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-