HomeMy WebLinkAboutPermit Sidewalk 1994-11-22
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11DENTIAL - COI'11'1ERCIAL
, ;~~~~~~C~~;T.
22" NORT~ FIFT~ STREET
SPRINGFIELD, OREGON "'1411
ENGINEERING DIVISION
OiTICE NO. 126,31,,3
INSPECTION LINE, 126,316'" J A, ..,J...,
. \ I+(AIJT PHl~
JOEl ADDRE55. /500 1:rJ...ivl/{ e CI.J (acc/J-osJ %OWl o~ ce)
*' '~
ASSESSORS MAP NO. '1 00::>, 2- i L.f J TAX LOT NO. In 1
SUBDIVISION,
SPRINCFIELO
RECEIPT NO, I 5'G's <f
CA~
C~ECK ~
ou.NE R,
HAcsA
Fair-vie-v)
ZIP, q1477
CIT1"~1)I-;'IlJf~_
Pi40NE NO.
*'
C~ECKED FOR DEL INO'.JENCIES '-==="-
ADDRESS, .:( 0 ()
lAJ
STATE, DiEfroN
tlJOt:<l< DEecRIPTION./
SIDEWALK, ~
CURS SIDE _
S:TSACK _
COM:'1ERICAL _
CURS,CUT, RESIDENTIAL _
SECOND DRIVEWAY I SEE TRAFi'IC I
REQUIRES APPLICATION FOR A SECOND DRIVEWAYI'T.4J.1
OR A CO.JNi'l' APP'..ICATION FOR FACILITY PEF<\"1IT IC ~.2"',1
IF IN ~E U.G.9.
51~NEDl
DATE OF APPLICATION
I t/7J!1tf
DATE,
WORK TO BE PERf'u"", I~D BY,
CONTRACTOR*' 5TATo AJ C{JfIff, TYlc..
ADDRESS :J.Cfd'l4f -]? Ai "por-LRi.
r-~....c....URE FOR INSFECTION REQUEST,
x..
CONTRACiOR
OUNER
REGISTRATION
*'
NO. 03371
Q7LfO:J....
E' "'{ frI P; O.E,r.
~ ~-M-
/I A -2...J?t/'
EXPIRES,. '? /J.I / qs-
-. -.
PHONE, Jft,{-Oo~
CALL 126.,16'" lRECO!'OER I STATE YOUR CITY D:SIGNAT:D JOS NUMS:R. JOS ADDRESS,T1'PE OF
INSPECTION REQUESTED t..'lD ll!-IEN YOU WILL B: READY FOR INSPECTION. CONTRACTORS OR ou.NERS NAI'1E t..'lD
PI-lONE NUMSER REQ\J:STS RECEIVED S:FORE 1,00 t..'1 WILL SE MAD: T~E S.o..'1E DAY, REQUESTS .:.FTER 1,00
AM WILL BE MADE T~: NEXT WORKING DAY
*' SEE BOOK
EXI"TING BUILDING PE~IT NO. I IF APPLlCASLE I
YOUR CITY DESIGNATED JOS NO, Isf qq I <7{ 0'2...
REQUIRED INSPECTIONS
n/ SIDEWALK I DRIVEtlIAY
L0 FO~ ALL_CONCRETE PAVINC; WIT':!N
T~: STREET RIGHT OF WAY, TO S:
MADE AFTER ALL EXCAVATING
IS COMPLETE AND FOF<\"1 WORK
AND SUB-BASE MATERIAL IS
IN PLACE
D
FEES.
SIDEWALKS
~I"'."'''' + ~"'.1::;/LF. ( X )
or WALK
CURB,CUT
~I"'."'''' + ~.1::;/L.F. ( X ).1)""
(j)
TOTAL PERMIT FEE.
s )C/, fJO
COMMERICAL DRIVEWAYS S~ALL
HAVE ,,' TO 8' FLAIRS
3'. OM 5Tt..~~ARD
CURS I APPROAC~ APRON,
AFTER FOF<\"1S ARE ERECTED
BUT PRIOR TO POURING
CONCRETE.
WALK x'
/
l
':,
x'
'\,
I,
1
I ;.lAVE CAREFULLY EX",,-"1INED TH: COMPLETED APPLICATION FOR PEF<\"1IT, ':"'lD DO ;.IERESY CERTIFY T~-'-T ALL
!N"rOF<\"1ATION ~EREON IS TRUE AND CORRECT, A'lD I FURT..,:R CERTIFY T~-'-T ':'NY AND ALL WORK PERFO~ED
S;.IALL BE DONE IN ACCORDANCE WIT~ T~E ORDIN':''lCES OF T~: CITY OF SPRINGfiELD, .:.ND T;.IE LAWS OF T~E
STATE OF OREGON PERTAINING TO T~E WORK DESCRISED ~EREIN, -'-ND THAT NO OCCUPANCY WILL BE M-'-DE
OF ANY STRUCTURE WIT~O.JT PEF<\"1ISSION OF T~E BUILDING DIVISION. I FliRT~ER CERTIFY T~AT ONLY CONTRACTORS
"'.'olD EMPLO'l'EES ll!-IO ARE IN COMPLIANCE WIT~ ORS 1"'1.0"" WILL SE USED ON T~IS PROJECT,
. ~ ,1l.L.J
SIGNED \. v .......;;t--
11/5.:1./ qlj
DATE I )