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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 "* ::::~I::~A~~ fft(0 T,~ 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. ~ ~'J. ~ 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