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HomeMy WebLinkAboutPermit Sidewalk 1995-8-16 11~ ~IDENT11~;ALK I c~~EiCIAL APPLICATION I PER'1IT ' SPRINGFIELD DAlE: ~ONTRACTOR * R:GIS,~TION NO. r)IO"'JO 22S NORTH FIFTH STREET SPRINGFIELD, OREGON '31411 ENGINEERING DIVISION OR'ICE NO. 126-~1S~ INSPeCTION LINe, 126-~16'3 JOB ADDREM. 500 1)..J-r~471IJHm.. 1A!.4Y ASSES50RS MAP NO,* /7 IJ:~ / >" 06. r- TAX LOT NO: '* CJ '10 J 5USDIVISION, OJNER 6t.JO~I,<If.nP~~/J.Jb 5/J 0 /J-r1.at NlJ-l'PiHJ-/:'J.'fr(, 6P.~'f) /') /L ZIP, 4"7Cf?7 P~ON: NO. 7~1t'.-/I1I{ ADDR:SS, STATE: lIJOR(. DE5CRIFTION, ~~;~~~: ~ :::~- SECOND DR1VEW.t.. y (SEE iRAfT1C ) R:a\JIRES APFLICATlo.-I FOR A S:COND DRIVEWAy(rr.4.1.) OR A COUNTY t.F'PLICATlo.-I FOR FACILITY PE!'I'"1IT (C '38-2"'~) IF IN THE U6.5, =::;T8AC<' co, r. I=RICAL _ PAE OF APFLlCATlo.-I WORK TO BE FERf'v""" Il~D BY. OilNER CONTRt.CiO~ "* t1Up~;.~s CdN.v~~ ??_q~ ,.. jJM~~ ADPR:55 ~~Il tff-- RECeiPT NO, /$7/7 CASH CHECK ~ "* C~ECKED FOR DELlNc:rJ~CIES _ , SIGNED, ~c. ~....t,...q((" E:XPIR:S, ~..4 /tfJ P;';ONE:, ~Y7-f/:'I"C;- ,.............c"..(JRE FOR IN5Fl:CTION REQUEST. c.4LL 126-~169 (R:COR!::>ER ) STATE YOUR CITY DESIG~TED J05 NWo9ER, J09 ADDRESS,TYPE OF INSPECTION R:a\JE:SED A'iD ~ YOU UJILL 9E: READY FOR INSPECTlo.-l, CONT~CTORS OR 0UN:R5 NA:-;E t.'1D p~ NUMBER. REQJEST5 RECEIVED 6=.r-........,...,: 1:00 t.M WILL BE MADE Tl--IE SAME DAy. REO'..JE5T5 ,!..,j=TER ':00 A'1 WILL BE MADe TI4E NEXT ll.JOR;<lN6 DAY "* SEE BbOK EXISTING BUJLDIN~ PER:'1IT NO. ( rr= APPLICABLE) ,,(OUR Cln- D=:SIGNATED J09 NO. Isf 950 J~c/ REQUIRED INSPECTIONS D SIDE:WALK I DRIVEWAY FOR ALL CONCREE PAVING WITHIN THE STREET RIG!-IT OF WAY, TO 9E: t1t.DE hCTER AlL EXCAVATING 15 COi'1PLETE AND FORM ~ A'ID SU9-9ASE: MATERIAL IS IN PLACe EYE I APF'l<OACH APRO: AFTER FO!'I'"1S ARE ERECTi BUT PRIOR TO POURING CONCRETE. FEES. SIDEWALKS CURB-CUT WALK x' ~10.00 + ~0.15/LF. ( X ) ~10.00 + ~.15/LF. ( X ) / ~ OF WALK 3Z,~/ COMMERICAL DRIVEWAYS SHALL t x' I. I4AVE S' TO 8' FLAIRS S ~'- O. STA'IDARD ., 'I TOTAL PERMIT FEE. I HAVE ,CAREfuLLY EXA'1INED THE COMPLETED APFLICATION FOR PE:R'1IT, A'lD DO I4E:REBY CERTIFY 714AT ALL IN'"rO!'I'"1ATION HEREON IS TRJE A"ID CORRECT, A'lD I FURTHER CeRTIFY THAT A'IY A'lD ALL WORK PE!<l'O!'l'"1eD S~ALL 9E DONE IN t.CCORDANCE WITH TI4E: ORDINA'ICES OF TI4E CITY OF SPRINGFIELD, AND TI4E LAWS OF TI4E STATE OF GON PERTAINING TO TI4E ll.JOR;< DE5CRI9ED I4EREIN, A'lD mAT NO OCCUPA'ICY WILL 9E MADE: OF A"Y Ri CTUR: U~T=~E:~ISSlo.-I OF TI4E: BUILDING I)I\'ISIO:< I FURTI4ER CERTIFY 714.1T ONL Y CONTRACTORS AND E aJ UJH::i2OMPLlANCE WITI4 ORS ''''I~S WILL BE USeD ON T1415 PRO;~~hr SIGNEV ( DATE / /j-