS-CUT, RE&IDENTIAL _
i 5=:COND DRIvEWAY (5=:=: TRAlTIC )
I REQUIRE& AF'PLICATION FOR A 5=:COND DRlvEWAY(.,..4.1.)
OR A COUNTY APPLICATION FOR FACILITY F-RMiT (C ~,203)
IF IN TH=: U.c..s.
DATE OF AF'PLICATION l.12..:.7Jo .q{
-a;,V\~
\11-7J';..q~ '
=:XPIR=:&, ':;:) -2J - 15
PHONE, t.Hol oc;1J:J,
..-....."'....JRE FOR IN5Fl:CTION REQUEST.
CALL 12b-31b~ <RECORDER) 5TATE YOUR CITY D=:5IGNATED .JOS NLl:'1SER, .JOS ADDRE55,TYPE OF
1N5F-CTION REQUE5TED A'lD iU-!EN YOU WILL S=: READY FOR IN&PECTION, CONTRACTOR& OR 0il.NER& NAM=: A'lD
PHONE: NUMElER. REQU=:&T& RECEIvED 6:r....= 1,= AM WILL EI=: MADE TH=: &-"ME DAY, R=:Cl'.J=:&T5 t.FTER 1,=
AM WILL 6E MADE THE NEXT l1JOI'l<lNG DAY
*' &EE 600K
EXI5TING ElUILDIN'" F-RMIT NO. ( IF AF'PLlCAElLE )
YOUR CITY DE51GNATED JOS NO. 151' 0' 4,/ (n L/1
&IDEWALK I DRIvEWAY
FOR ALL CONCRETE PAViNG WITHIN
THE 5TREET RIGHT OF WAY, TO SE
MAD=: AFTER ALL EXCAVATING
1& co:1PLETE A"iD FORM l1JOI'l<
A"iD &UEI,6A5E MATERIAL 1&
IN PLACE
REQUIRED INSPECTIONS
[]
FEES:
D
SIDEWALKS CURB-CUT
.10.00 + .0.15/LF. ( X ) .j> 8 .10.00 + t<D.15/LF. ( X )
OF WALK
TOTAL n:... ,IT FEE.
,$
t&7.70
COMMERICAL DRlvEWAY& &HALL
HAvE :.' TO 6' FLAIR&
3'- 0" 5TA'lDARD
CURe I APPROACH APRON
AFTER FORM& ARE ERECTE:
BUT PRIOR TO POURING
CONCRETE.
.
WALK x'
/ ""
J x' I.
'I
I i-lAVE C.L.RERJLL""" EXA"1tNED j~E COMPLETED APPLICATION FOR FE~IT. "':"'1D DO l-IEREey CERTIFY" ;~,L..T ALL
INFORMATION HEREON 1& T~E A'-'D'CORR=:CT, A'lD I FURTHER CERTIFY THAT A'lY """'D ALL UOR< PE""...."" ,:D
5HALL BE DONE IN ACCORDA"'CE WITH THE ORDIN""'lCE& OF THE CITY OF 5PRINGFIELD. AND THE LAUJ5 OF THE
STATE OF OREGON PERTAINING TO THE WOR< DE&cRISED HEREIN, "-ND THAT NO OCCUPA"iCY WILL ElE M"-DE
OF "-NY 5TR.JCTURE W/TI-JOUT PERMI5510N OF THE BUILDING DIV1510N. I FWRTHER CERTIFY ~HAT ONL Y CONTRACTO~5
.<.ND EMPLOYEE5 iU-!0 ARE IN COMPLIANCE WITH ORe. 101.0:':' WILL BE USED ON THIS PROJECT.
SIGNE~ ~
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