HomeMy WebLinkAboutPermit Sidewalk 1994-11-22
11DENTIAL - COMMERCIAL
: ;~~~~~~C~;~;T.
1)/':10
22" NORT~ FIFT~ STREET
SPRINGFIELD, OREGON ':11411
ENGINEERING. DIVISION
OffiCE NO. 12&-'1",
INSPECTION LINE, 12&-'1&':1
JOB ADDRE55. , ~os-
ASSES50R5 MAP NO.*'
-=7a i-r V i-ew
1'1 C)~ ?/ Ll-I
SUBDIVISION,
OUNER>
!-lAesA
ADDRESS, _~Qn LV ,yail-'Vt'eUI
STATE, Of IE 6-011.1
ll.IORK DE5CRIPTI~./
l/
ZIP, q7477
SIDEWALK,
CURS SIDE _
DATE OF APPLICATION
11/);;( 1tf
lUORK TO BE F'EFO"u"" II::D BY.
CONTRACTOR*' ,<;rAToAJ r.Ofl.St. TVlC.
ADDRESS :J.'1.FN -F Ai-l'fOr-T 1i!<L
,,...........c:DURC,FOR IN5PECTI~ REQUE5T.
SPRINGFIELD
.*
TAX LOT NO. I {'J I
CASH
RECEIPT NO, / 55~i-
C~ECK
.---
crrr,S'~~
P~ONE NO.
*'
C~ECI<ED FOR DELINCl'JENCIES :::::::::::
S=:TBACK _
CO:1M=:RICAL _
SIGNED,
DATE,
OL!.NER
x..
CONT~C70R
-~J#
EXPIRES,.? /J.I / 'IS-
'.
P;.;ONE. ~/-Oo~
CALL 12&-'1&':1 (RECORDER) STATE 'rOUR CIT'r DESIC,NAT=:D JOB NUMB=:R, JOB ADDRESS.rrPE OF
INSPECTION REQUESTED ""'Ii' ~EN 'rOU WILL B=: READ'r FOR INSPECTION, CONTRACTORS OR OUNERS NAM=: .I.."D
P!-lONE NUMBER l'EOU=:STS l'ECEIVED B=:FOl'E 1,00 .1..'1 WILL BE MADE T~=: S.4.'1E DA'r, l'EOUESTS .:.FTER 1,00
AM WILL 6E MADE T~E NEXT UJORl<:ING DA'r
CURS-CUT. RESIDENTIAL _
SECOND DRIVEWA'r (SEE TRAFTIC )
REOUIl'ES APPLICATION FOR A SECOND DRIVEWA'r(..,.,4.1.}
OR A COUNrr APPLICATION FOR FACILITY PE~IT (C ~-20')
IF IN Tl-lE U.G.9.
REGISTRATION
*
NO. 03.i 71
97'f'0 :L
* SEE BOOK
EXISTING BUILDING PE~IT NO. ( IF APPLICA6LE )
'rOUR CITY D=:SIGNA ,ED J06 "0, Isf q 4' / <1)6 I
E'-"(frIp; OIeF.
~ SIDEWALK / DRIVEWA'r
L.:J FO~ ~L_ CONCRETE !,A;'N~ WIT~JN
T~= SIREET RIC,~T OF W_'r, ,0 B=
MADE AFOER ALL EXCAVATING
IS COMPLETE A'lD FO~ 1lOR<
AND SUB-6AS=: MATERIAL IS
IN PLACE
REQUIRED 1N5F:CTI~5
FEE5.
SIDEWALKS
110.00 . 10.15/LF. ( X )
0;= WALK
TOTAL PERMIT FEE.
~ 12. Cf 0
D
CURB-CUT
110.00 . f0.15/L.F. ( X ) /~
if)
co:-tMERICAL DRlVEWA'rS Sf.lALL
HAVE :;' TO 8' FLAIRS
,3'. O. 5Tt...'1DARO
CURS / APPROAC~ APRON,
AFOER FO~S ARE ERECTED
6UT,PRIOR TO POURING
CONCRETE.,
WALK x'
/ ""
l x' I.
'l, 'I
I i-lAVE CAREFULL 'f" EX~~NED T~E COMPLETED .4PPLICA'iION FOR: PERS"irT, ":"'''D DO i-iERESY CERTIFY 71-tL..T ALL
!Nro~ATION ~EREON IS TRUE A"D CORRECT, A"D I FURTf.lER C=:R7IF'r T~AT "-'l'r ,;"D .:.LL UiOR< PEI<l"O~=:D
Sf.lALL 6E DONE IN ACCORDA'lCE WIT~ THE ORDIN.!..'lCES OF Tf.I=: CIT'r OF SPRING!'I=:LD, -"'D T~E LAWS OF THE
STATE OF OREGON PERTAINING TO THE 1lOR< DE:;CRIB=:D ~EREIN, A"D Tf.lAT NO OCCUPA'iC'r WILL BE MADE
OF AN'r STRUCTURE WITf.lOJT PE~ISSION OF TH=: BUILDING DiViSION. I FURTHER CERTIF'r ,f.I,;T ONL'r CONTRACTORS
.I.."D EMPLO'T'EES Wf.IO ARE IN COMPLIANCE WIT~ ORS 101,0:;:; WILL BE USED ON THIS PROJECT.
:;IGNED
~~
r
/ / /:;.,;;/ 91./
DA,E ( .