HomeMy WebLinkAboutPermit Sidewalk 1994-8-11
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__6IDENT~I:~K 1~~~~;:IAL
APPLICATION I PERMIT
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225 NORTI-l FIFTI-l STREET
SPRINGFIELD. OREGON <31411
ENGINEERING DIVISION
Ofl'ICE NO. 126-3153
INSPECTION LINE. 126-316<3
JOB Aw..,(<&.a&~ZI&:) ~cf :Ih.- t-iUS I 'PUf"Lei. ')
ASSESSORS MAP'NO.* 17033412 TAX LOT NO. ~ OO~ () U
SUBDIVISION.
0IINEf<, 7r'EVt;:- ~f-/lI'1t-1- (oSfetNh'AIW?FeoPB1fl~
ADDRESS. J 1'Z- N, L(. 'I r.P- CITY. 4-9 J;..[ f.o,:;{g.Jf/
STATE. /')11_ ZIP. 1?c.;~ PI-lONE NO. 7<&-Ux> I
UJORK DE&cRIFTION.
SIDEllJALKo ____ CURB SIDE _ SETBACK _
CURB-CUT. RE!\IDENTIAl _ COMMERICAl _
SECOND DRIVEWAY (SEE TRAFFIC) <!u7 61 ()~IJ./~
REGlJIRES APPLICATION FOR A SECOND DRIVEWAY(.,.-4.1a)
OR A COUNTY APPLICATION FOR FACILITY PERMIT (C '3&-2"3)
IF IN TI-lE U.G.B. /) .11 I /ql L
DATE OF APPLICATION yo) '7
WORK TO BE F'EFOif'v.... leD BY, ~ OIINER CONTRACTOR
CONTRACTOR ~ /-7--{ /? \J }4_~M I ,//). REGI!\TRA TION NO!
ADDRESS 1/ 1 _ W. LJ q 7. ~ --5P f'.I iJ leFt /E.L.P 6 ^-
SPRINGFIELD
RECEIPT NO.
~
CA51-1
CI-lECK
'*'
CI-lECKED FOR DELINGlJENCIES _
SIGNED.
DATE.
(b;J-K7M
4.,/ II / i?d
EXPIRES.
PI-lONE, 14fo - (/l (D I
.-'" .. _. .J Il"!S FOR IN&Fl:CTION I"!EQlJE&T.
CAlL 126-316<3 (RECORDER) STATE YOUR CITY DESIGNATED JOB NUMBER. JOB ADDRESS,TYPE OF
INSPECTION REGlJESTED AND UI-lEN YOU WILL BE READY FOR INSPECTION, CONTRACTORS OR OIINERS NAME AND
PI-!ONE NUMBER REQUESTS RECEIVED BEFORE 1,,",,, AM WILL BE MADE TI-lE SAME DAY, REGlJESTS AFTER 1.,"",
AM WILL BE MADE TI-lE NEXT WORKING DAY
"* SEE BOOK
EXISTING BUILDING PERMIT NO. ( IF APPLICABLE)
YOUR CITY DESIGNATED JOB NO. Isf q i./ I 2 3> D
I"!EQUII"!ED IN&FSCTION&
g
SIDEWALK I DRIVEWAY
FOR AlL CONCRETE PAVING WITI-lIN
TI-lE STREET RIGI-lT OF WAY, TO BE
MADE AFTER AlL EXC;AYATING
IS COMPLETE AND FORM WORK
AND SUB-BASE MATERIAL IS
IN PLACE
~ "' -,.
FEE&{ 5IDEW~K5/
.ltZl.tZltZl + W.1&/LF. ( X )
OF WALK
CURB-CUT
.ltZl.li:'>tZl + W.1&/LF. ( X )
D
TOTAL .-c~ liT FEE.
$ IV.45
COMMERICAL DRIVEWAYS SI-lAlL
I-lAVE 5' TO !I' FLAIR5
3'- '" STANDARD
CURB I APPROACI-l APRON.
AFTER FORMS ARE ERECTED
BUT PRIOR TO POURING
CONCRETE.
WALK X'
/
J
""
X' J
I I-lAVE CAREFULLY EXAMINED TI-lE COMPLETED APPLICATION FOR PERMIT, AND DO I-lEREBY CERTIFY TI-lAT AlL
INFORMATION I-lEREON IS TRUE AND CORRECT, AND I FURTI-lER CERTIFY Ti-IAT ANY AND AlL lOC>RK PERFORMED
SI-lAlL BE DONE IN ACCORDANCE WITI-l THE ORDINANCES OF THE CITY OF SPRINGFIELD, AND TI-lE lAW5 OF THE
STATE OF OREGON PERTAINING TO THE WORK DE5CRIBED HEREIN, AND THAT NO OCCUPANCY Will BE MADE
, OF ANy STRUCTURE WITHOUT PERMISSION OF THE BUILDING DIYISION. I FURTHER CERTIFY THAT ONLY CONTRACTORS
AND EMPlOYEES WH~IN COMPLIANCE WITH OR5 1"1-"55 WllL.BE USED ON TI-lIS PROJECT.
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