HomeMy WebLinkAboutPermit Sidewalk 1999-10-08I D
N n DtrD r
I -'\l Etvr E D T o
225 FIFTH STREET
SPRINGFIELD, OHEGON 97477
ENGINEERING DIVISION
oFFtcE TELEPHONE (503) 726-3753 77/eru,
,4t- 8-?4
PERMIT NUMBER:
DATE ISSUED:APPLICATION DATE: Irs - /i 4/
PHONE
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CITY:STATE fil! zre,
ONE
trlL_47'atSTATE
.. ,.,727 P
TAX LOT:/ Oaort
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ADDRESS: .9 bf /SaN /-xl
ADDRESS: /7zGo Hdt</tL- CITY
rAX MAP: /7'O
SITE INFORMATION:
LOCATION OFWORK:
SUBDIVISION
OWNER:
APPLTcANT -*flb"
REOUESTED PERMITS:
Q PRooF oF INSURANCE: $500,000 MINIMUM lF WORK lS DONE BY PROPERWOWNER
$ 60.00
,/4"*
1d:
@$0.06
E DRIVEWAY/CURB-CUT/Sr DEWALK; .............
ALK IN EXCESS OF gOFT
.$ 10
TOTAL DUE WITH PERMIT $
E ADDTTTONAL DRIVEWAY
2yMouNr oF SIDEW
E[ SIDEWALK REPAIR:
"'$ 30.00
CONTRACTOR I NFORMATION :
(,,
TION NO
/-az)/v E
'O/tJ
RATION DATE: ,< - t'1,' ?t'a{'
ONE
PHONE:4o
CONTRACTOR:
ADDRESS:
CONTRACTOR REGISTRA
PROJECT SUPERVISOR:
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, CONTBACTOR'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.
rH E LAN E unlriid6'eb"dHbiflrthruc cou N crL's"oNE CALL NUMBER', 1-900-332-2344
48 I{OURS BEFORE DIGGING
SIGNATURE:
address is readable from the
DateSignature
application and do herebv certifu that all information
bb'done in accordance with the Ordinances of
and the laws of the State of Oreqon pertaininq to the
re in compliance with ORS 701.055 will be use"d
that
work
on
on ect.pro
, I state herein
r aoree'
and the
to ensure that
I approv€C set
ufurthoall
ofstreet,
are
the
atr.eq
srte at
-1
time,
PAID:
BY
s
h,
AMOUNT RECEIVED
RECEIPT NO:
City of Springfield
IVEWAY/SIDEWALK P IT APP GATION
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