HomeMy WebLinkAboutPermit Sidewalk 2000-10-30
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SITE INFORMATION: ' ',' : :, ,. ...::,~,,:/. ;',>;.
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.AP~UCANT";'6 ill; :,~\.. ':PElic;u5/Jn;'--'..\
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REQUESTEDPERMITS:',' :'.. .,:', ".,'..
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· !:irDRIVEWAY/CURB-CUT/SIDEWALK: ...............".....:......................:..:........;..:....;;::$ 60,00 ',..,
'AMMOUNT OF SIDEWALK'IN,EXCESS OF 90FT: . ' @$0.06 SF,' "$'; .:,:..,. '
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O"SIDEWALK REP~IR,; .....:;........,..,:....,;.......:.........."..,..............,..,..,;,:.......,..$ ,lO,OO, ""
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...0' ADD'TIOI\IALDRIVE,WAY:',:,' .................,;,;"....,..:....:....,........;..:........,...;..$.30.00 .... , ;:' .': ,
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o PROOF OF INSURAroCE' $500,000 MINIMU'M IF WORK IS DONE BY' PROPERTYOWNER. c' f,.'
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:\"'f:~ "',:.' f;,;.'i> (, ,:l,':~'f '.' . .',;. .,:' .' . TOTAL DUE wn:H PERMIT!.' $;"''-;','(;.0 d'O
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. COI\ITRACTOR INFORMATION: ".; ':.' ..:., :'S.
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C~~TRACTOR: j(Cr/VF:(',OJ../tRF71: SF.RV;OE.. ," ,,".:,~..," ,':,\::r
ADDR'ESS:' , lfB j',p /Mj:,/ Mi '../\ 10::," '::,:," ";'; ':', 'PHONE;' T1/"-:"-12q~i.f~'
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, CONTRACTOR REGISTRATION NO: c?,p, 'If '/31;'" ~? "'EXPIRATION DATE:" ., a' '
," ~RO~ECTSUPERVIS6R;'-N -4 TJ'/'A 1./ l> /J FR..FiE. ' " ': : :,,;;': ~ ::fH~~E:'
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-,INSPECTIONS:. ;,"1. '.~\--: .".; " '. '.'( :' ':.. .,., ", .' ',' ,:. "': .::\.~~..;.Q;._'t"iJ~,".f'.i~;.-;....\~t,l:;,-).jll.i':;.;->~';f'.~:.'..\ ',,\.', 1':.1; 'r./t.:1~.~;~}.---;'!:o/1~,
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, ':. AN INSPECTION REQUEST SHOULD BE MADE, PRIOR TO POURING CONCRETE,'A1;l:ER, HE PllOPOSED WORK:HAS BEEN F.OR ,ED '
')'AND MADE READV TO POUR '",; ,.I ". ,,<,.., '" ,,". ','1, " ." ' ',' ,,,"'" ~'~mr"'~"'">'''''''' ,.. ,. ,;" <.., '<J. '
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' 'CURB CUT.AND 61DEWALK INSPECTIONS CALL 72&.3769 (RECORDER) STATE .VOURDESIGiNATE[fcny:Joli NUMBER/PERMIT?, , "
;; NUMBER, JOB ADDRESS,TYPE OF iNSPECTION REQUESTED, AND WHEN YOUWILL BEiREADHORINSPECTION; CONTRACTOR'S
,!,OROWNER'S'NAME,AND PHONE NUMBER. REOUESTS RECEIVED BEFORE 7:00 A:M~WllCBE MADE THE4>'';,,;:;?~,..: ..'. ;':'#(.~'"
:':'SAME DAV;REOUESTSAFTER 7:00 A:M:WILL BE MADE 'l'HENEXT WORKING DAV~.INSPECTIONS ARE,'I'O BE CALLED It:I.I'4..:
AFTER EXCAVATIONS ARE MADE.AND FORM WORK IS IN PLACE BUT PRIOR,TO<POURlNG.CONCRETE:i~',J;:,' ".:', ' ' ,;',;/ ,:'~,;, "
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'. '::,~' /:"':~'.~i;'::;':T~(~' L~ONNEEUCTAILLITL.IENSU'CMOBOERRJ?IN1' ASOT" OIN3G342C203U4N~~I~~~':':,.c: ':<;;'::;':~~0;';;' i:
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'SIGNATURE:.' ','" ""lOf~ ?'.... ~~. .,./:. :- ;,........, ~'::"~N:~.,. .' "'''! ..' ~ '1'-: ~~t~~~'ti'~t.;.,q'r;",,^~~'IJ;l,~. :,\<..",)?f; JI 'f '.. It','.: ... './ :,~",...1';~$.'.w,l.~
, ,'~'IiAMbuNT RECEIVED':'\'~I"" ,.- v':': ..... ..,;' .1../ii'4'\pt~i;;~'!' '!f'" DATE PAID:'~~~~!~t'~~~ '''. .~;;. ",'( . .'.', '::' '.
