HomeMy WebLinkAboutPermit Sidewalk 1994-10-26
111':10
RJIIiIIDENTIAL - COMME~IAL
---'-W SIDEWALK I CURBCUT ._
APPLICATION I PERMIT
22" NORTH FIFTH STREET
SPRINGFIELD, OREGON ~1411
ENGINEERING DIVISION
OiTICE NO. 126-31,,3
INSPECTION LINE, 126-316~
JOB ADDRE58. \ \0 ~ 1 ~-At~ ~I vJ
ASSES50R5MAPNO.*' 110?LrLj-j
SUBDIVISION, M~l.1e VIl..I..A6S'
OilNER, tirru. <; )y\~ A, A '+\A IN ; ~
ADDRESS, '300 IN ~ il. ~ 'I \h e.<01:::y==
STATE'~ ZIP, Ci, W77
SPRINGFIELD
~~
TAX LOT NO: * 1')6101
RECEIPT NO, \0-z,."JA..-..
CA$H
CHECK -JL:'
CITY, Sr>te1
P;.IONE NO. (o~ 7 -7ljj7!3
*
CHECKED FOR DELINO'JENCIE5 _
WORK DESCRIPTION.
SI!:>ElUALK,.1L... CURS SIDE _ SET5ACK
CURS-CUT, RESIDENTIAL _ CO:-1MERICAL _..
S=COND DRlvEUJA Y (SEE TRA'TIC )
R:QUIRE5 APPLICATION FOR A SECOND DRIY::WAYI'T-4.1a)
OR A COUNT'!' t.PPLICATION FOR FACILITY F.ORMIT IC S8-2"3)
IF IN THE U.6.9.
DATE OF APPLICATION )1) .7...lo -q~
SIGNED, .~ a ,^^^"~
\n -7J;-1~
DAi"::
UJO~ TO 6E FERF,........ IcD BY, O=R'/ CONTRACTOR
CONTRACTOR*' "')C4..,"f))\.! ('vl\..l "\Te..V..mc))IJ. /i\J(R:6ISTRATION NO.* -=?~7J
AC>DR:S5 2..4::A<-1f':) AIe..'i>?>J2..1 f.:D
8<<A-
=XPIRES, :::5 -2.1 -55
P;.Io.-IE, t/(~ I (lC,LI::>,
............c.....JRE FOR INeFECTION REQUEST,
CALL 126-316~ lRECORI:>ER ) STATE YOUR CITY D=SI6NATED JOB NWo5=:R, JOB AC>DRESS,T'I'P!: OF
INSF.OCTION REQUESTED A~D Ill-1EN YOU WILL 5=: REA!:>Y FOR INSPECTION, CONTRACTORS OR 0t:NE:R& Nt.M=: A~D
PHON=: NUMSER REGlU=:STS RECEIvED ",:rvr= 1,= .1.11 WILL SE MAC>=: TH=: SAI1E DAY, REO'JESTS AFTER 1,=
AM WILL BE MADE THE NEXT lLORKlNG DAY
*' SEE BOOK
EXISTING BUILDIN6 F.ORMIT NO. I IF APPLICABLE)
YOUR CITY DESI6NATED JOB NO.ISr- qL( I ~L/q
REQUIRED INSPECTIONS
[]
D
SIDEWALK I DRlvElUAY
FOR ALL CONCRETE PAVING WITHIN
TH=: STREET RI6HT OF WAY, TO SE
MAD=: AFTER ALL EXCAVATIN6
IS ca1PLETE A~D FORM lUOR<
A'lD SUS-SA5E MATERIAL IS
IN PLACE
FEES,
5IDEW.Ad..K5
~10.00 + ~0.1S/LF. ( X )
OF WALK
CURB-CUT
& 1 ~10.00 + ~.1S/LF. ( X )
TOTAL PERMIT FEE.
. ~ . 7 0 . 0'0
COMMERICAL DRlvEWAY5 SHALL
HAvE ,,' TO 8' FLAIRS
3'- O' STA~DARD
CURS I APPROACH APRON
Ar"'TER FORMS ARE ERECTE:
BUT PRIOR TO POURING
CONCRETE.
..
WALK X'
/ "'"
l X' I.
" .,
I HAvE CAR::'"FULL Y EXA'1IN=:D TI-!=: COMPLETED APPLICATION FOR PERMIT. "'~D DO I-!EREBY CERTIFY THAT ALL
IN'"rORMATION I-!=REON IS TRUE A"D'CORRE'CT, A~D I FURTI-!ER CERTIFY TI-!AT A"Y A"D ALL UOR< PER!'ORMED
SHALL BE DONE IN ACCORDANCE WITH TI-!E ORDIN"''lCES OF THE CITY OF SPRINGFIELD. A'lD THE LAW5 OF THE
STATE OF OREGON PERTAININ6 TO THE WOR< DE5CRI9=D H=REIN, A'lD THAT NO OCCUPA'lCY WILL 9E MA!:>E
OF A'lY STRUCTURE lUITHOJT PERMISSION OF TH=: BUILDIN6 DIVISlo-.l, I FURTHER CERTIFY THAT ONLY CONTRACTORS
AND EMPLO'l'EES WHO ARE IN COMPLIANCE WITH ORS 1"1-";';' WILL 9E US=:D ON THIS PROJECT..
,"f)~
SIGNED
~
r-
DATE ~)?~