HomeMy WebLinkAboutPermit Sidewalk 2003-06-3000tu3d AVo 0B t INi
25oR 97477
Building/Combination PermitStatus Issued
2_11 \ltfh S treet, Sp rin gfi erd, oR
541-72G3753 phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
SITE ADDRESS:
ASSESSORIS PARCEL
611 MILL ST
NO.: 1703352302700
Springfield TypE OF WORK:
TYPE OF USE:
AddresJJ
PROJECT repair
Owner:
n
Contractor Type Contractor
Owner ROWAN ROWENA L
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
License Expiration Date phone
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
o/o of Lot Coverage:
Lot Size:
Sq Ft lst tr'loor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Sidewalk Type:
Downspouts/I)rains:
REQUIRED PARI(NG
Total:
Handicapped:
Compact:
Total Value of Project
Page 1 of2
PUBLIC IMPROVEMENTS
Description Type of Construction Value Date Calculated
PERMITNO:
ISSUED:
APPLIED:
EXPIRES:
VALUE:
coiM2003-0056s
06/30/200s
06t30t2003
12t30/2003
Valuation Description I
Building/Combination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541 -7 26-37 69 Inspection Line
PERMIT NO: COM2003-00565ISSUED: 06/30/2003APPLIED: 06/3012003EXPIRES: 1213012003
VALUE:
tr'ees Pair
Fee Description
Sidewalk Repair Permit
Total Amount Paid
Amount Paid
$10.00
$10.00
Date Paid
6/30/03
Receipt Number
2200200000000001153
Plan Reviews
To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
I Sidewalk - Setback: After forms are erected but prior to placement of concrete.
By signaturer l state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compHance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during construction.
(^ l" - 03
Owner or Signature Date
C+
Pase2 of2
Keoulreo lnsDecfions I
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date:
coM2003-00565 Sidewalk Repair Permit 10.00
Item Total:$10.00
Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Peid
Cash TOM ROGGE nJm
(
In Person
Payment Total:
$10.00
$10.00
(
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
oFFrcE TELEPHONE (503) 726-3753 PERMIT NUMBER: (ayvt Z;Ct? - OOSbS
SFBI}TGFIELO
DATE ISSUED: (b - 4C * e 3
SITE !NFORMATION:
STATE:N
PHONE:
-|-l-STATE:CITY:
-slj - to?SPHONE(qqtr
TAX MAP;
LOCATION OF WORK:
ADDRESS:
:( TAXLoT:
APPLICANT
ADDRESS:
CITY:
suBDrvrsr
OWNER:
I cuna cur/DRtvEWAY: NUMBER oF DRIVEWAYS: x
I rraulrteLE PERMIT DlscouNT EA: .. (MAx 2) ---".- -.- -------..---'---:.----- $3o-oo '-
(rirUll pERMIT DTSCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECTION gNLY
AFFiles ro 2nd AND 3rd PERMlrs oNLY- Nor SIDEWALK REPAIR)
TOTAL DUE WITH PERMIT $
E PROOF OF INSURANGE: $500,000 MINIMUM lF WORK tS DONE BY PROPERTY OWNER
949
$75-OO
: $_G
6t
$a
$
ts $/c
SIDEWALK:
AMOUNT OF SIDEWALK IN EXCESS OF gOLF
SIDEWALK REPAIRI.
- $ 75.oo
@$0.07 sF.
CONTRAGTOR IN FORMATION :
\
co
c)'
EXPI RATION DATE: M
PROJECT SUPERVISOR:
PHONE: 5
CONTRACTOR REGISTRATION NO:
ADDRESS:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE AFTER THE qRqPQS-ED WORK HAS BEEN FORMED AND'MADE
READy ro pouR. cuna iul fN-o sroEwAr-r irySFEbiror.rs clil zzo-r1qs (neconoenl .qT4IE-YquR DESIGINATED clrY JoB
NUMBER/pERMtr NUMBER JoB ADDRESS rvpa oii-NiFEdrlcifi-ne-qu-ESido nruo wHeiu vou wlLL BE READY FoR lNSPEcrloN,
coNTRACToR' s oR owNER,s N AME eHo pHor'ie itiJ-MBER: Rio0ESrS neoriVeo aeroRe 7:00 A.M. wlLL BE MADE THE
SAME DAY REQUESTS AFTER 7:00 A.M. WILL BE MADE THE NEXT WOBKING DAY. INSPECTIONS ARE TO BE CALLED lN
XiTE-R"Eib;wA=n6n's;riE MADr ANo-fcintvt-w-onr ts LN puece BUT PRIoR ro PouRlNG coNcRErE'
YOU ARE REQUIRED TO CALL
COORDINATING COUNCIL' S
';i - - 1-800-332-2344
IRS BEFORE DIGGING
THE LANE UTILITIES"oNE GALL NUMB_ES
SIGNATURE:
DRIVEWAY/SIDEWALK PERMIT APPLICATION
CiE d Sprinsfield
{i(C i
PAID:b - U, C)3AMOUNT RECEIVED:
RECEIPT NO: - |RECEIVED BY: b
Br,iiglllH'B;l,BF,i%f,t1 ffiSi'i"i,llfi,':", f,'r'l,;yif',Jlli"r'"ff*"#tf;lif i'tJfi$iSiSi3.33,iB'i,!il:f;98,[ifl1fllJ:'Srmarion
herein
Xl".!i'd#n'J#1,qf,'$;,f;SplS?,uolf ,f,*1"'.1ligTi,."'S,S:l':fiX%Hfi19*llWillg:iSi#:[ftF,i:="$lx,h'31?,"J0?13t31,f,iffi'llL%"
the work
on this project
#S"?lY'ffSX S'"f'""1P.'?fiitfli!if,i3;[r#?i[iifiHS'8,11,{SS,t'li333t[l:f.i1?Ifif,',Bil3'1Jij"'#ifl""'i'"':"""':lBltll["''?;'{#Jii"ut""
e,f**p1*g fiif,sBt"''"%lgih"#}$itrml\i,';#ilru:6*lF"i} x,1txn"i[tl Hill,lifu5issii,'#Hn*"t'i'[;"" (30) rrom the
the City and the costs wlll be billed to the permittee.
I further aoree to ensure that all required inspections are requested at the proper.time, that project address is readable from the street'
inO ttre ap,-proved set of plans will rbmain. on-the site at all times duriog construcuon.
Signature Date ^o
:;i:,
APPLICATION DATC:
:$