HomeMy WebLinkAboutPermit Sidewalk 2001-06-22SPRINGFIELD
Job# 01-00643-0l
RESIDENTIAL PERM!T
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2
Job Number: 01 -00643-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 4000
Subdivision:
,l
v
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 445 S 00004th St Spr
AssessorsMap#: 17033534
Lot: Block: Addition:
GITY OF SPR7NGFiELD, OREGON
Owner: Oregon Dept of Veteran affairs
Address: 445 South 4th Street
Scope Of Work: Sidewalk
Phone Number:
City/State/Zip:
Repair
Springfield, OR97477
Value: $0
Sidewalk and Handicap Repair. City has contracted with Hamaker Construction for repairs,
lVlaintenance will insoect.
Contractor Type Contractor Registration # Expiration Date Phone
Contractor - ROW Hamaker Contruction Co. 541-344-8779
PO Box 2704, Spr, OR
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
-
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
To request an inspection call the 24hour recording at726-3769. All inspections 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
working day.
Required lnspections
Sidewalk
Gonstruction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handlcap Access?
# Of Stories: Height (feet):
Current Units: Proposed Units:
Census Code: Does not apply
Area (Sq. Feet)
Main:Accessory:Total
pubtic woirs
-After excavation is complete, forms and sub base material is in place.
Job# 01-00643-01 Page 2 of 2
Fee
Public Works
Sidewalk Repair
Total Public Works
06t22t2001 00000000 1 $10.00
$10.00
Grand Total
By signature, I state and agree that I have carefully examined the completed application and do
hereby certify that all information 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, applicable City
Standard Specifications and Drawings, and the laws of the State of Oregon pertaining to the work
described herein. I further certify that only contractors and employees who are in compliance with
ORS 701.055 will be used on this project. I also understand the City may inspect the work described
on this permit any time during a one year period following notice of completion, at the City's
descression
$10.00
Signature Date
Paid On Receipt# Value/Quantity Fee Amount
Jqn 1S Ol 1O:26a
SENT BY: SPHINGFIELD PW;
Hamaken Const
,dl 7361021; MAY.30.01 14:22;
s4 1 -344- s?s3
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OFFICE TELEPT1ONE IEOSI 720
APPr.rcAiloNDArE: blq/Ot
7--- -7-DATE ISSUED:_
PEBMIT ot-ao<(3-o{
SITE IIIIFORMATIoN:ZIEF--<'T-t--
SUEOlvl6lONl
7
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ADORESS:
LOCAT'OI{ OF
rAX MAP:
A??Ltcat{l
AODSESS:
fl CUHBCUT/oFIvRi\rAYr NUMBEROFORIVEWAYS X,,,,.,.......t66.00........., - C
O MutnnE PERMTT otSCOUin EA: .,,.(MAX 2l ,...........
lltU$L?tslrlllT OFCouNf cooD FoR oilE StrE AiD oilE s,rE NsEcnotll.oilLl
APPLIES TO 2nd AND 3rd PERMITS ON[Y. M)T Slom,AtK RgPAln
-
El pBooF oF rr{suRANcE: iE@,0o0 MrNrMuM F woRK ls oo]llE lv pRopERTvowt{ER
(SlDGWAIK:,
,I
+
AMOUNT OF STOEWAI ( tN EXCESS OF 00F1.
68.il)..,...... - C
TOTAL OUE UI'ITX PERMIT I
CONTRACTOR INFORMATIONT
AOONESS:
PFOJECT 6UPERVISON:
EXPIiAIION DATE:
INSPECTIONS:
AN INSPECTIOiT iEOUCSI SHOUTO gE MAOE PflON IO POUNIIIO COI{CErE AFTER TXE MOFOSCD WON[( HAS OEIN FOiMFD ANO MAOEil Dl, olpu!. CUn! quT AXO-qDE!r U( tils?tlnor3 cAU ,:1..!163 IRECORDERI Sr TE YDue DESlolliA?ED qlly JOE
NUMIET/PERMIT NUMBEB, JOB ADoRCSS, TYP€ OF $GPECflON FEouEsrrD, AirD w{EN vou wttL r! tEADy rot rrBpccnoN,
COTiIIFACIOh' 6 ON OWNER'6 N AME AI{D PI{ONC ruMBEfi. BCOUESIS RECEVED EEFONE 7SO A.M, wlLL E MAOE TfIEsAi/E OAY. iEotTESTE AFTER ,:OO A,U. WILL 8E M 9E rt{E NEXr wOnKnO 9AY, iltPECTlgt{$ AnE Tq 9E CALIED tN
AFTER CXCAVATIONS ANE MAOE ATlo FONM TJVOFX I' ll.' E.ACE EU? PEOF iO POUNTNO COI'CiC?E'
48 HOUnS
THE
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SIGNATURE;
DRlVEWAY/SIDEWALK PERM!T APPLICATION
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