HomeMy WebLinkAboutPermit Sidewalk 2001-04-27Job# 01-00431-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 1
SPRINGFIELD IRf;i'J$S: C1-000I08I
ilATE:AFFt l? t00i
At'lI REID:I $ 65. C0
[Hf,I.IGT:
fiffSHItR:0I]
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 527 00034th St Spr
AssessorsMap#: 17023124
Lot: Block: Addition
Job Number: 0'1 -00431-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 1081
Subdivision:
ctTY oF sPRtrvGFtEL4 OREGOTV
Owner: Maria Sotelo
Address: 527 34lh Street
Scope Of Work: Sidewalk
Phone Number:
City/State/Zip:
Alteration
541-9BB-1249
Springfield, OR 97478
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 24
a.m. will be made the same working
working day.
hour recording a|726-3769. All inspections requested before 7:00
day, inspections requested after 7:00 a.m. will be made the following
Required lnspections
PuOlic Works
Curbcut
Construction Types
Occupancy Groups
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq.
Main:
-After forms are ereceted but prior to placement of
Accessory Total
# Of Storiesr : - I'lergtrt(feet):
Current Units: Proposed Units:
Census Code: Does not appiy;' l i: 'i ' r, {'"i i't--t41-1- EXP1RE lf THE W,RK
through OAH 952-001-
r copies of the rules by
il,lote: the telephone
on Utility Notification
s 1-uuo-332-2%4)
AUii,I{"}i:iJr} UNDER THIS PERMIT Is NoT
CGMI,!;i;liiD 0R lS ABANDONED FoR
Fee Paid On Receipt#antity Fee Amount
Public Works
INew Curbcut
Total Public Works
$65.00
$6s.00
c:-
04127t2001 5085
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Grand T $6s.00
u /tr/o r
trrrnDD1IIEEEE
225 F|FTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
oFFrcE TELEPHONE (503) 726-3753 iffi
APPLICATION DATE:
PERMIT NUMBER:
DATE ISSUED:
SITE INFORMATION:
PHONE
\+-t? -7\'-24-lQfft
crw,sorrnoft.tto\ sre
STATE:CITYr
ZIP:l
ONE;
P:
LOCATION OF WORK:
ADDRESS:(-
TAX MAP:
TAX LOT:
SUBDIVISION
OWNER:
APPLICANT
ADDRESS:
REOUESTED PERMITS:
(MULTI PERMIT DISCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECTION ONLY
APPLIES TO 2nd AND 3rd PERMITS ONLY. NOT SIDEWALK REPAIRI
TOTAL DUE WITH PERMIT $
fl PROOF OF INSURANCE: $500,000 MINIMUM lF WORK !S DONE BY PROPERTYOWNER
-$
=$ (-
X"u x.............$ 6s.00
E SIDEWALK REPATR:
......$ 65.00......... = $
AMOUNT OF SIDEWALK IN EXCESS OF gOFT
E SIDEWALK
@$0.06 sF.:$
RB CUT/DRIVEWAY: NUMBEH OF DRIVEWAYS
............$ 10.o0.......... - $
..$ 30.00E MULTIPLE PERMIT DISCOUNT EA: ....(MAX 21..........
CONTRACTOR INFORMATION:
EXPIRATION DATE:
a
PHONE:
F
ADDBESS:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERVISOR:
INSPECT!ONS:
AN INSPECTION REOUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WOHK HAS BEEN FORMED AND MADE
READY TO POUR. CURB CUT AND SIDEWALK INSPECTIONS CALL 726.3769 (RECORDER} STATE YOUR DESIGINATED CITY JOB
NUMBER/PERMIT NUMBER, JOB ADDRESS, TYPE OF INSPECTION REOUESTED, AND WHEN YOU WILL BE BEADY FOB INSPECTION,
CONTRACTOR' S OR OWNER'S N AME AND PHONE NUMBER. REOUESTS RECEIVED BEFORE 7:00 A.M. wlLL BE MADE THE
SAME DAY, REOUESTS AFTER 7:OO A.M. WILL BE MADE THE NEXT WOBKING 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'dt6UH=8fittri\Nc couNcrl' s" oNE CALL NUMBER" 1-800-332-2344
48 HOURS BEFOBE DIGGING
SIGNATURE:
Bv sionature. I state ard aoree. that I have carefullv examined the comDleted aoolication and do herebv certifv that all information herein is true
and c6rre-ct. and'l further certilv ttiat anv and all work i:erformed shall be done in abbordance with the Ordinances of
the Citv of Sorinofield. aoolicab'le Civ Siandard soecifiiations and Drawinos. and the laws oI the State of Oreqon Dertaininq to the work described
herein.'l further ibrtifi thdt only contractors and 6mployees who are in coinpliance with OBS 701.055 will be:used
on this project
The Citv mav inspect the work site described in this permit at any time durinq a one vear period followinq the receipt by the City of notice of
comoletion bf ttril deicribed work and soecifv, at the Ciw's sole disiretion, anv Edditional restoration work i-equired to'retdrn the site to a standard
acce'ptable to the City. The permittee will be'notified in writing of any work reqLired and will have thirty days (30) from the date of the notice to
comflete the work. Work n<it completed at the end of the thiiiy 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 Droper time, that proiect address is readable from thestreet, and the approved set ol plans Will remaih on the site at all times during cbnstruction.
Signature Date
RECEIVED BY
DATE PAID:AMOUNT RECEIVED:
RECEIPT NO:
Citg of dprinefield
CATIONPRMIT APDRIVEWAY/SI EWALK
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