HomeMy WebLinkAboutPermit Sidewalk 1995-6-6
1I~
-Jl5IDENT11~;ALK I C~~.CIAL
APPLICATION I FE~IT '
225 NORTH FIFTH STREET
SFRlNGFIELD. OREGON ~1411
ENGINEERING DIVISION
OiTICE NO. 126-'15'
INSPECTION LINE. 126-,16S
JOB ADDRE55. / '-I 7 ~ L-IW g r:4
ASS:S501<5 MAP NO.*" /1 O~ 21 J.f4-
SUSDIVISION.
Sf
TAX LOT NO: *' ~?60
OJ...NER.:
-;3"L---r 1}.J\l~-rM~(
91S- VJlu.a.qk~1l11L
~R ZIP. n{l6/
CITY. flj)~
P;.lONE NO. 9J~- 61. 6{"
ADDR:SS,
STATE:
llJC>R<: DE5CRIFTION. _
5!!:>:uJA!...K: ~
CURS-CUT:
CUSS Sf DE _
~5IDa-;TIAL _ .
5=:re.ACK
CO,.li ERICAL
S:COND DRIVEWAY (S:: TRAfTIC )
R:QUIR:S APPLICATION FOR A S:COND DRIVEWAy(rr-4.1.)
OR A COUNTY t.PPLICATION FOR FACILITY P:~IT (C '08-20')
IF IN TH: U.G.5.
DATE OF APPLICATION
CA5H
R:C:IPT NO.
617~~
CH:CK
*"
CH:CKED FOR D:L1NOJ:NCI:S ---
,SIGNED.
DAlE:
c.--;;ONTRACTOR
R:GISTRATION No.'b":;9(7
~
(p-'~ .
WORK TO BE FERl=v1"<J IcD BY. O~R
CONTRACTOR"* '1/ A J.l ~-r;.) /A-i-4.&;}.)
ADDR:SS ~Gf7_ /lxiJI MU ed
~<=.....URS FOR IN5FECTION REQUEST.
CALL 126-,16S (R:CORDER ) STATE "-OUR CITY, D:SIG~T:D J05 Ntr.4S:R J05 ADDR:SS,TYF': OF
INSPECTION R:alESTED A'lD IIh-U:Ol YOU WILL S: R:ADY FOR INSP:CTION, CONTRACTORS OR OLI.N:R5 N~: t.'lD
PHONE NUMSER R:QJ:STS R:CEIVED B~rv= 1.= "-'1 WILL S: MAD: T1~: SAM: DA"-, I'!:QJ:STS .<.i'TER 1.=
""'1 WILL BE MAD: TH: NEXT u.<::>R<:ING DA"-
*" SEE BOoK
EXISTING SUILDINC:l PE~lT NO. ( IF APPLICABLE)
95D 9/ {)
REQUIRED INSF!OCTIONS
./ *"
YOU~;UZ11'( D:::SIGNAi'ED JOB NO. IS:
,..-
mSIDEWALK I DRIVEWAY
........... FOR ALL CONCRETE PAVING WIn.lIN
mE STI'!:ET RIGLlT OF WAY. TO SE
MI...D: t.FTER AlL EXCAVATING
15 COMPLETE A"-lD FO~ WO~
, A'lD SUS-SASE MATERIAL IS
IN PLACE
FEES.
SIDEWALKS
CURB-CUT
~10,00 . ~.15/LF. ( X )
D
:XPI::<:S, 3-ZS -'?t,
PHON:.~~~~9
_ CURS I APPROACH APRo.
AFTER FORi15 AR:E EREcn
BUT PRIOR TO PO:JRING
CONC::<:TE.
WALK x'
/ ""
I. X' I.
" .,
~10.00 . ~0.15/LF. ( X )
OF WAL~ ~ ,I' ;;
TOTAL F!O~IT FEE. II II--t
I riAVE ,CAREFuLL"- EXA'1INED TfJE C"""/'PLETED APPLICATiON FOR PEf<l'1IT. A'lD DO LlER:BY CERTIFY 7Ll.l.T ALL
l"rO~ATION HEI'!:ON IS TRiJE A'lD CdRR:CT. A'lD I FURTHER CERTIFY TLlAT A'lY A'iD ALL WORK FEfq'Of<l'1ED
SriALL SE DON: IN ACCORDA'lCE WITLl THE ORDIN-'-'lCES OF THE CITY OF SPRINGFIELD, AND THE LAWS OF TLlE
5TATE OF OREGON PERTAINING TO TI-lE u.<::>R<: DE5CRIS=D H=R:N, A'lD iLlAT NO OCCUPA'lC.,- WILL SE M-'-D=
or: t.~y 5TP.JCTURE Ulji;..JOJT PE~155100 OF TI-iE 5U1LD!NG Dl\"151Ot./.. I FURil-lER CERTIF'T" il-l,j,j ONL Y COSTRACTO~5
AND EMPLOYEES WHO AI'!: IN COMPLIANCE WITLl 01<5 10l.o?5 WILL BE USED ON TLlIS PROJECT.
CO:1MERICAL DRlVEWA"-S SHALL
LlAVE 5' TO 8' FLAIRS
"- O' ST"-'lDARD
19-. 00-/
51GNED V
r; / (/ Y-S
DATE