HomeMy WebLinkAboutPermit Sidewalk 1994-10-26
11~
~IPENTIAL - C()l'"'1ME~IAL
---=-.- SIDEWALK I CUR6CUT ..
APPLICATION I PERMIT .
SPRINGFIELD
225 NORTH FIFTH STREET
SPRINGFIELD, OREGON ~'4"
ENGINEERING DIVISION
OiTICE NO. "6-3'53
INSPECTION LINE, "6-3'6~
JOB ADDREe5. \ [q q [, v::.dl~ 'F'J l vd
ASSESSORS MAP NO.*' 11 O'?"Z..7Y 1
SUBDIVISION, MtW\2..\l:: VIL.i.A6["
Oil.NER, t-lrru. <; )y\:J .4, A-t\A (lY ; ~
ADDRESS, '3DDw \- ll. ~ '{ \/1 e<01::y==
STATE'~ ZIP, C1,Ll17
UJOF<K DEecRIPTION.
SIDEWALK, u:::::.
TAX LOT NO: '* rJ6 WI
RECEIPT NO, t'7'Z-z.-""L
CASH
CHECK -d
CIT'T"SpteJ
PrlONE NO. ton - ~7S
*'
CHECKED FOR DELINQUENCIES _
CUR;3 SIDE
SETSACK
CURB-CUT, RESIDENTIAL _ CO:-lMERICAL ----,.
S:COND DRIYEWAY I SEE TRAFFIC)
REaJ1R:S APFLICATI~ FOR A 5ECOND DRIV:UJA1(""~.4.1a)
OR A COJNT'T' APPLICATION FOR FACILITY P"RMIT IC ~-'''3)
IF IN TH: U.G.!3.
DATE OF APPLICATION )0 .LIo -q~
SIGNE:D, -=.fl.ilAArJi-1fw'-
'11-7}:'-1~ .
DA.iE:
WORK TO BE FERf'v"" I~D By. O:!N:R'/ CONTRAC,OR
CON,RACTOR*' ""'A-1~)\J !'cj-,.j ~m[))v. INCs=GISTRATION NO.*' ~37J
ADDR::SS 2..4::A'-1o AII2..'i>~J2.:r ~.D
"XPIR::S, '3 -2) -55
Pi-lONE, q (0 I b Z::;L/ ::>,
r~"c.....URE FOR IN5FECTION REQUEST.
CALL "6-3'6~ <RECORD:R) STATE YOUR CITY DESIGNAT:D JOB NlJ:'1B:R. JOB ADDRESS,T'T'PE OF
INSPECTION REQUESTED A'ID Jl!..IEN YOU WILL B: READY FOR INSPECTION, CONTRAC,OR5 OR O.:NER5 NAM: A'ID
Pf.lONE NUMBER REQU:S,S RECEIYED S:FOR:: 1,= /"'1 WILL SE MADE TH: SA'1E DAY, R::QU:STS AFTER ,,=
AM WILL BE MADE T~ NEXT UOR<ING DAY
*' SE:E SOOK
EXISTING BUILDING PERMIT NO. I IF APPLICASLE )
YOUR CITY DESIGNA'i'ED JOB NO. Isf Lf L/ 110 5)
REQUIRED INSPECTIONS
[]
SIDEWALK I DRIYEWAY
FOR ALL CONCRETE PAVING WITHIN
THE STREET RIGHT OF WAY, TO SE
MADE AFTER ALL EXCAVATING
IS COMPLETE AND FORM UOR<
A'ID SUS-BASE: MATERIAL IS
IN PLACE
D
CUR;3 I APPROACH APRON
AFTER FORMS ARE ERECTE:
BUT PRIOR TO POURING
CONCFETE.
FEES.
SIDEWALKS
~10.00 . ~0.15/LF. ( X )
OF WALK
CURS-CUT
-"IS-
o< ~10.00 . ~.15/LF. ( X )
\~.It7
COMMERICAL DRIYEWAYS SHALL
HAYE 5' TO 8' FLAIRS
3'- '" STA'IDARD
WALK X'
/ ""
l X' I,
" "
TOTAL PERMIT FEE.
~
.
I i-lAVE CAR:~LL Y EXA~NED T!-JE: COMPLETED t.,FPLICATION FOR PE~rT ~"-.lD DO l-lERE6Y CERTIFY T~.L.T ALL
l~rO~ATI~ I-!EREON 15 TRJE A-"':D'CORRECT, A"-JD I FURTI-!ER CERTIFY TI--lAT A~Y ~~D AlL u..oR< PE~R'1ED
SHALL BE DONE IN ACCORDANCE WITH Tl-lE ORDIN4'1CES OF THE CIT'T' OF SPRINGrIELD. AND THE LAWS OF THE
STATE OF OREGON PERTAINING TO THE WORK DESCRIBED H:REIN, 4ND THAT NO OCCUPA'ICY WILL B: M4DE
OF A'IY STR'JCTURE WiT>,OJT P:~ISSION or THE BUILDING DIVISION. I FURn~ER CERTIFY ,H,!,T O:-.!L Y CONTRACTORS
AND EMPLOYEES WHO ARE IN COMPLIANCE WITI-I 0R5 '''1-''55 WILL SE USED ON THIS PROJECT.
Hllh?
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j(j / ;2&/ 91/
DATE / I
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SIGN:D