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,',: '1,..RECEIPT NO:',." -',""'''''' ' ..' -.....:' ,', C'.', "("'C' ..;' .", ....,' RECEIVEDBV:","::,;'~""'".;''r'':;:,'!7''-''''''' .
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By signature, I state and'agree, that I have carefully examined the completed applicatilln and do Iiereby certify thpt all information herein
,\ is tru~ ani:lcorrect and I further certify that any and all work'performed shall be'done In accordance with the Ordlnancqs of; ..,..,;, ...~\'~."i:O:'!j,'
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'. The City.m~y inspect~he work site described in this ~ermifat,anY time duriQQ 8'one Ye~'r'perir,d foll6wing'the racelPf by the CI~ of ;,otl'C' ,
'of.completlon of thB eocrlbed wj)rk.ind IpBcllv.. Bt r City's JlPle peSC{Q8810Q, sny ad Ilfons r.'toratlon, work rell" reClto retu n.the st
ffi 8 stenaardsccepta lle to the Clly:'The.PermlttBe wi be notified In wntlng of any Wor requ red'anp Will have thirty days (30) rom.the' l
ate 9.' thep!ltice 10 coroP'et~lhe work, Work nlol,compl~t,ed,althe,end'Of ,he t~lr)y.days,\yII! ~e Po~rr~rmed by .., ": ,..:' ;;>:~ '.:: ...:
I ,;cllV'naJnIOOIIIWIII~ed'IOlh~permll"";,~;',';",:,, ',,:~~~.t~""ri.:'" ':, ': ..' ,..{,':-';:'. ,; ."
,~r'~,~,~,"~~, r', II, re,' 8,,1~, ."~, r;'(,"81 81) )~~~If.;'i{ ,"~'itii~It","~1~qiieSI'aq it thQ 'prop~rtlmil; that.,"~i", a~di'~~8Iiiea~able' fr~m' i;,~ :~'1'~~ ~'
"street;: ,!!~.~"ryo/~'pro.Y~d '.Olof, plans WI". r~malnonl~eSI!e ~l a I times elurlng oonslru~ll,~~,:"':''':-:-''~'',', ",' " " ";,. ;';
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I Job# 00-01633-01 I
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-01633-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 5091 Forsythia Dr Spr
Assessors Map#: 18020422
Lot: Block: Addition:
Tax Lot #: 01900
Subdivision:
Owner:
Bill Ferguson
5091 Forsy1hia Drive
Phone Number: 541-747-9738
City/State/Zip: Springfield, OR 97477
New Value: $0
Address:
Scope Of Work: Curbcut
Second Driveway, 12 ft throat
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
To request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
working day.
CC-Second
Required Inspections
I Public Works I
-After forms are erected but prior to placement of concrete
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
,Area (Sq. ;- ..:)
I Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
Fee
Paid On Receipt#
Public Works
11/06/2000 3706
Value/Quantity
Additional Driveway
Total Public Works
Grand Total
1
Fee Amount
$30.00
$30.00
$30.00
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I Job# 00-01633-01 I Page 2 of 2
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 corect, and I further certify that any and all work
performed shall be done in accordance with the Ordinances of the City of Springfield, applicable City
Standard Specifications and Drawings, and the laws of the State of Oregon pertaining to the work
described herein. I further certify that only contractors and employees who are in compliance with
ORS 701.055 will be used on this project.
The City may inspect the work site described in this permit at any time during a one year period
following the receipt by the City of Springfield notice of completion of the described work and specify,
at the City's sole descression, any additional restoration work required to return the site to a standard
acceptable to the City. The permittee will be notified in writing of any work required and will have
thirty (30) days from the date of the notice to complete the work. Work not completed at the end of
the thirty days will be performed by the City and the costs will be billed to the permittee.
I further agree to ensure that all required inspections are requested at the proper time, that the project
address is readable from the street, and the approved set of plans will remain on the site at all times
during construction.
d3 11 (j} Y f1M~' ,AHY1
Signature t7
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//-6 - 2000
Date