HomeMy WebLinkAboutPermit Sidewalk 1999-5-23
~, ' City of Springfield
DRIVEWAY/SIDE ALK PERMIT APPLICATION
225 FIFTH STREET BPAINQl"lIU..
SPRINGFIELD, OREGON 97477 ~
ENGINEERING DIVISION .A!.
OFFICE TELEPHONE (503) 726.3753' ~
APPLICATION DATE: 3 h:?/99
PERMIT NUMBER: C/7CJ7 CJ c;;-
OATE ISSUED: . ~:;;:2<::/ /<?4
SITE INFORMATION:
LOCATION OF WORK: d. 302. i'0'cOI./e.J)Wr >>r.. ,
APPLICANT '/)UP-:; D A V,C;,r: PHONE
7q~ ~ 9'32.1
ADDRESS:
,;;{.30z.
(:,,/2.0 UI2.DAU:
TAX MAP:
/76~ 2[., 7..7
-4<00 h
CITY: . "7W',JIJ&:C/8/7
STATE: Of(
ZIP:
9'70"7-1
TAX LOT:
SUBDIVISION:
OWNER:
PHONE:
ADDRESS:
CITY:
STATE:
ZIP:
REQUESTED PERMITS:
IB15RIvEWA Y ICURB-CUT ISIDEWALK: ......................... ........... ................................. $ 60.00
AMMOUNT OF SIDEWALK IN EXCESS OF 90FT. @$0.06 SF. $
o SIDEWALK REPAIR: ...................................................................................$ 10,00.
~00 .,0
o ADDITIONAL DRIVEWAY,
.. ..... ..... ..... ... ... ........... ....... .... ............ ..........$ 30,00
o fmK''' n" INSURANCE' $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
TOTAL DUE WITH PERMIT $
~ fJDoa
CONTRACTOR INFORMATION:
~NTRACTOR: 7...gJ.l-r r~o 5TfZ,~'TTIJ0
I ~~~RESS: 2.14{,,4 [./2,-,1.0 (<'D. foGEtvG..
CONTRACTOR REGISTRAq NO: /'1 Coq?..
PROJECT SUPERVISOR: DM.Lj .::::'1 ILl" ~
f /P' .J"
t. .ff
C"JR. Q74.-d'L-- PHONE3<%'-87&b
EXPIRATION DATE: /6-99
PHONE: 554 -57fa.C:::
~
INSPECTIONS:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WORK HAS BEEN FORMED
AND MADE READY TO POUR.
CURB CUT AND SIDEWALK INSPECTIONS CALL 726-3769 (RECORDER) STATE YOUR DESIGINATED CITY JOB NUMBER/PERMIT
NUMBER, JOB ADDRESS, TYPE OF INSPECTION REQUESTED, AND WHEN YOU WILL BE READY FOR INSPECTION, CONTRACTOR'S
OR OWNER'S NAME AND PHONE NUMBER, REQUESTS RECEIVED BEFORE 7:00 A.M, WILL BE MADE THE
SAME DAY. REQUESTS AFTER 7:00 A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE CALLED IN
AFTER EXCAVATIONS ARE MADE AND FOFIM WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE.
YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
SIGNATURE:
AMOUNT RECEIVED:
RECEIPT NO:
kG _ oc>
3<-f1s--;
DATE PAID:
RECEIVED BY:
~/?L//f'( '~I
~..v 6fi/
By signature, I state and agree, that I have cmefully examined the completed application and do hereby certify that all information herein
is true and correct and I further certify that e,ny and all work performed shall be done in accordance With the Ordinances of
the City of Springfield, applicable City Stand3ra specifications and Drawings, and the laws of the State of Ore.gon p'ertaining to the work
descrJbed ~erein. I further certify that only contractors and employees who are in compliance with ORS 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 the receipt by the City of noticl
of completion of the described work and specify, at the City's sole descression, any additional restoration work reguireo to return the SitE
to a standard acceptable to the City. The permitlee will be notified in writing of any work required and will have thirty days (30) from the
date of the notice to COfTlFlete the work. Work not completed at the end of the thirty days Will be performed by
the City and the costs Wil be billed to the permittee. "
I furthor agree to ensure that all required inspections are requested at the proper time, that project address is readable from the
street, ana thi 7provep set of plans will remain on the site at all times during construction.
Si8nature~/P ;?J.(/Y ..) Date S -21-P:)
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