HomeMy WebLinkAboutPermit Sidewalk 1994-1-27
II~O
~5IDENT1[~;AL:-1 c~~iC_'~L _'
_. AFf'L[CAT[ON I PERM[T '
225 NORT~ F[FT~ STREET
SPRiNGfiELD, OREGON 91411
ENGINEERING DIVISION
OFFICE NO. 126-3153
INSPECT[ON L[NE, 126-3169
. SPRINGFIELD
J06 ADDRE88. /(,,;,)3 IfA-R..EoR... DRIVE
ASSESSORS MAP NO.*" /~'-D3- 02.32 TAX LOT NO: *" 2100
RECEIPT NO, 0 II 4-'6.0
CASl-I
SUBD[VIS[ON,
C~ECK
OIU-lER, .suzAN/Je: I3RouJN
ADDRESS, ito<;3 J+AP-13OR DP-IVtE
STATE,,oRE; ZIP, q 7+77
WORK DE5CRIPTION.
~
CITY, Sf/<./AJU"fELD
P~ONE NO. 4S 5"- 71'::3
*"
C~ECI<ED FOR DELlNa'JENCIES _
SIDEUlALK, CU!'19 S[DE
CURB-CUT, -X- RES[DENTIAL ~
SECOND DR[vEWAY (SEE TRAFF[C )
REQU[RES AFf'LICAT[ON FOR A SECOND DR[vEWAY('T.4.1a)
OR A COUNrr ,l.,PPL[CAT[ON FOR FAC[L[TY PERMIT (C 9/;-2(3)
[F IN T~E U.Cio.9.
S:TBACK
CO:1MER[CAL _
S[GNED,
DATE,
DATE OF AFf'L1CAT[ON
1/2-7/14-
-l3~ ~
1/27/"14-
UJOIO:K TO BE PE~D 6.,.., OliNER X CONTRACTOR
CONTRACTOR*" McmL CLAD BUILDeRS IIJL;!<EG[STRAT[ON NO.*" '1#7"1
ADDRESS ,/?-:!.''G~-:': c.4 Sf4- AId), S"TH 51: 5/i/2//Vc:;,ct'G"(L)
r-~:...,JRE FOR IN5Ff:CTION REQUEST, Cl2E:5cuecc / O/<, cr 74-2.r.;"
CALL 126-3169 (RECORDER) STATE YOUR CITY DES[C,NATED JOB NUMBER. JOB ADDRESS,TYPE OF
[NSPECTlON REQUESTED A'lD UJ;.1EN YOU W[LL BE RE,l.,DY FOR [NSPECTION, CONTRACTORS OR OliNERS Nh'"1E "''lD
, PJ..lONE NUMBER. REQUESTS RECE[vED BEFORE 1,0" "-'"1 WILL B: MAD: Ti-!: SA'"1E DAY, REQU:STS AFTER 1,00
AM W[LL BE MADE T~: NEXT ~[NG DAY
*" SEE BOOK
EXIST[NG BU[LDINC, PERM[T NO. ( IF APPL[CABLE )
YOUR C[rr DES[GNATED JOB NO. [Sf
EXP[RES, i '/b/~4.
PHONE, 'ii'9S'- 27&'b
c.r3/ '377
~ --..-r~ /
-/ .1- ~ - l;..) \0
D
~ CURB I ,l.,PPROAC~ APRON,
AFTER FORMS ARE ERECTED
BUT PRIOR TO POURING
CONCRETE.
REQUIRED INSPECTIONS
S[DEWALK I DR[vEWAY
FOR ALL CONCRETE PAV[NC, WIT~[N
T~E STREET R[C,~T OF WAY, TO BE
MADE AFTER ALL EXCAVAT[NC,
[5 ca1PLETE ""'lD FORM WORK
A'ID SUB-Bt.5: MATER[AL [5
IN PLACE
FEES,
~U?)X/06r,
.10.012)', ~.I:;/LF.( X )jj,!)D
SIDEWALKS
.i0.00 , ~0.1:;/LF. ( X )
OF WALK
TOTAL PEI'MIT FEE,
~ /1,5'0
COMMERICAL DR[vEWAYS S~ALL
i-!AvE &' TO e' FLA[RS
3'- 0" STA'IDARD
WALK X'
/ "\
l X' J
"
[ HAvE CAREFULLY EXA'"1INED THE COMPLET:D AFf'L1CAT[ON FOR PERM[T, "''lD DO HEREBY CERT[FY T~,l., TALL
INFO~ATION J.4EREON IS iRL.!E A"'-lD CORRECT, A"JD I FURTr4ER CERTIFY i~AT .:.,~.,... A~D ALL lJ..iOR<, PE~O~ED
S~ALL BE DONE [N ACCORDANCE W[TH THE ORDIN"''lC:S OF T~E CITY OF SPRINc..F[ELD. AND T~E LAWS OF T~E
STATE OF OREGON P:RTA[N[NC, TO THE WORK DESCRIB:D i-!:RE[N. "''lD T"AT NO OCCUPA'lCY W[LL BE MADE
OF ANY STRUCTURE WITHOJT P:RMISS[ON OF T~E BUILDING DiViSION. I FURTHER CERTIFY THAT ONLY CONTRACTORS
AND-EMPbO ES UJ;.10 ARE [N COMPLIA'ICE WIT~ ORS 1"1.D!'>& WILL BE US:D ON T~IS PROJECT.
/' ~2A~/J/ ' /-~7-7r/
S/ ~;/' DATE