HomeMy WebLinkAboutPermit Sidewalk 1994-10-25
11"">0
~5IDENT1'~;AL:-1 c~~ERCIAL
- APPLICATION I PEI'l'1IT .-
ns NORTH FIFTH 5TREET
5PRINGFIELD, OREGON ~1411
ENGINEERINc; DIYI510N
OfFICE NO. 1,&,31S3
IN5PECTION LINE, 1,&'31&~
JOEl ADDf'!Eee. Lll-q -BAN 1)~-tvJ '1::(
A55E550R$ MAP NO.*' 11 D?7..7Y 1
5UBDIYI5ION, M~2-1E V\L./,4.6S'
Oil.NER, t1rnA<; iY\~ A.d,,/\ Ilv~ ~
-'-DDRE55, 3:?D vJ 'r-ll~ V III e.<.0 ".l>r
5TATE{~, ZIP, C; I t.l77
lJ..IOI"!l< DESCRIPTION.
51!:?EWALK, .lL..
CURB-CUT,
CURB 51DE _
RE51DENTIAL _
SPRINCFIELD I
~",~'-
~~
;;4J'
TAX LOT NO: '* MIDI
RECE IPT NO, I? -z.z..z...
CA5I-l
CHECK ~'
Cln-, Spfel
PHONE NO,lon~~7S
'*
CHECKED FOR DELINQ'JENCIE5 _
5:TBACK _
CO:-Il"ERICAL _.
5ECOND DRIYEUJt. Y (SEE TRAFi=IC )
REQUlRE5 APPLICATION FOR A 5!:COND DRIY::WATI"T,4.1.)
OR A COUNn- ":'PPLlCATION FOR F":'CILITY P:I'l'1IT (C '?8-,03)
IF IN TH: U.c;,S.
!:?ATE OF APPLICATION ,10 ,7Jo -q~
5IGNED,
DAiE:
WORK. TO 6E PEF<Fv,.., Il::D B'T": O~R V CONTRACTOR
11- . r_ '* :::>-
CONTRACTOR ~/::'4-'--'~)\..l r O.u <\Ie-I^- (Tl fSN f I fJ"""GI5TRATION NO. J3i J
-'-D!:?RE55 2..4 :AL\1'-l A-Ie...?~...~])
~ MArJ-
111-7;:' -1~
EXPIRE5, "3 -2.1 -]:;
P...ONE. tf(nl Oc:;tj:>,
,.-.....i:.....UF<E FOR IN~CTION f'!EGlUE8T.
CALL 1,&-31&~ (RECORDER) 5TATE YOUR CITY D:5IGNAT:D JOB NLIl"1BER, JOB ADDRE55,n-PE OF
IN5PECTION REQUE5TED A"D WHEN YOU WILL BE REA!:?Y FOR IN5PECTION, CONTRACTOR!> OR O~R!> NAME .t..'l!:?
P~: NUMBER REQUE5T5 RECEIY::D B=r~r= 1,00 A'1 WILL SE MADE THE 5A"1E DAY, REQUE5T5 ..:.FTER 1,00
AM WILL BE MADE THE NEXT WORKING DAY
'* 5EE BOOK
EXI5TIN<:: BUILDING PEI'l'1IT NO. ( IF APPLICABLE)
YOUR Cln- DE51GNATED JOB NO. 151' 1 Lll \PL\ Lj
51DEWALK I DRIVEWAY
FOR ALL CONCRETE PAVING WiTHIN
THE 5TREET RIGHT OF WAY, TO BE
Mt.DE AFTER ALL EXCAVATING
15 co:1PLETE A'lD FOI'l'1 WORK
A'l!:? 5UB,BA5E MATERIAL 15
IN PLACE
f'!EGlUIf'!ED INSPECTIONS
ElJ
FEES.
SIDEWALKS
$10.00 + $0.15/LF. ( X ) 30
OF WALK
TOTAL PERMIT FEE.
,~, ly.jo
D
CURB-CUT
$10.00 + ~.I5/L.F. ( X )
CO:1MERICAL DRlVEWAY5 SHALL
HAVE S' TO 8' FLAIR5
3', 0" 5T.t.."DARD
CURB I APPROACH APRON,
AFTER FOI'l'15 ARE ERECTED
BUT PRIOR TO POURING
CONCRETE.
WALK X'
/
I,
"
x'
""
t
1
I T-lAV'E CAREFULL..,... EXA...,lNED if-JE .COMPLETED .4FPL1CAT1ON FOR PE~rT, ":"''lD DO I-lERE"ey CERTIFY Tt-l..L..T ALL
INFOI'l'1ATlON HEREON 15 TRJE ":'''D'CORRECT, A"D I FURTHER CERTIFY TH":'T A"Y A'lD ..:.LL lliORK PER'O~ED
5HALL 6E DONE IN ACCORDANCE WITH THE ORDIN":''lCE5 OF THE Cln- OF 5PRINc..FIELD, AND THE LAW5 OF THE
5TATE OF OREGON PERTAINING TO THE WORK DESCRIBED HEREIN, ":'''D THAT NO OCCUPA"CY WILL BE M":'DE
OF A"Y 5TR.JCTURE WITHOJT PE~1551ON OF THE BUILD IN<:: DIVI51ON. I FURTHER CERTIFY THAT ONL Y CONTRACTOR5
"-ND EMPLOYEE5 WHO ARE IN COMPLIANCE WITH OR$ 101.osS WILL 6E U5ED ON THIS PROJECT.
\1}/t7JfALt/'
51GNED .
~
'tf
/()/2fa/9~
DATE' I