HomeMy WebLinkAboutPermit Sidewalk 1994-10-26
II~
. '~..IPENTIAL - COMME~IAL
, . SIDEWALK I CUR6CUT .
AFPLICATION I PERMIT
225 NORTH FIFTH STREET
SPRINGFIELD. OREGON 91411
ENGINEERING DIVISION
Ofi'ICE NO. 116-~15~
INSPECTION LINE, 116-~169
JOB ADDRE85. \ 10 q5 lLe(l~ 13\ vJ
ASSES501<5 MAP NO.*' 110?'Z..7Y 1
SUBDIVISION, M.~2.il:: VII..LA6E'
t-bu <; )y\~ .4, ^ ':kA 11\1 ; ~
ADDRESS, '300 W \- ll.~ '( Ih e.(,\.) 1:Y
ZIP, Ch Lj 77
SPRINGFIELD ,
~~
TAX LOT NO: '* rJO tol
RECEIPT NO, 1'7 Z'Z.?""
CASH
C...ECK --l,L'
ou.NER,
CIT'!', Spf-eJ
PrlONE NO. to~ 7 - ?f57S
*'
CHECKED FOR DELINO'JENCIES _
STATE,~
WORK DESCRIPTION.
SI!:>EWALK,.1L:... CURS SIDE _
CURS-CUT, RESIDENTIAL _
SECOND DRIVEWAY (SEE TRAFi'IC )
R:QUIR:S AFPLICATION FOR A SECOND DRIVEWA'f'("T-4.ia)
OR A COUNT'!' t.FPLICATION FOR FACILITY PER:'1IT (C 98-l"'~)
IF IN TJ..!E U.c..9.
DATE 0;: APPLICATION )0 .7Jo -Cf4
SETBACK
CO:-1MERICAL _..
SIGNE!:>,
DAiE:
UJORK TO BE FERf=v"" Il::D BY. O~R v"" CONTRACTOR
CONTRACTOR*' <)JA1-m0 ('1!)'1J~rn['j'}\J. 1t\JCR:GISTRATION NO.*' ~?J7J
ADDR:SS z..qy:rl.Jn AI~P~I ~D '
.~~~
\11-7;;'..q~
EXPIR:S, :5 -2.1 -55
PrlONE, tj(ol (1r:,4::>'
r~,""c....URE FOR INSPECTION REQUEST.
CALL 116-~169 (R:CORDER) STATE YOUR CITY DESIGNATED J06 NlJ:"16ER, J06 A!:>DRESS,T'f'PE 0;:
INSPECTION REQUESTED .o.'lD Il!-IEN YOU WILL 6E READY FOR INSPECTION. CONTRACTORS OR O\l.NERS NAME A'lD
PHONE N\JM9ER REQUESTS RECEIVED BEFORE 1,"""' .0.'1 WILL 5E MADE T...E SA'1E DAY, R:O'JESTS ..<.FTER "",,",
AM WILL BE MA!:>E T...E NEXT lLlORKlNG DAY
*' SEE BOOK
EXISTING BUILDING: PER:'1IT NO. I IF APPLICA9LE )
YOUR CIT'!' DESIGNATED JOB NO. 15'1" q Lf 110 LI)(
REQUIRED INSA:CTIONS
[]
D
SIDEWALK I DRIVEWAY
FOR ALL CONCRETE PAVING WITHIN
T...E STREET RIG"iT OF WAY, TO 9E
MADE t>FTER ALL EXCAVATING
IS COMPLETE AND FOR:'1 WORK
AND SU9-BA5E MATERIAL IS
IN PLACE
FEES.
SIDEWALKS CURB-CUT
.10.00 · .0.15/LF. ( X ) d 7 H0.00 . tel.l5/LF. ( X )
OF WALK
TOTAL A:RMIT FEE.
$ .
t~ ,c6
COMMERICAL DRIVEWAYS SI-IALL
...AVE 5' TO 8' FLAIRS
~'- 0" STA'l!:>ARD
CURS I APPROACI-I APRON
AFTER FORMS ARE ERECTE'
BUT PRIOR TO POURING
CONCRETE.
.
WALK X'
/ ""
l X' I,
" .,
I I-IAVE CAREFULLY EXA"1INED TfJE COMPLETED AFPLICATION FOR PERMIT. A'lD !:>O I-IERE9Y CERTIFY TI-I'/' TALL
INFORMATION ...EREON 15 T~E AND CORRECT, A'iD I FURT...ER CERTIFY mAT A'lY A'iD ALL UiOR< PERl'ORt1ED
SI-IALL BE DONE IN ,/,CCORDANCE WIT... T...E ORDIN'/''lCES 0;: TI-IE CIT'!' 0;: SPRINGFIELD, A'lD mE LAWS OF T...E
STATE OF OREGON PERTAINING TO TI-IE lLlORK !:>E5CRI5ED ...EREIN. '/'ND TrlAT NO OCCUPANCY WILL 9E M'/'!:>E
OF ,t.,NY STRJCTURE Wln-lOUT FEF:'115SroN: Of T1-lE BUILDll'iC2 DIYI5lo--L I ~UR7!--l:ER CERTiFY 7i-1AT o-.J.L Y CONTRACiOR5
AND EMPLO'f'EES Il!-IO ARE IN COMPLIANCE WIT... ORS ''''1-'''55 WILL 5E USED ON T...IS PROJECT.
&;;t- DA;' /{J/~/9~
~
SIGNED