HomeMy WebLinkAboutPermit Sidewalk 2001-9-13
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I Job# 01-00993-01 I
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TRANS#:01-oo06690
DATE:SEP 13 2001
AMT RECD:2 $ 61.75
CHANGE:
CASHIER: 061
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CITY OF SPRINGFIELD, OREGON
COMMERCIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00993-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection line: 726-3769
location Of Proposed Site: 602 Main St Spr
Assessors Map#: 17033531
lot: Block: Addition:
Tax lot #: 08700
Subdivision:
Owner:
Jan Van Houten
602 Main Street
Phone Number: 541-688-8132
City/State/Zip: Springfield, OR 97477
Repair Value: $0
Address:
Scope Of Work: Sidewalk
Water line repair. One or two sidewalk panels will be replaced while repairing water line.
Contractor Type
General Contr
Contractor
Registration # Expirationfl(!ate
74466 9/8/2$..o.)~<:;j ~O'\.
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Office Use .0: 'i) ~ \'0
. ~'O'<" (\1...<;:) O~ ~.
land Use: ",'<'l ~y..O~ f0<:-<:.J r.;,~(J # Of Buildings:
Zoning Code: ~\) .~<:-~ ~ ~ Occupancy Group:
Bedrooms: c,Cl'l" ,-'Of\) <:.J Heat Source:
Range: ~~ Sq. Footage:
Phone
Plumbing Contr
Cardwell
840 Beach Blvd, Winchester, OR 97467
A Austin 1 Stop
po box 23935, Eugene, OR 97402
541-343-5748
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
To request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7;00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
working day. 'loll \~
o..)lles \)\\\1\'1 \\
Required Inspections \'<',. ,00I""~" e\'-'"
- Q,ofl:lle Ie S OO\-
I Plumbing ,~N.'.OI\eou'l\ IIlWS0' r;>.9':>7: '0'1
Water Line - Prior to filling trench. ,,~~~ I~;S 0'Oo\1I.-'\:IIOse 1lQ,~ Or\~e IIl\eS e
" .., III ".ofl\e ,0 \~IO . eS 0 e\1~afl. f\
I Public\Wlirks:>1' ~^('I\-O() \fI co\11 . \~e \a\ \\~IC0'\la
SW-Curbside -After forms are erected but prioo['iO('Placement:'6;~Oricffifu.\\\\'I ~~"
. " Il \,.-. fI\~'" I'v' "'....,.
IfI 90.-{0 \~ece OlaQ,a .?'?'~'Z
00 0'\\lflQ, \0.1 \~a. ,.<000
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I Job# 01-00993-01 I
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Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
rArea (Sq. Feet)
I Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
Fee
Paid On Receipl#
Plumbing
09/13/2001 6690
09/13/2001 6690
09/13/2001 6690
09/13/2001 6690
Value/Quantity
I
Fee Amount
Minimum Plumbing Permit Fee
State Surcharge - Plumbing
Water Service Footage
Administrative Fee - Plumbing
Total Plumbing
49
$.00
$3.15
$45.00
$3.60
$51.75
Sidewalk Repair
Total Public Works
Grand Total
By signature, I state and agree that I have carefully examined the completed application and do
hereby certify that all information 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
ORS 701.055 will be used on this project. I also understand the City may inspect the work described
on this permit any time during a one year period following notice of completion, at the City's
descression.
b~ fJ~ ~ "n' t>i
Public Works
09/13/2001 6690
1
$10.00
$10.00
$61.75
Signature
Date
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DRIVEWAY/SIDEWALK
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225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
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PERMIT APPLICATION
APPLICATION DATE:'
~.
PERMIT NUMBER: d [ - DO 9'f3-0-[
DATE ISSUED:
SITE INFORMATION: ( f.. k / J/, ~/}.;; 7j/jtro'7 , Sf.
LOCATION OFW?RK: ::::::i-".k l'-uo/k 1./41/"" )p;';.k
APPLICANT ,)(J(/) l~"'" ,;.J..,C ~ 1--;>
tCO"J ')'??c" _. ,\'-I
PHONE
7./" 6~.?(]
.TAX MAP: (1-. (\ <l:,,-....~ - 31
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TAX LOT:
ADDRESS:
CITY:
SUBDIVISION:
OWNER: . )/jv7
ADDRESS: j c.fLf 5'
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STATE:
'. ZIP:
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-~ e v CI / CITY: ;;;;,..,. '.4-~.<! \.
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STATE:
PHONE: C/iYf' {.., / ?;<
t"1'< ZIP: 97fL() I.
REQUESTED PERMITS:
o SiDEWALK:...................................;.............................................$ 65.00......... = $
AMOUNT OF SIDEWALK IN EXCESS OF 90FT. . @$O.06 SF. = $
c::J SIDEWALK REPAIR:......:..................................:......:.....................$ 10.00.......... = $
10.6\J
o CURB CUT/DRIVEWAY:' NUMBER OF DRIVEWAYS
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x.............$ 65.00.......... = $
o MULTIPLE PERMIT DISCOUNT EA: ....(MAX 2) .......,::~.....................$ 30.00.......... = $J-
(MULTI PERMIT DISCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECnON.!lNlY
APPLIES TO 2nd AND 3rd PERMITS ONLY. NOT SIDEWALK'REPAIR!
.....TOTAL DUE WITH PERMIT $ 10. C5D
o PROOF OF INSURANCE: $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
CONTRACTOR INFORMATION:
CONTRACTOR:
CL.~t,_~o ~ 1l:"'.3-t .
II!.
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:) _.~t..:......
?l.....b~
V
ADDRESS:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERVISOR:
PHONE:
.EXPlRATION OATE:
PHONE:
INSPECTIONS:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WORK HAS BEEN FORMED ANa MADE
READY TO POUR. CURB CUT AND SIDEWALK INSPECTIONS CALL 726.3769 (RECORDER) STATE YOUR DESIGINATEO c:iTY JOB
NUMBER/PERMIT NUM6ER, JOB ADDRESS, TYPE OF INSPECTION REQUESTED, AND WHEN YOU WILL BE REAOY FOR INSPECTION,
CONTRACTOR'S OR OWNER'S NAME ANO PHONE NUMBER. REQUESTS RECEIVED BEFORE 7:00 A.M, WILL BE MAOE THE
SAME DAY, REQUESTS AFTER 7:00 A,M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE CALLED IN
AFTER EXCA V A TIONS ARE MADE AND FORM 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:
.DATE PAID:
.RECEIVED BY:
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that alllntormatlon 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 furtfler certify tflat only contractors and employees who are in compliance with ORS 701.055 will be used .
on this project.
The City may inspect tho work site described in this permit at any time during 8 one year period following the receipt by the City of notice of
completion of the described work and sp'ecify, at the City's sole discretion, any additional restoration work rcqpirecl to return the site to a stllldard
accoptabla to the Ci~y_. The perminee WIll be notified in writing of any work required and will have thirty days (3D' from the date of thlb!)Otice to
complete the work. Work not completed at the end of the thirty days will be performed by ::i: -I
the City and the costs will be billed to the perminee. '. -I 35 ~
I further agree to ensure Jhat all required inspections are requested at the proper time, that project address is readable from the ~ rr1 t5
street, and the 8PPTOVeaSefOf plan IW41'lI Te in 0 the site at all times dunng constrUCtion. ("').. *I:
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Signature ~ 7 Oat.;:S L.l ... I-" 0
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