HomeMy WebLinkAboutPermit Sidewalk 1995-09-07ll,EO P'=gIDENTIAL -C,OYIY|F'-CIAL
SIDEIUALK / clURffiJl
APPL ICATIOI.{ / PEE1IT
SPRINGFIEL()
225 NORTH FIFTH gTREET
gPRlh!3FlELD, OreGo/d 314'1'I
E}.IG INEERING D IVIgIOT.I
GlcE No. 12641>3
IN9PECTION LINE: 126 -31ba
JOts ADDRE99:RECETPT No, /97?4/L
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S=COND DRI\€IIJAY ( 5EE TRA;=IC )
EAUIR=S APFLICATIOI.I FOR A *COND DRI\€I'AY(T-4.IA)
OR A C(2JNTY APPLICATION FOR FACILITY P=R-1IT (C AE-2O3)
IF IN TFiF UG9.
DAi=- G APPLICATION
oiiN=R
9IGNED'
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*
=GISTRATION NO.*-CONTRACTOR
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PROCEDURE FOR INgFECTIOI.I RE@IIEgT:
CAL 12b.31b3 (E,CO@ER ) gTATE YOUR CITY D=gIG}.{AT=D JO3 Ntfi3=R, JO3 ADDR=gg,TYP= C
INgFECTIOI.I EAUESTED A{D IIJi.{EN YOU II,,ILL B= R=A9Y rcR NgP=CTION, CONTRACToP<S OR OU,N=R5 NAI..l= ,/.\D
PI{OT{E NLF1SER R=AU=9TS R=CEIYED B=FOR= 1,OO I}1 IUILL BE HADF Ti.{= 5Ar1E DAY, REAU=sT5 /.=TER IOOA'I UILL tsE IIAD= THE NEXT U12R<ING DAY
EXI9Tlli'; BUILDING P=R'1lT NO. ( lF APPLICABLE )
g
*AEE A.*YOUR CITY D=sIGNA;ED JO3 hio. I9T
9IDEuJALK / DRI\GuJAY
FOR ALL CONCRETE PAVING IUITIIN
THE STREET RIGHT G IUAY. TO 3=
I'1AD= ,€iER ALL EXCAVATING
19 CO|,.iPLETE AND FOff1 UJOR<
AND 5U3-3A5= I1ATERIAL 15
IN PLACE
.-CUB / AffiOACH APROI
AFT=R FOB15 Are ER=CTi
BUT PRIOR TO POURING
coNcRETE.
FEE9, SIDEIUALKS
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oF LUALK /6
ToTAL PEffllT FEE'* /2,40
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COI'IIIERICAL DRIV=UJAYg gHALL
HAVE 5'TO A'FLAIRS3'. O* gTADARD
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I i"{AVE.CARERILLY EXA'1INED THE COI-IPLETED APPLICAT|CFN FOR PER.1IT, AND DO HER=BY CERTIFY 'I'I-{AT ALLINT, IATICI.I HER=ON 15 TRTIE AI{D CORR=CT, A!{D I FURTH=R CERTIFY TITAT ANY AND ALL UJOR< PESO='1EDSIALL BE DONE IN ACCORDANCE IUITH TIi= ORDINANCES G TI]E CITY OF SPRINGFIELD, AID T,I-]E LAI.1Jg CF TI-]ESiATE G OREGON PERTAINING TO TI{E II,I?RK DEgCRIS=D HEREIN, AND T|-.IAT NO OCCUPANCY I]-JILL 3= IIAD=G ANY 5TRIJCTU= II.IITiJCJT FER1I59ION tr THE tsUILr)ING DIYISIOII" I FURiIIER CERTFT ]HAT ONLY CONTR,ACTORS
AND EI1PLOI.EES UJ+-.IO ARE IN COI1PLIANCE IUITH OR5 1O1@> IIJILL BE USED OI\I T}.1I5 PROJEC:T.
DATE
q- 7- ? t-
REAIIRED INgPECTICNg
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