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HomeMy WebLinkAboutPermit Sidewalk 1999-05-27I -N I L\ED -I E I D f1 225 FIFTH STREET SPRINGFIELD, OREGON 97477 ENGINEERING DIVISION oFFrcE TELEPHONE (503) 726-3753 Z APPLICATION DATE: PERMIT NUMBER: DATE ISSUED: SITE INFORMATION: ADDRESS: )\5O $it\ s{, crry,Sof\nq$ie\d SrArE: DR ,,r,Q1tll NE STATE:.,*,5o$ \d, PHoNE: ..l{ tl- 5q 3 D( OWNER ,,r' Q ! t{rl ? rAX Lor: D t 11 aZ Zt, Z> [\) LOCATION OFWORK APPLICANT -l- SUBDIVISION REOUESTED PERMITS: I onvewaY/cuRB-cur/STDEWALK: ...... AMMOUNT OF SIDEWALK IN EXCESS OF gOFT E SIDEWALK REPAIR: TOTAL DUE WITH PERMIT $ E ADDITIONAL DRIVEWAY (o cso9 $ 60.00 $@$0.06 sF. ,...........$ 10.00 ...........$ 30.00 CONTRACTOR INFORMATION : pHoNE: Ir.{ 17 _o rl 5 O 0 o 0-c 1 efu EXPIRATION DATE PHONE CONTRACTOR REGISTRATION NO PROJECT SUPERVISOR: CONTRACTOR ADDRESS: INSPECTIONS: AN INSPECTION REOUEST 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 726.3769 (RECORDER) STATE YOUR DESIGINATED CITY JOB NUMBER/PERMIT NUMBER, JOB ADDRESS, TYPE OF INSPECTION REOUESTED, AND WHEN YOU WILL BE READY FOR INSPECTION, CONTRACTOR'S OR OWNER,S NAME AND PHONE NUMBER. REOUESTS RECEIVED BEFORE 7:OO A.M. WILL BE MADE THE SAME DAY, REOUESTS AFTER 7:00 A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE CALLED lN AFTER EXCAVATIONS ARE MADE AND FORM WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE, YOU ARE REOUIRED TO CALL THE LANE UTILITIES COORDINATING "ONE CALL NUMBER" 1.800.33 48 HOURS BEFORE DIGGING COUNCIL'S 2-2344 SIGNATURE: Bv sionature. I state and aoree. that I have carefullv examined the completed application and do hereby certifu that all inforJnation herein is1ruEi irid coireEt. anO tlirthijiCertifu inaranV an'd all work performed shall b6'done in accordance with tf e Ordinances.of rhe ei-tv or soiinofieio -aoor1sftb,f,f;LYoTnlsslt lga?g:?'l"J,i.3Li,3J3yfi3?,x"ifl ,J1""iiffi"?r",i,,:,i,6'fis"1gi:oto51fifi11't,ssj" the work de-scri6ed herein: I furth on this project. The Citv mav insoect the work site described in this permit at anv time during a one Vear period following the receipt by the City of. notict of comoletion of 'the described work and soecifu. at the Citv's sole descressidn, anv 6dditional restoratioa work required to retutn the.slte td ;;i;hd;rd ac'ciiotablelo the Ciiv. Tne pErmitt6e wltt Ob fiotiiieO ih writing of'anywork required anQ will have thiity days (30) from the date of the notice io complete the work. Work not completed at the end of Ihe thirty days will be performed by the city and the costs will be billed to the permittee. lfurthor aqree to ensure that all required inspections are requested at the proper time, th.at project address is readable from the street, and the approved set of plahs will remain on the site'at all times ddring construction. (oO €o Date 5- A r?q q 34 z-\ = I AMOUNT RECEIVED RECEIPT NO: DATE PAID RECEIVED BY: Signature I City of Springfield t IVEWAY/IDEWALK P RMIT AP LICATION I PRooF oF INSURANCE: $500,000 MINIMUM lF WORK lS DONE BY PROPERWOWNER l6r'i tni\\ 5f. , ADDRESS: 1[Sc m\\t 5{'TAX MAP: