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HomeMy WebLinkAboutPermit Sidewalk 1994-12-8 l;/~O ~IDENT~'~;AL:-' c;~~ERCIAL . . - AFf'L1CATION I PER"!IT . 225 NORT;.I FIFT;.I STREET SPRINC>FIELD, OREGON 'il1411 ENGINEERING DIVISION ClFfICE NO. 1'& -3153 INSPECTION LINE, 1'''',31&'il Joe ADDRE58. :2 /3 ASSES501'1& MAP NO.* +0,"1'(/1 e.uJ 1'7 e." '1.."1 ~I SUBDIVISION, ou.NER, H ALS A ADDRESS, .::(.Q.n LV STATE, O~ E iroN . ~ DESCRIPTION. Jair-V/El-<.' ZIP, q7477 SIDEUJALK, CUR9 SIDE _ DATE or AFf'LICATION IJ-!t!qrj ll.IORK TO BE PE~D BY. CONTRACTO~* STAToAJ Cold. Tl'1c.. ADDRESS ;).,(3(N -J? Ai "por'LBd._ r-~....c;DURE FOR: IN5Fl:CTION REQUEST. SPRINGFIELD ~~ .* TAX LOT NO. ~f3t!)(j RECEIPT NO, 15'''')> CASH C;.IECK v' CIT1\~ol-i" f~ P~ONE' NO.:! ' / CHECKED FOR DELINOJENCIES* / SETBACK COMM"RICAL _ SI6NED, DArEl OUNER )(. CONTRACiOR "(/Lb'!J ~. ,7/P.. jqt/ l I EXPIRES,.? /J./ hs- '. . PhONE, ~/ -OO~ CALL 1,&-31&'il IR::CORDER ) STATE TOUR CITT DESIGNATED JOB NWl9ER J09 ADDR::SS,TTPE or INSPECTION REOJESTED "''Ii:> UI.-IEN TOU WILL eE R::ADT FOR INSPECTION, CONTRACTOI'1& OR ou.NEl'1& NAME "''iD PHONE NUM9ER R::QUESTS R::CEIVED eEFOR:: 1,0<?> "-'1 WILL 9E MADE THE SA'1E DAT, R::QUESTS AFTER 1,0<?> AM WILL ElE MADE THE NEXT llJOR<lNG DAT CUR9-CUT, ~ RESIDENTIAL_ SECOND DRIVEWAT I SEE TRAFFIC) REQUIRES AFf'LICATION FOR A SECOND DRIVEWAT('T,4.1.) OR A COJNIT AFf'LICATlON FOR FACILlTT PER"!IT IC 'ile-,"3) IF IN TI-IE U.G.s. REGISTRATION * NO. 0337/ 'i7LfO;). * SEE BOOK EXISTING ElUILDING PER"!IT NO. I IF'AFf'LICAElLE ) TOUR CITT DE51C;NATED J09 NO.ISf- 9L1ll?13j SIDEWALK I DRIVEWAY FOR ALL CONCRETE PAVINC; WITHIN THE STREET RIC;HT or WAY, TO 9E M.<.DE AFTER ALL EXCAVATING IS COMPLETE A"D FOR"! UJOR'< AND sue.9ASE MATERIAL IS IN PLACE REQUIRED INSPECTIONS D FEES. SIDEWALKS 110.012' . 10.15/LF. ( X ) Of WALK TOTAL PERMIT FEE. s /2.c.j{) E"'(eJ1ej O/€.r CUR9 I APPROACH APRON, AFTER FOR"!5 ARE ERECTED ElUT PRIOR TO POURING =NCRETE, WALK x' / I. ", "" X' J. ~ CURe. CUT 110""0 . 10.15/LF. ( X ) / ~ COMMERICAL DRIVEWAYS 5HALL HAVE S' TO e' FLAIRS 3'. O. STt..~OARD I ;..lAVE CARERJLL Y EX":''1NED T;.IE COMPLETED AFf'LICATION FOR PER"!IT, "'''D DO ;..IEREBY CERTIFY THt.T ALL !NFOR"!ATION HEREON IS TR:JE t.>o:D CORR::CT, A'iD I RJRTH"R CERTIFY T;.It.T "'''Y "-ND ALL UiOR'< PERl'OR"!ED S;..IALL BE DONE IN ACCORDANCE WITH THE ORDIN":'''CES or THE CIIT or SPRIN6f'IELD, AND THE LAUl5 or THE 5TATE or OR::C;ON PERTAININC; TO THE UJOR'< DE5CRI9ED HEREIN, "-ND T;..IAT NO OCCUP"-,",CY WILL 9E M"-DE or ANY STRUCTURE WITHOJT PER"!IS5ION or THE ElUILDINC; DIVI51~ I FURTHER CERTIFY THAT ONLY CONTRACTORS "'''D EMPLOYEES WHO ARE IN COMPLIANCE WITH ORS 101.055 WILL BE USED ON THIS PROJECT. ~I~E~--" g'5t 'DAT!~/o/9(L