HomeMy WebLinkAboutPermit Sidewalk 1995-10-26
11~
~IDENT~I~~ALK I ~~~~::IAL
APPLICATION I PE~IT
SPRINCFIEI.I?f
225 NORTH FIFTH STREET
SPRINGfiELD. OREGON 91411
ENGINEERING DIVISION
OfTICE NO. 126-3153
INSPECTION LINE, 126-3169
JOB ADDRE55: rq/
A55::550R5 MAP NO,*'
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T AX LOT NO: '* -, <)..oc)
RECEIPT NO, 0/940",
CA5!-I
5USDIVISION,
v-
CHECK
O.:N::R, PO\NE:;LL ll..l~ct
ADDRE5S, "'4-\ Mll"J}.:J ~1/LEEl
STAT::, 01.. ZIP, <=:l,q..l'
b..~Ilo;J&:S ,l"-\(A
CITY, SP1==O
PHON:: NO, "'4l-I00'00
CH::CKED FOR DELlNQ~::NCI::S-'I' d:'
CO:-1)-T::RICAL
*
llJOR<. DE5CRIFTI~:
S!D9lJALK, V'
V
CUS5 5!D:: V
5:::i8ACK
,SIGNED,
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I~~. ';:--
!:>ATE 0.= AF?lICATIOoI
10- 2..Q,-0 S
DA7E:
/ CONTRACiOR
REGISTRATION NO.*' l"2.'?l<33
C::mA. ~..,... e"'"
I 0 - 'z,c. -9S
WORK. TO BE PE~"" Il:D BY: O:!.N:R
CONTRACTOR*" Dk:..'-IIO ~ '''''Bl.f:R-, \l.Jc....
A!:>!:>RE5S P-o . ~ z..4/O V~l~
PROCEDURE FOR IN~CTI~ REQUEST:
CALL 126-3169 lRECOR!:>::R ) 5TATE YOUR CITY D::5IGNAT::D JOS Nu:-15::R. J05 A!:>DRESS,TYP:: 0.=
INSPECTION REQUESTED A~D lI.\-IEN YOU Will 5:: READY FOR INSPECTIOoI, CONTRACTORS OR 0UN:R5 NR'1:: "',,!:>
PHONE NUM5ER REQU::5TS RECEIVED 5:orvr= 1,0'" t..'"1 Will 5E MAD:: TH:: SAME DAY, REQ'J::STS -'-FTER 1,C>O
.4.'1 WILL 6E MADE TH:: N::XT ~ING DAY
::XPIR::S, ?>-'Z., ~(,
P;....iO~E:
EXISTING SUILDING PE~IT NO, I IF APPLICA5LE )
'* S::E ElbOK
YOUR CITY D::5IGNATED JOS NO. ,sf
9.c;/7/3
REQUIRED INSFECTI~S
D
SIDEWALK I DRIVEWAY
FOR ALL CONCRl'iTE PAVING WITHIN
THE STREET RIGHT 0.= WAY, TO 5E
MAD:: t..COER ALL EXCAVATING
15 COi1FLETE AND FORM WO~
A~D 5U5-5A5:: MATERIAL IS
IN PLACE
~ ,_CURS I APPROACH APRo.
V -"FTER FO~S ARE ::RECTi
SUT PRIOR TO POURING
CONCR::TE.
CUg,e, ~ l2."",^p R~~,--
~ WlTIJ, SlJ-J
FEES:
SIDEWALKS
~1@.@~ . ~@.I?/LF. ( X) i 0
OF WALK
CURB-CUT
~1@.@@ . ~.IS/LF. ( X )
TOTAL FERMIT FEE:
~ i 1.130
COMMERICAL DRIVEWAYS SHALL
HAVE 5' TO 8' FLAIRS
3'- "'" STA"!:>ARD
WALK X'
/ ~
t X' I.
., "
I t-l.t.VE .CAREFuLL.,.. EXA'1INED TJ-JE COMPLETED APPLICATION FOR PER:1IT, ..:....~D DO l-IEREBY CERTIFY 7i-l.L..T ALL
lNi'O~ATION HEREON IS TFaJE A'-:D CORRECT. A~D I FURTH::R C::RTIFY THAT A~Y "'~D ALL WOR< PE~O~ED
S;.lALl 5E DONE IN ACCORDA'iCE WITH TH:: OR!:>IN-'-"CES 0.= THE Cln- Q;' SPRINGFIELD. AND TH:: LAWS 0.= THE
5TATE or OREGON PERTAINING TO Tt-IE WOR:l<. DE5C~19ED H::REN. A'1D T~t..T NO OCCUFANCY WILL BE M..!.DE
or: ,4",,"" STF".JCTU~ UIl'H-lOJT PE~IS5Io:-..: Of THE 6UILD!NG DIV1510t-l I FURTI-I=R CERTIFY Ti-l~T ONL"'" COSTRACTOR:5
AND EMPLOYEES WHO ARE IN COMPLIANCE WITH ORS 1"'1~5 WILL 5E US::D ON THIS PROJECT.
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SIGNED
DATE