HomeMy WebLinkAboutPermit Sidewalk 1994-10-26
1If%):
-F<iii6IDENTIAL - COMMEic. IAL
--'-:W SIDEWALK I CURElCUT
AFFLlCA TION I PERMIT
225 NORTH FIFTH STREET
SPRINGFIELD. OREGON <31411
ENGINEERING DIVI5ION
OiTICE NO. 126-'15'
INSPECTION LINE, 126-316<3
Joe ADDREe5. l~ l ~ \Ld\~ 1:)\\ld
A55E550R5 MAP NO.*' 11 O?'Z.7Y 1
5U6DIVI5ION, M~2..iE VIl..i.A6E'
Oil.NER, t-bu. <; )\1\0 A. ^ '-t\" r)V; i1:J
ADDRES5, ''300 \JJ t- II ~ v III e.<.U W
5TATE,~ ZIP, C1, L177
llJORK DESCRIPTION.
SIDEWALK, ..l.L:::...
TAX LOT NO: *' O() (01
RECEIPT NO, 10'1-2..1-
CASH
CHECK L
CITY, Si>fe1
PHONE NO. io~ 7 - ~7S
*'
CHECKED FOR DELINO'JENCIE5 _
CURS 51DE _
5ET6ACK
CURS-CUT, RE5IDENTIAL _ COMMERICAL _...
5:COND DRIYEWA.,.. (5:E TRAFrIC )
R:QUIRES AFFLICATION FOR A &E:COND DRIV:OWA""("T-4.1.)
OR A COUNTY t.PPLICATION FOR Ft.cILIT.,.. PERMIT (C '38-20')
IF IN T!4: U.GB.
DATE OF APPLICATION 10.7....10 -Cf4.
5IGNED,
DAlE:
UlORl< TO BE FE~""" I~D By. OUN:R'/ CONTRAC70R
CONTRACTOR *' -qyA-1~1\J (' ol\.l '\re..R III O)V 1 I/l.K51:GISTRATION NO.*' ~'3 7 J
ADDR:5S 2.."l=:AL\l':l AI~'P~1 ?-D
~,"A^rJ- ~'^--
\n-7J,j..q~ '
:XPIR:5, 3 -21 -55
PHONE, t.'/{ol bZ::;lJ:>'
FR,......~....JRE FOR IN&FI:CTION REGlUEST.
CALL 126-316<3 (RECORPER) 5TATE .,..OUR CIT.,.. D:5IGNAT:D J06 NWi5:R, J05 ADDR:55,rrFE OF
INSPECTION REO'JESTED A"D IU-!EN .,..OU WILL 5: READ.,.. FOR INSPECTION, CONTRACTORS OR 0UN:R5 Nt.M: AND
P;.ION: NUM5ER R:OU:5TS RECEIYED 6:rv= 1,,,,", AI"1 WILL 6E MADE TI-<: 5AME DA.,.., REO'JESTS t.FTER 1,,,,",
AM WILL 6E MADE TI-<E NEXT WORKING DA.,..
I HAYE CAR:FULL.,.. EXA'1INED T....E 'COMPLETED AFFLICATION FOR PERMIT :"~D DO ....ER:6.,.. 'CERTlF.,.. THAT ALL
IN""rORMATION HEREON 15 TRUE A-:D'CORRECT, A~D I FURTHER C:RTIFY THAT A~"" A~D ALL UiOR< PER!'O!<:'1ED
51-<ALL 6: DONE IN ACCORDANCE WITH THE ORDINA~CE5 OF THE CITY OF SPRINGFIELD, A~D THE LAW5 OF THE
STATE OF OREGON PERTAINING TO THE WORK DE5CRI5:D H:R:IN. A~D THAT NO OCCUPANC.,.. WILL 5: MAD:
OF A".,.. STRUCTURE WITHOJT PERMI55Io.. OF TH: BUILDING DIVISION. I FURTH:R CERTIFY THAT ONL.,.. CONTRACTORS
AND EMPLOYEES UJ!..IO AR: IN COMPLIANCE WITH ORS 101.055 WILL 6E USED ON THI5 PROJECT.
JJ~ ~ . /()/:2~/PL/
;;--
*' 5!:E 6001<
EXISTING BUILDINCiI PERMIT NO. ( IF APPLICA5LE )
.,..OUR CITY DESIGNATED J06 NO. I5'f' 0 LJ \ Lf1 (
REQUIRED INSPECTIONS
ElJ
D
SIDEWALK I DRIYEWA.,..
FOR ALL CONCRETE PAVING WITI-<IN
THE 5TR:ET RIGHT OF WA.,.., TO 5E
MADE t>FTER ALL EXCAVATING
IS co:-1PLETE A"lD FORM =
A"D 5U5-6A5E MATERIAL IS
IN PLACE
FEES.
SIDEWALKS
110.00 + 10.15/LF. ( >< )
OF WALK
CURB-CUT
~ 110.00 + ~.15/LF. ( >< )
TOTAL PERMIT FEE.
. ~ .
COMMERICAL DRIYEWA.,..S 5HALL
I-<AYE 5' TO e' FLAIR5
:;'- Oil 5TA"!PARD
\0.1'5
SIGNED
DATE
CURS I APPROt.cH APRON
AFTER FORMS ARE ER:CTEi
6UT PRIOR TO POURING
CONCR:TE.
..
WALK x'
/ ""
I, x' I.
., "
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