HomeMy WebLinkAboutPermit Land Drainage Alteration 1997-4-15
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City of Springfield
22S Fifth Street, Springfield, Oregon 97477 - Development services
j"C6#<11 ro-.s 3
Date of Application 4 -l S '-'11 Expiration Date:
Property Owner M;~ o!; ".lI'\A.N 11Irn [;,/2...
Address: J-\<;t"i ~ ....,n~ (ilL
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Phone: 'I t.tlo '~<6-'61
City<::;oh~ State:~Zirfi7<.Jf6
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Site Address: L;i' -s ~\uvt (, h~ A1&, -\'\Ov. G<(C,J;, \i'j'\~ "Springfield, Oregon
o UGB Tax Map No: 1"1. 02. 04. ;;r>, ()~}O~() Tax Lot: ~ '5oo~
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FILL, uantity qa \~~ ,Source Location@) <;~~ o.\JOJ~Q.,J, ~.llili",~,\)H"'()\f~
SUPPI~r ~Q...~ ~u."", Io"",~'bq\o',~ ,Materia "'l;,'~'W C:0~";:,:.~J..
GRADING, Quantity 40 <.~s
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EXCAVATION, Quantity Al-Mlt;:.
Supplier:
Address
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Destination:
Project Supervisor
" Phone
o SITE PLAN Required Oata:Quantity of mmerial, Property lines and descriptions, Tax map and
lot number, Site address, Existing, contour lines, Proposed contour lines, Existing drainage
ways, Proposed drainage weys, Significant trees and foliage, Ground cover, Soil types,
Buildings, Septic systems, Sewers, Areas subject to floodlr1g, Utilities, Areas subject to land
slides, Proposed site improvements, ' ,
o CROSS SECTIONS,
o SOILS & GEOLOGY PLAN,
o DRAINAGE, POLLUTION AND EROSION CONTROL PLAN
o REPLANTING PLAN
o ADDITIONAL INFORMATION,
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COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
, PHONE
CITY
STATE
, PHONE
CITY
STATE
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CONTRACTOR NAME:
PROJECT SUPERVISOR: %W\J1./
, Registration Number: 0 \ J. 0 '4<..1 '1
ADDRESS: '-1'1;i S }O ~ 6JI",,--,-,
STATE: t'>~~ ,ZIP: o"U,<',(
MOBILE PHONE: '~
PHONE ,'-\ I- ' 0%11
, Expiration Date: '2 - 2.0- ';'6
, CITY: 4,.,:;,r:. \,.0
OFFICE PHONE "'c~-'--- FAX ~
, EMERGENCY PHONE: ---
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information herein is true and correct. and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield, applicable City Standard specifications and Drawings, and the laws of the State of
Oregon pertaining to the work described herein, I further certify that only contractors and employees who are in compliance
with GRS 701,055 will be used on this project.
.
The City may inspect the work site described in this permit at any time during a one year period following tho receipt by tho
City of notice of completion of the described work and specify, at the City's sole desecration, any additional restoration work
required to return the site to a standard acceptable to the City. The permittee will be notified in writing of any work required
and wilt have thirty (30) days from tho date of the notice to completo the work, Work not completed at the end of the thirty
dllYS will bo performed by the City and the costs will be bit/cd to the permitteo,
.
I further agree to ensure that all required inspections are requested at tho proper time, that project address is readable trom
the street, and the approved- set of plans will remain on the site at all times during construction,
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DRAINAGE,
\it' Storm, 0 Ditch, 0 Culvert, 0 Natural
WETLANDS, Description
FLOOD PLAIN, Zone:
, FEMA Community Panel No;:
FLOODWAY, FEMA Community Panel No.:
Date:
PLAN CHECK FEES:
UP TO 100 CUBIC YAROS
101 TO 1,000 CUBIC YAROS
1,001 TO 10,000 CUBIC YARDS
10,000 TO 100,000 CUBIC YARDS
- $20,00
$30.00
$40.00
$40,00 For the first 10,000 cubic Yilrds, plus
$20,00 for each additional 10,000 cubic yards or fraction thereof.
$220,00 For the first 100,001 cubic yards, plus
$20,00 lor each additional 10,000 cubic yards or 'roetion thereof.
$340 For the first 200,001 cubic yards, plus
$6,00 lor each additional 10,000 cubic yards or fraction thereof.
100,001 TO 200.000
200,001 CUBIC YARDS OR MORE
GRADING PERMIT FEES:
UP TO 100 CUBIC YARDS
101 TO 1,000 CUBIC YARDS
$30.00
$30,00 For the first 100 cubic yards. plus
$14.00 for cach additional 100 cubic yards or lrDetion therool.
$156.00 For the first 1,000 cubic yards, plus
$12,00 for oach additional 1.000 cubic yards or fraction thereof.
$264,00 For the first 10,000 cubic yards, plus
$54.00 for each additional 10,000 cubic yards or fraction thereof.
$750.00 For the first 100,001. cubic yards, plus
$30,00 lor each additional 10,000 cubic yards or fraction thereof.
1,001 TO 10,000 CUBIC YARDS
10,000 TO 100,000 CUBIC YARDS
100,001 TO 200,000
Estimated Volume:
90 e"l F/L..-L
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Receipt:
Date:
Plan Check Fee:
" ,
Received By:
Date:
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Receipt
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Grading Permit fee:
Received by:
Date:
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Planning Date:
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Engineering (~4~ j Date:
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Building: Date:
0 Maintenance: Date
Permit Number 9'7/7&)",')<
Issued by: ~~
Date: 6/07
Fin~1 Insnpr.tinr:l.S...:.
Planning:
19705S3 --. j)/ZAFH/t-6/[. Pv,..pliP
Engineering': .... 6/ZAoiH6 01-1"'"
Date
ro pu8i.J<- $TO"'''' ~ 6/'1/97
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ItLLevJ€O Iol-'I'lH!r4 1-"1 (C!:~L.tfl1 j..."(1)at I' M'14-I/';/-r..-
Po;. CO~ r'-C LT$
Building:
Date
Maintenance:
Date:
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