HomeMy WebLinkAboutPermit Land Drainage Alteration 1996-5-29
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225 FIFTH STREET
SPRINGFIELO. OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (5031 726-3753
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INSPECTION LINE (503) 726.3769
DATE ISSUED: ? -2"7'~~6
PERMIT NUMBER:
9~7.r::;
see REVERSE SIDE FOR REOUIRED INSPECTIONS
o Plans (2 setsl anached (Plans must meet City of Springfield Code Chapter X Article V showing existing and proposed site conditions.)
lOCATION OF WORK
APPLICANT ""''''-~' f"L.e.":ltllt:!.:'- A~<'-~ It.u...4t.1.1 """.I'-ev.-" A\I~"Pll=-IAN'7, OJZ:."I'7OZ01
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SITE ADDRESS: 6,)I.,-rE.,"J-.Y 1"01....,_'- "'-or 1_"; ............,-",,, ~ TAX MAP: 1'7- O~ - ~~
CITY:~F"-IN&oI"'II~...1A7 STATE:
0f;Z.
ZIP: ""'7477
TAX LOT: ~.... 0 "5
SUBDIVISION:
OWNER: ~F-"'e?-J",'- <:::.~ ?eOPF-~-rleh IN".. PHONE: (<?IZ") &:1'51- ?'IAo
ADDRESS: &7&:; ,,,. M0:l.~a."A'.a.'?lOOCITY: ~1l:.A&.o STATE: II.- ZIP: c,ot:.!f!2:?:>
4F~~ GY"4Yo "'d.!5t!!/JJ>e;J"'>7'"". 70/7'~
CONTRACTOR: ~"":;.I~~ "'fIr.wp)Jj~S:":-~, ~.. .;>?l/';>? _r~ .__.~~E:~__Jh'( J
APPROVED BY:
I2l FLOOD PLAIN:---.et:- <7>.M...J.rH- DATE:. COMMENTS:
~ETLANDS BY: ~J? -'7".U17+ DATE: COMMENTS:
rA" - Stf..f:- C4MM€HA .., \"" .
~ ENGINEERING BY: ..- _0111/;.;', DATE: . s-; -z.~/'lb COMMENTS:'
DRAINAGE:
GRADING: ~~ 5~y.~ ?Z7'J~/T ./'?-7~C::L~
SLOPE:
SOIL CONDITIONS:
COMMENTS: (,) D '
nJ:.-1 CI ~b' ,r;~V; : IV
.~nA. 5h-5.b.t,
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CONDITIONS:
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD
( MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES) AND THE OREGON SUPPLfMENTS.
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REVISIONS 9/6/95
FORM # 128
FEES:
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PI AN CHJ:f':K' J:I=F~'
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UP TO 100 CUBIC yARDS...................................
101 TO 1,000 CUBIC YARDS .............:................
1.001 TO 10,000 CUBIC yARDS..........................
10,000 TO 100,000 CUBIC yARDS......................
100,001 TO 200,000................................._.......
200,001 CUBIC YARDS OR MORE ...........
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GRADfNG PERMIT FEES'
o UP TO 100 CUBIC YARDS ...................................
o 101 TO 1,000 CUBIC YARDS ..............................
I8l 1,001 TO 10,000 CUBIC yARDS..........................
o 10,000 TO 100,000 CUBIC yARDS......................
o 100,001 TO 200.000.........................................
ESTIMATED VOLUME OF FILL:
~~~ ... "1-
PLAN CHECK FEE:
GRADING PERMIT FEE:
TOTAL DUE:
PAID WI APPLICATION
BALANCE DUE
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..
$20.00
$30.00
$40.00.
$40.00 For the first 10,000 cubic yards, plus
$20.00 for each additional 10,000 cubic yards or fraction thereof.
'$220.00 For the first 100,001 cubic yards, plus
$20.00 for each additional 10,000 cubic yards or fraction thereof.
$340 For the first 200,001 cubic yards, plus
$6.00 for each additional 10,000 cubic yards or fraction thereof.
$30.00
$30.00 For the first 1 DO cubic yards, plus
$14.00 for each additional 100 cubic yards or fraction thereof.
$156.00 For the first 1 ,000 cubic yards, plus
$12.00 for each additional 1,000 cubic yards or fraction thereof.
$264.00 For the first 10,000 cubic yards,.plus
$54.00 for each additional 10,000 cubic yards or fraction thereof.
$750.00 For the first 100,001 cubic yards, plus
30.00 for each additional 10,000 cubic yards or .fraction thereof.
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CHECK NO.
CHECK NO.
17 '2J7?
RECEfPT NO.
RECEIPT NO.
$ -4n. ~n
$ -:lIth; dLJ
$ ~,~6
$ . Y.t:'. - DATE:
$ 2;'4r: - DATE
RECEIPT NO.- - 11-!P'1<0'
A final inspection will be required after work is completed. Please call the Inspection Line at (503) 726.3769 and allow two business
days advance notice of the date you wish inspection.
o Engineering Final Site inspection by:
o Planning Final inspection by:
o
REQUIRED INSPECTIONS:
"'2 - ~ -'96.:
--r-~. -;J"';:
RECEIPT NO.--yS"9:::>
CHECK NO. /Y"'C./':=? ";f
Date:
Date:
Building Final inspection by:
COMMENTS: --?~ :<l,;z::>.s::-/.-;'" ~~?>____...
/IV L:<el ;,.-=-~ ~>=-Z> S--2<Y%
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VALIDATION:
~.ho>.......""". .'
Date:
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By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information
herein is true and correct, and I furthor certify that any and all work performed shall be done in accordance with the Ordinances of the
City of Springfield. and and the laws of the State of Oregon pertaining to the work described herein. I furthor certify that only
contractors and employees who are in compliance with OAS 701.055 will be used on this project.
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I furthor a9L~ to ensure that all re~ujred\mspectlons are requested at the proper time, that project address IS readable from the street,
and the arpro~ set of Plar~ wd\\emamjon the sIte at all times dUring constructIon.
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