HomeMy WebLinkAboutPermit Sidewalk 1994-10-25
11~
~IPENTIAL - COMM~IAL
~ 51DEWALK I CURBCUT .
APPLICATION I PERMIT
22" NORTI-l FIFTI-l 5TREET
5PRINGFIELD, OREGON ~1411
ENGINEERING DIVI510N
OFFICE NO. 126-31,,3
IN5PECTION LINE, 126'316~
SPRINGFIELD
',*
TAX LOT NO. riD WI
RECEIPT NO, 1'3-z..z:t-.
CA51-1
JOB ADDRE8e. Y 0"1 -:f[-t~Y VI~W 1)('
A55E55ORS MAP NO.*' 11 D?7.7L) 1
5UBDIVI5ION, M-ut.{N2-IE VILLA6f'
OilNER, t-\rm <;)y\~ A..f.^ 11v; ~
t.DDRE55, ZX:JD vJ \- 0.. ~ v Ii, e.<01:>;=
5TATE'~ ZIP, c" Lil7
lIJORl< DESCRIPTION.
51!:lElIl,Al K, .lL::...
CI-lECK vL
CITY, Sr>fe1
P;..IONE NO. (on - =::E7S
'*
CI-lECKED FOR DELINQJENCIE5 _
CURS 51DE _
5E';9ACK
CURS-CUT, RE51DENTIAL _ CO:1MERICAL _
5ECOND DRIvEWAY (5EE TRAFFIC)
REQJlRE5 APPLICATION FOR A 5ECOND DRlvEWAY(.,..4.1.)
OR A COUNTY APPLICATION FOR FACILITY PERMIT (C ~,203)
IF IN THE U.GB.
DATE OF AFPLlCATION .10. 7-10 ~q~
5IGNED,
DA7E:
lUOR!<. TO BE FE~D 6..,...: OUNER~ CoNTRACiOR
CONTRACTOR*' <:)/A-/-mV reJlJ ~Te..li,JTlC'))0. IN~GI5TRATiON NO.'* ~'371
t.D!:lRE5S 2..'9':AL.\"h AIe...'jJ~1 ?:D
=./l.,"v\ ^".9-~
'11..7}:'-"i~ '
EXPIRES, ~ -2.1 ..55
P;..IONE, ti/nl (lC,lJ::>'
,-,........i::....JRE FOR IN&FECTION REQUEeT.
CALL 126-316~ (RECORDER) 5TATE YOUR CITY DESIGNAT:D Joe NUl"lB:R Joe t.DDRES5,i'rPE OF
IN5PECTION REQUE5TED "''iD UJ;..IEN YOU WILL B: READY FOR IN5PECTION, CONTRACTORS OR OUN:RS NAM: "''iD
Pf.IONE NUMBER REQU:5T5 RECEIvED BE'ORE 1,00 AM WILL B: MADE T;..I: 5...'1E DAY, REQJE5T5 ACTER 1,00
AM WILL BE MADE Tf.IE NEXT ll.ORl<lNCi: DAY
*' 5:E BOOK
EXI5TING BUILDING PERMIT NO. ( IF APPLICABLE)
YOUR CITY DE51GNATED Joe NO. 15f q Lj I h L\ I
REQUIRED lNeFEcTIONe
[J
D
51DEWALK I DRIvEWAY
FOR ALL CONCRETE PAVING WIT;..IIN
T;..IE STREET RIG;..IT OF WAY, TO BE
Mt.DE AFTER ALL EXCAVATING
15 COMPLETE A'iD FORM ll.ORl<
A'iD 5UB-BA5E M.4TERIAL 15
IN PLACE
FEEe.
SIDEWALKS
H0.00 . ~0.1:;/LF. ( X )
OF WALK
CURB-CUT
if-s ~10.00. ~.I:;/LF. ( X )
TOTAL FERMIT FEE.
,$
tlo :7S
COMMERICAL DRIvEWAYS 5;..1ALL
;..lAvE ,,' TO 8' FLAIRS
3'- 0" 5TA'i!:lARD
CURS I APPROACI-l APRON
AFTER FORMS ARE ERECTE.
BUT PRIOR TO POURING
CONCRETE.
.
WALK x'
/ '"
I. x' I.
., '1
I ;..lAvE CAREFULLY EXA'1INED TI-'E COMPLETED APPLICATION FOR PERMIT "''iD DO ;..IEREBY CERTIFY T;..IJ.T ALL
lNr=o~ATION l-IEREON 15 TRUE A""D'CORRECT. Al...tD I FURTI-4ER CERTIFY Tl-IAT A'lY ~"JD ALL lLOR< PE~~ED
5l-lALL BE DONE IN J.CCORDANCE WITI-l T;..IE ORDIN"''iCE5 OF mE CITY OF 5PRINGl'IELD, AND T;..IE LAU15 OF T;..IE
5TATE OF OREGON PERTAINING TO T;..IE WORK DE5CRIBED ;..IEREIN. J.'iD T;..IJ.T NO OCCUPA'iCY WILL BE Mt.DE
OF "''iY STR..ICT'JRE WITHOJT P:RMI55ION OF TI-lE BU!LDING DIVI51ON. I FURTHER CERTIFY TI-IAT ONL Y CONTRAC,OR5
AND EMPLOYEE5 WI-IO ARE IN COMPLIA'iCE WITI-l ORS 1"1-<*" WILL BE U5ED ON mls PROJECT.
51~~ALJ~ Il~
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DATE / I'