HomeMy WebLinkAboutPermit Curb Cut 2021-11-16SPRINGFIELD
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 o{ 2
Job Numbe r: 01 -0127 4-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 00601
Subdivision:
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 479 0001Bth St Spr
AssessorsMap#: 17033624
Lot: Block: Addition:
4-012101-01Job#
ctrY oF SPRINGFIELD, ORE GON
Owner: Jerry Breazeale
Address: 479 l8th Street
Scope Of Work: Curbcut
Phone Number:
City/State/Zip:
New
Springfield, OR97477
Value: $0
Overwidth curbcut approved for 30 feet 10126101.
Quad Area:
# Of Units:
Gonstr. 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 24 hour recording at726-3769. All inspections requested before 7:00
a.m. will be made the same worklng day, inspections requested after 7:00 a.m. will be made the following
working day.
Required lnspections
Public Works
CC-Overwidth -After forms are erected but prior to placement of concrete
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
Tota!:
Fee Paid On Receipt# Value/Quantity Fee Amount
Public Works
1 $65.00
$6s.00
Grand Total
1111612001 7274
$65.00
New Curbcut
Total Public Works
Job# 01-01274-01 Page2 ot2
By signature, I state and agree, that I have carefully examined the completed application and do
hereby certify that all information herein is true and corect, 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.
The City may inspect the work site described in this permit at any time during a one year period
following the receipt by the City of Springfield notice of completion of the described work and specify,
at the City's sole descression, any additional restoration work required to return the site to a standard
acceptable to the City. The permittee will be notified in writing of any work required and will have
thirty (30) days from the date of the notice to complete the work. Work not completed at the end of
the thirty days will be performed by the City and the costs will be billed to the permittee.
I further agree to ensure that all required inspections are requested at the proper time, that the
address is readable from the street, and the approved set of plans will remain on the site at all
during construction.
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225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
oFFrcE TELEPHONE (5031 726-3753
SPFIiIGFIELD
APPLICATION DATE:
PERMIT NUMBER: .'/l- 0lDc1-Ql
DATE ISSUED:
SITE INFORMATION:
.\ \i
So*.*F*[ srArE:---\--r__ZIP:
PHONE
CITY:STATE:
LOCATI
e z€t,
ZIP:
TAX MAP:t"t fi3 ? 6'aLl o@U0.
PHONE '7rli * ,l z8 (
OF WORK:
CITY:
SUBDIVISION:
ADDRESS
owN
APPLICANT
ADDRESS:
rAX Lor: Lbl
REOUESTED PERMITS:
(MULTI PERMIT DISCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECTION ONt Y
APPLIES TO 2nd AND 3rd PERMITS ONLY. NOT SIDEWALK REPAIRI
TOTAL DUE WITH PERMIT $
I nnoor oF INSURANCE: $500,000 MINIMUM tF woRK ts DoNE By pRopERTyowNER
$ 10.00.......... - $
$
$
$ 30.00.
X
$
...$ 65.0O.......... : $
AMOUNT OF SIDEWALK IN EXCESS OF gOFT @$0.06 sF.
E SIDEWALK REPAIR:
[| cune cur/DRrvEWAy: NUMBEB oF DRrvEWAys
E MULTTPLE PERMTT DrscouNT EA: ....(MAx 2)
E SIDEWALK:............
CONTRACTOR INFORMATION:
Ct
PHONE
EXPIRATION DATE:
5 <-
PHONE:
h,
ADDRESS:1
CONTRACTOR REGISTRATION NO
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 SIDEWATK INSPECTIONS CALL 726.3769 (RECORDER) STATE YOUR DESIGINATED C,ITY JOB
NUMBER/PERMIT NUMBER, JOB ADDRESS, TYPE OF INSPECTION REOUESTED, AND WHEN YOU WILL BE READY FOR INSPECTION,
CONTBACTOR' S OR OWNER'S N AME AND PHONE'NUMBER. REOUESTS RECEIVED BEFOHE 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.
rHE LANE unuriE'dE6UH'BifitriltNc couNctl' s" oNE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
SIGNATURE:
AMOUNT RECEIVED: _DATE PA-!D:
RECEIPT NO: RECEIVED BY:
Bv sionature. I state and aoree. that I have carefullv examined the comDleted aoplication and do herebv certifv that all information harein is true
and cbrrett. and'l funher certifv ttiat anv and all work i:erformed shall be done in abbordance with the Ordinancei of
ihC Ciit oi Sorinofield. aoolicab'le Ciw Sfardard soecifibations and Drawinqs, and the laws of the State of Oreqon pertainins to the work described
herein.'l further dertifi thdt only contractors and employees who are in cofrrpliance with ORS 701 .055 will be used
on this project
The Citv mav insoect the work site described in this oermit at anv time durinq a one vear period following the receipt by rhe City of notice o{
comoletion bl thil deicribed work and soecifv. at the Citv's sole disiretion, anv edditional reitoration work rbquired to retuln the site to a stanclard
icie-ola-b'iij tci thii eitv.'t-trJoriniiitt-CwitiG'riotifieri in vi,ritinq o{ any wor( reqirired and will have thirty days {30} from the date of the notice to
complete the work. Work nrit completed at the end of the thirly days'will be performed by
the City and the costs will be billed to the permittee.
DateSignature
to are requested at the proper time, that project address is readable {rom the
site at-all times during construcfon.on
I further
street, and
DRIVEWAY/SIDEWALK PERMIT APPLICATION
Cils of dpringfield i ,r ! rn{: ,,.f,4r.1 i,-!
il /r< lo*-