HomeMy WebLinkAboutPermit Sidewalk 1994-11-15225 NORTI{ FIFTI] gTREET
9PRIN6FIELD, OREGON 914'1'1
El.l6 lNEERlI.l6 D lvl 5 lol.lffitcE No. 12b-)].b3
IN9PECTION LINEz 12b' 31b9
JOts ADDRE99:
IDENTIAL - COMI-IERCIAL
gIDEIUALK / CURtsCUT
APPLICATION / PERi.IIT
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ADDRE59,
STATE:C€F ll?, 'n17 7 PI{ONE NO,
CITY:e
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-
SECOND DRI\€IiJAY ( gEE TRAT+IC )
eaulR=9 APPLICATIoN FoR A *coND DRI\€uJAy(T-4.1a)
OR A COJNTY AFFLICAiION FOR FACILITY P=B1IT (C ?,s.2O3)
IF IN THE U6^8,
DATE G AFPLICATION
O'Il.lER coNT,R4C'io
REcErPrNo! Ol5*7O
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CHECK _,.-
9IGNED:
L)AIEI
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CONTRACTOR
ADDR=Sg Et-
R=GI9TRATjON NO.EXPiRE9,
0 PiiONE,
PROCEDURE FOR INSFECTIOhI REAUEST,
CAI-L 12b-3'169 (RECO.@ER ) gTATE YOUR CITY D=9IGNAT=D JOB NUI.13=R, JO3 ADDRE9S,TYPE cF
INSPECTIChI REAUEgTED AND IIJHEN YOU UJILL B= READY FOR IN9PECTICAj, CONTRACTOR9 OR OUNERS NAXE AD
P}JONENI.U'13ER.REOU;gT9 R=CEI\€D B=FOFE 1,,O@,H IIJILL BE I1ADE THE gAlE DAY,REAU=5Tg /\FiE?1.OO
AX1 IUILL BE I-1ADE TI-.IE hiEXT IUOR<iNG DAY
EXIgTI}.iG BUILDING PEB1IT NO. ( IF APPLICAtsLE )
*YOLIR CITY :ETED JOB NO. iS;''4l4t 15z,sEE BOO<
REAU IRED INgPECT IC,t.Ig SIDEI,IJALK / DRI\EUAY
rcR ALL CONCRETE PAVING I]JITHIN
TH= STREET RIGI.]T OF I]JAY, TO tsE
IIADE AFTER ALL EXCAVATING
19 CO|.IPLETE A}.ID FOB1 UJOR<
AND 5UB-BA5E HATERIAL 15
IN PLACE
CUF5 / APPROACI-.{ APROlrl,
AFTER FO315 AE EREC]ED
BUT PRIOR TO POURING
CONCRETE.
FEE9: gIDELUALK9 cuRts-cuT IUAL< X,
'iO.OO + \O.1>/LF.( X )
OF UALK
rlO.OO+aO.1>/LF.(X)
COI-1I.1E RI CAL DRIVEU,]AY9 SHALL
HAVE 5'TO A'FLAIRg
3,. A" gTA\DARD
lll
TOTA PERI1IT FEE,9 tZ, +o
I lA\G CAREFULLY ExsllNED Tl-.lE COIIPLETED APPLICATIoN FoR FER''ilr, ,jr^lD Do HEREBy cERTtF.r THAT ALLINFOSIATIOI{ I]EREON 15 TR.]E AND CORR=CT, A\D I FURTHER CERTIFY -I-HAT ANY AND ALL i]r"R< PEFoEiED5I..IALL BE DONE IN ACCORDANCE UJITH TI{E ORDINANCE} OF THE CITY G SPRINC,FIELP, AND THE LAI1I9 OF TI.]EgTATE OF OREGON PERTAINING TO TIIE UJORK DE9CRIEED +IEREIN, AND TI-.]AT NO OCCUPANCY I].JILL 3E I-1AD=G ANY STRLICTUR= tUlTi'lOJT PEBllSSlo?.I OF TFIE BUILDING DlVlSlON. I FURTHER cERTtFy T+1AT oNLrr cONTRAcTOR3/.ND EMPLOTEEg (ulo ARE IN COMPLIANCE IUITH OP:g. 1O1.O>> IUILL BE USED Ot.I TI{I3 PROJECT.
DATE
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UT'RK TO BE FERFORI,IED BY:
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