HomeMy WebLinkAboutPermit Curb Cut 1999-05-07rI i.I oDIDDDaI N
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
oFFrcE TELEPHONE (s03) 726-3753 LH oo'6r(
IAPPLICATION DATE:
PERMIT NUMBER:
DATE ISSUED:
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SUBDIVISI
OWNER:PHONE
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CITY
ADDRESS:
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PHONE llt 7yz /85 o
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APPLICANT
SITE INFORMATION:
LOCATION OFWORK:
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REOUESTED PERMITS:
I PRooF oF INSURANCE: $500,000 MINIMUM tF WORK lS DONE BY PROPERWOWNER
TOTAL DUE WITH PERMTT $
6-D
p-onvewav/Sllne-cur/StDEWALK i .........,$ 60.00
AMMOUNT OF SIDEWALK IN EXCESS OF gOFT @$0.06 sF. $
E SIDEWALK REPAIR: ..,.,..,.
E ADDTTTONAL DRTVEWAY:
,....$ 10.00.
.....$ 30.00
CONTRACTOR INFORMATION :
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/47-lBSb
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0,PHONE:
EXPIRATION DATE
PHONE
ADDRESS DE-*t /**:u
CONTRACTOR
PROJECT SUPERVISOR t4il,4,eb
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CONTRACTOR REGISTRATION NO: E C 6#
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
TVMBERTJOB ADDRESS, TYPE OF INSPECTION REOUESTED, AND WHEN yOU W|LL BE READY FOR INSPECT|ON, CONTRACTOR'S
0R OWNER'S NAME AND PHONE NUMBEB, REOUESTS RECEIVED BEFORE 7;00 A,M, WILL BE MADE THE
QAITE D-AY, BEqUESTS AFTER 7:00 ,A,M, WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS enE ro BE CALLED tNAFTEB EXCAVATIONS ARE MADE AND FORM WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE.
r H E L A N E u r r L r ffr6-tb"d h'BiRt'A'h ru c c o u N c I L, s"oNE CALL NUMBER" 1-800-332-2344
48 HOURS BEFOBE DIGGING
r.gquestgq at the proper time, th.at project address is readable from thestte at all trmes dunng constructton.
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application and do hereby certifu that all information
be'done in accordance with the Ordinances of
and the laws of the State of Oreqon oertaininq to there in compliance with ORS 701.055 will be use"d
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re, I state an herein
on
all reouired
of plahs wil
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The City mav inspect the work site described in this oermit at anv
of combletion of the described work and specifu. at the Citv's sofeto a stqndard acceptable to the City, The pbrmittee will be frotifieddate ot the notice to complete the work. Work not comDleted at ththe City and the costs will be billed to the permittee.
to ensu
Date
RECEIVED BY:
DATE PAIDAMOUNT RECEIVED
RECEIPT NO:
I furthor aoree'
street, anfl the
PERMIT AP ICATIIVEWAY/S!EWALK
I City of Springfield e
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SIGNATURE:
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