HomeMy WebLinkAboutPermit Sidewalk 1995-08-14t\EO F_9IDENTIAL - COHT1E$".CIAL
SIDEIUALK / CURBCTJT
APPLICATIOhI / PER-IIT
SPRINGFIELO
225 NORTH FIFT}.I gTREET
gFRll.l3FlELD, OREGOhI 9141]
E}\&3 lNEERlr.{6 D lvlglol'{ffilcE No. 126-)1>?
IN9PECTTON LIN=. 126 - 316A
JOB ADDRE99:
lgA55=5WRS riAP NO.''
EU3DlVl9lON'
tr\REC-IPT NO:
CAgl
CHECK
/8
AX LOT NO.
OrlxE,R'VmBFt CD
,3DDRESe: 3og s- 4 ag CllYt sFf t2 CA=C<;DFOR D=LNA .,A-'=_J 4
5TATE,f to-
cuR3 gtD= _
R=grD=l.iTlA _
PHCr.i= NO.
col-1i'1=RtcA!- _
LuoR<toh{,
5r?3!Ai-K,
CUR3-CUT:
S=COND DRI\GUJAY ( gEE iRATIC )
R=aUlR=9 APPLlcATloll FoR A *coND DRI\€|!AY(T-4.1a.)
OR A CO'JNTY APPLICA?IOhI FOR FACILITY P=31IT (C AA-2O3)
lF tN TFi= uG-3.
DAIE G AP.:LICATION
ruoRK 10 aE BY:oii.t€R,X cohrrRAcioR
*REGrsr.RAIoN No..' 632-t =xPi=5, /-l*?b
9IGN=D:
DA'iE'
Y.Clo^n [ *rnn<cA&rCONiRACTOR
^-n*cc {L PHONE:
PROCEDUFE rcR NSPECTICt.I REQUE9T:
cJ4-L 12r,-3].63 (e.CO@ER ) STATE YOUR CrTy D=gtct{AT=D JO3 Nlr-i3=.R, JO3 ADDR=99JYP= G
IN9F=CTIOhI EAUESTED AID LIHEN YOU IUILL B= EADY FOR INSPECTION, CONTRACTOR9 OR OIU{=R5 NAT= A\D
Pi-{oN= Nt['13ER EaU=STS R=CEI\€D B=FOF= 1.OO /51 riilLL 3= HAD= THE 9A1E DAy, R=AU=5i5 :.=TERlzO.O
AH TjJILL AE HAD= TH= N=XT UI2R<ING DAY
EXlSTlN'g BUILDING P=BllT NO. ( lF ICA3L; )
*CITY 9IGNA Jo3 No. tsr9=E tud.
REAUIRED INgFECTIA{g gIDEUJALK / DRI\EIUAY
FOR ALL CONCRETE PAVINC IUITI{IN
TI{E STREET RIGI..IT OF IUAY, TO 3=
fi/.D= #TER ALL EXCAVATIN6
19 coi-lPLETE AhrD FOtr1 ttJcR<
AND 9U3.3A9= IIATERIAL 15
IN PLACE
..CUFB / AffiOACI{ APROI
AFTER FO3,15 A. ER=CT;
391 pftloR TO POTJRING
C'oNCR=TE.
FEE9' SlDEtlJALKg
rlo.Oo + *O.15/LF.( X )
OF TUALK
TOTAL PERI-IIT FEE:I z-€.oo
I1O.OO+*O.lb/LF.(X)
CURB-CUT uJAL< X
/40 b ,s= / €- <tt ftt.& cornrenrco,- DRr\€ruA..e .Ho,-L
H/^\G. i'TO A'FLA|RS
3.. O'STINDARD
x'
I ;-]A\G CAREFULLY EXAYINED THE COI'IPLETED APPLICATiON FOR PEBIIT,INFOBIATICt{ I{EREON 15 TRJE AT{D CORR=CT, A\D I FURTH=R CERTIFY THA
AND DO HEEBY CERTIFY;I1AT ALL
T A\IY AND ALL IUOR< PEFOSiEDSI]ALL BE DONE IN ACCORDANCE IUITI{ TH= ORDINA\CE5 G THE CITY G gPRING#IELD, A}.ID THE LAUJS G TI-]EgTATE d oREGoN PERTAINING TO THE tlJoRK DEgcRtB=D tr=REtN, AND TH AT NO OCCUPANCY IUILL 3E I,1AD=G ANy 5TEi.'CTU= tUtTilcJT pEsltsgtotl tr THE BUtLptNG DtYtgtCtt I FURiIIER CERTIFY'I'I.]AT ONLY CONTRACTORSARE IN COIIPLIANCE IUITH O# 1OIO55 IUILL BE USFD ON THI9 PROJECT
g
AI.ID
D DATE
-/ts - /J*