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HomeMy WebLinkAboutPermit Sidewalk 2019-07-05Driveway/Sidewa I k Perm it Appl ication City ofSpringfield Application Date: Permit Number lssue Date: a .r{. t7 lgrnq- 7,{. r -?U/ 225 Fifth Street, Springfiel d,otegon97477 Transportation & Engineering Section, Public Works Department Phone: 541 726-3753 SITE INFORMATION Location of Work: Applicant: Address: L/q E 5 t7 *T^ City:ST 1L t)aq?, L | 0 State: o/t zlP:v+ Phone:<7-//-qfr- ]**o Tax Map raxrot l1D 3,3 (''L3Cr2 f6D Subdivision Owner: Address: City: Phone: FeesREQUESTED PERMITS: [- Sidewalk Amountof sidewalkinexcessof90feet- ,/sidewalkRelair /4utb Cult)riveway: Number of Driveways f Multiple Permit Discount each: (Maximum 2) Multi permit discount good for one site and one site inspection only applies to 2nd and 3rd permits only. Not sidewalk repairs y'svoTechnology tee l- Proof of lnsurance: 5500,000 Minimum if work is done by property owner' Facility Meets 2011 PROWAG For ADA Compliance State:ZIP: State: a-A+ZIP: 25.00 5125.00 lstCut x567 2ndCut @So.l2 sF {4t 4+1," a) 542 Total due with permlt S f CONTRACTOR'S I Name: Address: City: Phone: l 4l #o-S -.tContractorExpiration date: Phone: Project SuPervisor INSPECTIONS: An inspection request should be made Prior to pouring concrete, after the ProPosed work has been formed and made ready to pour' Curb cut and sidewalk insPections call: 541 726-3769 (recording)State your designated City job number/permit number, job address, type of inspection requested, and when You will be readY for inspection,Contractor's or Owner's name, and Phone number. Requests received before 7:00 am will be made the same day, requests after 7:00 am will be made the next working day' lnspections are to be is in place, but prior to pouring con(rete' called in after excavations are made and form workffi I\ "Oneaall Number" 1€00J32-2344,48 hours before re digging. SIGNATURE: Amount Received: to the permittee. I further agree to ensure that i the approved set of Plans will Date Paid: Receipt No. Received BY: By signature, l state and ug,"".h* l h*".*"fully examined the completed application and do here by certify that all information herein is true and correct, and I further certify that any and all work performed shall be done in accordance wiih the ordinances of the city of Springfield applicable City 5o"al"ri Jp".iri.rtions and a'awings ;na the laws of the State of oregon pertaining to the work described herein, I further certify that only contractors and ".ptoy"., *io ure in compliance with oRS 70'l'055 will be used' The city may inspect the work;iie described in this permit at any time during a one year,period following receipt by the city of notice of completion of the described *.rr "Jip..itv, ut tt " city's 'ol" iiit'etion' a'iy udditional restoration work required to return the site to a standard acceptable to the city. The permittee will oe.notineJin *rliing or any work required and will have thirty days (30) from the date of the notice to comprete the work not compreted at ttre ena'oi'iie it ifv auvr *irr be performed by the city and the costs will be billed at the proper time that proiect address is readable from the street and construction. Signature all required Date:1-<-t1'