HomeMy WebLinkAboutPermit Sidewalk 1993-1-12
225 NORTI-l FIFTI-l STREET
SPRINGFIELD. OREGON <31411
ENGINEERING D1YISION
Ofl'ICE NO. 126-3153
INSPECTION LINE, 126-316<3
RESIDENTIAL - COMME~IAl
~ SIDEWALK I CURBCUT .
APPLICATloi-U PERMIT .
\, ..._0.
(2.ti.~1;2...<{1
Ill%)
SPRINGFIELD
JOB ADDI"iEa&, .fi3:z. .::JIl-N/oJ".~r
"*
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0IINEf<, FV71//2.JC. ,'<, H-o~.s.
ADDRE!\S, ?."lQ7_ /'1~olj,-,_<; j")R.I<i~CITY, F';lJG,~
STATE, CPt!... ZIP, "J?L/o~1 PI-lONE NO,4 t;3")- "',/ '7~
UJORK DE&cRIFTION.
en, ~ .?.,-
. TAX LOT NO. ~
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J70l ^ ')
RECEIPT NO, '1 2-'( 1
CA51-1
CHECK X
'*'
CI-lECKED FOR DELINGlJENCIES _
SIDEWALK. CURB SIDE _
CURB-CUT, ~ RESIDENTiAl _
SECOND DRIVEWAY (!lEE TRAFFIC)
REGlJIRES APPLICATION FOR A SECOND DRIVEWAy(.,.-4.1a)
OR A COUNTY APPLICATION FOR FACILITY PERMIT (C '3&-2"3)
IF IN THE U.G.B.
SETBACK _
COMMERICAl _
DATE OF APPLICATION
1112-/'13
SIGNED,
DATE,
~.fK5
I / I:>-/Cj~ 0
.
WOFO:K TO BE F'E1llFu..... .eD BY,
CONTRACTOR"* PV'fV1U f3
OIINER CONTRACTOR
"*
/.I.o~ .... REGISTRATION NO.
EXPIRES,
ADDRE55
PI-lONE,
.-.......wcw(JRE FOR IN&FSCTION I"!EGllJE6T,
CAlL 126-316<3 (RECORDER) !\TATE YOUR CITY DESIGNATED JOB NUMBER. JOB ADDRES5,TYPE OF
INSPECTION REGlJESTED AND UI-lEN YOU WILL BE READY FOR 1N5PECTION, CONTRACTORS OR OWNERS NAME.AND
PI-lONE NUMBER REQUESTS RECEIVED BEFORE 1,'"'" AM WILL BE MADE TI-lE SAME DAY, REQUESTS AFTER 1,,",,,
AM WILL BE MADE THE NEXT WORKING DAY
* SEE BOOK
EXISTING BUILDINC' ~~IT NO. ( IF APPLICABLE)
YOUR CITY DESIGNATED JOB NO. Isf !:if ~ _ ~ q~ !)1J4-~
".
I"!EQUII"iED IN&FSCTION&
D
SIDEWALK I DRIVEWAY
FOR AlL CONCRETE PAVING WITHIN
THE STREET RIGHT OF WAY, TO BE
MADE AFTER AlL EXCAYATING
IS COMPlETE AND FORM WORK
AND SUB-BASE MATERiAl IS
IN PlACE
EJ
CURB I APPROACI-l APRON,
AFTER FORMS ARE ERECTED
BUT PRIOR TO POURING
CONCRETE.
--------
FEE&.
SIDEWALKS
.ltZl.tZltZl + W.1&/LF. ( X )
OF WALK
( CURB-cuT)'
.:~tZl + W.1&/LF. ( X )
WALK X'
TOTAL FSFlMIT FEE.
$ /S~
COMMERICAl DRIVEWAYS SI-lAlL
HAVE 5' TO !I' FLA1R5
3'- ". STANDARD
/
1.
""
X' J.
I HAVE CAREFULLY EXAMINED THE COMPlETED APPLICATION FOR PERMIT, AND DO HEREBY CERTIFY THAT AlL
INFORMATION I-lEREON IS TRUE AND CORRECT, AND I FURTHER CERTIFY THAT ANY AND AlL WORK PE.....~'" ,,,D
SHAlL BE DONE IN ACCORDANCE WITH THE ORDINANCE5 OF THE CITY OF SPRINGFIELD, AND THE 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 DIVISION. I FURTHER CERTIFY THAT ONLY CONTRACTOR5
AND EMPlOYEE5 UI-lO ARE IN COMPliANCE WITH OR5 1"1~5 WILL BE USED ON THIS PROJECT.
~ t<(3.rr;- . 1 / tJ '73
SIGNED \ DATE / v