HomeMy WebLinkAboutPermit Sidewalk 2000-12-01SPRTNGF!ELD
Job# 00-01744-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 1
Job Numbe r: 00-017 44-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot #: 10500
Subdivision:
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 406 00004th St Spr
AssessorsMap#: 17033524
Lot: Block: Addition:
ctTY oF SPRfiNGFfiELq OREGON
Owner: Rod Dunn
Address: 406 4th Street
Scope Of Work: Sidewalk
repair sidewalk 40ft
Phone Number:
City/State/Zip:
Repair
541-362-1864
springfield, OR97477
Value: $O
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 callthe 24hour recording a1726-3769. 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.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq.
Main:Accessory
# Of Stories: Height (feet):
Current Units: Proposed Units:
Census Code: Does not apply
Total
Fee Paid On Receipt# Value/Quantity Fee Amount
Public Works
Sidewalk Repair
Total Public Works
12t01t2000 3934 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
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SPHINGFIELD, OREGON 97477
ENGINEERING DIVISION
oFFtcE TELEPHONE (503) 726-3753.
APPLtcATtow oArr: I
SITE INFO ON:
LOCATION OF
APPLICANT
ADDRESS:'i3 t
CITY:ATE:
SUBDIVISION
OWN
ADDRESS:
AMOUNT RECEIVED:
PERMIT N[Jffiglff; oo Otf t+v- cr i
DATE ISSUED: t >'-/ - Cf<)
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TAXMAP:
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ONE:362- lg6q
STATE:0/L ZIP:CITY:e
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REOUESTED PERM ITS:
EDRIVEWAY/cURB.cUT/SlDEWALK:.,..'...'..'.
E PROOF OF INSURAilICE: $5OO,OOO MINIMUM IF WORK tS DONE BY PROPERWOWNER
TOTAL DUE WITH PERMIT $
El ADDTTTONAL DRTVEWAY:
\ sroewaLK REpATR:.
AMMOUNT OF SIDEWALK IN.EXCESS OF gOFT. '@$0.06 sF. ,$
,.$ 10.00i
,,,,,,.,,..,.,..;..$ 60.00
CONTRACTO REGISTRATION NO:
PHoNE: 9/ ^)
RATION DATE
PHONE
CONTRACTOR:
ADDRESS
PROJECT SUPERVISOR:
SIGNATURE:
LANE,,ONETH CIL'S
RECEIPT NO:D
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INFORMATION:
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PROPOSED WORK HAS BEEN FORMED
Signature
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