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HomeMy WebLinkAboutPermit Sidewalk 2008-4-2 Gig 0/ c5pringfiald DRIVEWAY/SIDEWALK PERMIT APPLICATION 225 FIFTH STREET " SPRINGFIELD, OREGON 97477 ENGINEERING DIVISION . OFFICE TELEPHONE (503) 726-3753 APPLICATION DATE Wi:~ PERMIT NUMBER DATE ISSUED SITE INFORMATION LOCATION OF W~K I /? ~ I APPLICANT 06 [ h Ut"l ADDRESS / &; / 0 '-IJ I . CITY r:AJr I t./tV( STATE -. ~ /- f:J!-- S'T - fA.M. J1 4(( (?lL "7~ 1-IvE 6L ,TA!r~PHONE 3VfcfzCf2 ZIP CJ, t({j 7_ TAALOT TAA MAP SUBDIVISION OWNER E:::- /if t' tl't' A \ . :rJVtJ2ru~ PHONE ADDRESS {1 (J, f3f1lf.. _; 7 D '3 STATE /)R ZIP CITY (f $ I( REQUESTED PERMITS l& SIDEWALK $ 8500 =$ AMOUNT OF SIDEWALK IN EXCESS OF 90FT @$O 08 SF =$ o SIDEWALK REPAIR $1500 =$ ~ CURB CUT/DRIVEWAY NUMBER OF DRIVEWAYS X $ 85 00 1 st Cut =$ o MULTIPLE PERMIT DISCOUNT EA (MAX 2) $3000 2nd Cut =$J (MULTI PERMIT DISCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECTION .!lliLY =$ APPLIES TO 2nd AND 3rd PERMITS ONLY NOT SIDEWALK REPAI~ o 5% Technology Fee $ TOTAL DUE WITH PERMIT $ o PROOF OF INSURANCE $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER CONTRACTOR INFORMATION CONTRACTOR (J/ /;<<Vj {~U/(u!//14I l:DYe ADDRESS ! ~~ 71! W, 71?lJfve GViJ t:/LL CONTRACTOR REGISTRATION !:J9 q / t & 6 . PROJECT SUPERVISOR I' 0("'1' E(? /1~1f ("" INSPECTIONS 97t(6LpHONE J'~~~~ EXPIRATlONDATE -"7/fJ/o11 PHONE AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WORK HAS BEEN FO RMED AND MADE READY TO POUR CURB CUT AND SIDEWALK INSPECTIONS CALL 726-3769 (RECORDER) STATE YOUR DESIGINATED CITY JOB NUMBER/PERMIT NUMBER JOB ADDRESS TYPE OF INSPECTION REQUESTED, AND WHEN YOU WILL BE READY FOR INS PECTION CONTRACTOR'S OR OWNER S NAME AND PHONE NUMBER REOUESTS RECEIVED BEFORE 7 00 A M WILL BE MADE THE SAME DAY, REQUESTS AFTER 700 A M WILL BE MADE THE NEXT WORKING DAY INSPECTIONS ARE TO BE CALLED IN AFTER EXCAVATIONS ARE MADE AND FORM WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE YOU ARE REOUIRED TO CALL THE LANE UTILITIES COORDINATING COUNCIL'S I ' 11/ "ONE CALL NUMBER" 1-800-332-2344 I ~ I ' 48 HOURS BEFORE DIGGING j I /J ,,_ SIGNATURE I' ,r I /(J~ I All c.;) ~ cJ ttJ c!fLil~5-- 0 u ~oo AMOUNT RECEIVED DATE PAID LL-2 ~DJY CA): /J), /J7~ _ __ '----64 ~ \.....-- RECEIPT NO RECEIVED BY By slgnalure I slate and agree, that / have carefully examIned the compleled applIcatIon and do he reby certIfy thaI all mfOfmabon herem IS llUe and cOlrecl and I further certifY that any and all work perfOlmed shall be done In accOldance With Ihe Ordinances of the City of Spnnglleld, appllcanle City Slandard speclllcatlons and DraWings, and the laws 01 the Sidle of Oregon pertaining to the work described herein I further certify Ihat 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 descnbed In thiS permit al any lime dunng a one year penod to 1I00000g lhe receipt by the City 01 nollce of com~etlon 01 the described wOlk and specrfy, at the City'S sole discretion, any addItional resloratlon work reqUired to return the SIIe to a standard accep.table to lhe CI The permlnae Will be notified In wrlllng of any work reqUlfed and Will have Ihllly days (3D) from the date of Ihe notice to complete the work WOIk nOI comp eled at the end of the Ihlrty days Will be performed by ttie CIty and the costs Will be billed to ttie permittee . str"':t~u:::::art~~r~~oe~u~~t~r~~~r~lr~e~~~~t\~ss:ree~?~w~~~~ g~:~n~P~g);'~~~~nthat pro) eel address IS readable from the Signature Dale 'Y JL I ----Go () \c> - d -() o. 2f ] ,?/'2-j 2--06 b- 000 S-/ I 2--S (!<sJVI L 06 7- -0 0 f I 4-- WJECTS\3740 Nathan Keepers\DWG\Tentative Partltlon\dwg\TENT,dwg, C4 GRAD & PAY, 2/1/2008 10:05:59 AM, o6User, HP DesignJet 500 42__HPGL2 Card.pc3, Arch C - 18 x 24 in, (landscape), 1:1, Media: MIlano JPC-4M2;, Ink hp c4844a ~~ I 110,) ~.. . ~ LPPN 97 -P0093 PARCEL 2 '" , ,'\ '\ \.\', , , " '\ '\ \ \ '\ .\ '\ '\.\ \ \ \.\ '\ \ '\ \ '\ '\ \ \.\ '\ \ \ '\ '\.\ ,'\ \ ,'\" \ '\ .\ '\ \ \ \ \ '\ \ \ '\ '\ \ \ '\ \ \ '\ \ \ \ '\ \ \ '\ \ '\ " .\ '\ \ '\ '\" \ '\ \ '\ ','\ \ \ \ \', \.\ \ \ \ \ -=:-. - c-- -;-~ .~- .~ r-- ,-19" W - '~{q~ '.:=::=:=::::= .=====-' ~== .::::::::..==::' - - ' =....::= --~ ~.:-.- c - -10. 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C c: 225 Fmh Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-00814 COM2007-00814 COM2007-00814 Payments: Type of Payment CredltCard cRecemtl RECEIPT #: DescriptIOn SIdewalk PermIt Curbcut PermIt PW DIsc - 2nd PermIt PaId By ROGER D OBERG City of Springfield Official Receipt Development Services Department Public Works Department 1200800000000000300 Date: 04/02/2008 Item Total: Check Number AuthorIzatIOn Received By Batch Number Number How ReceIved ew 090212 In Person Payment Total: Page I of I 11:23:28AM Amount Due 8500 8500 (4500) $125.00 Amount PaId $125 00 $125.00 4/2/2008