HomeMy WebLinkAboutPermit Sidewalk 2009-5-26
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."'>., :.,"'"., DRIVEWAY/SIDEWALK".: :,-:' :::; ,-'"PERMIT APPLlCATION;;!.;\;~tr>
225 FIFTH STREET ""~JNDFI.E:LD'
SPRINGFIELD. OREGON 97477 ~
ENGINEERING DIVISION
OFFICE TELEPHONE (50;) 726.3753 ~
APPLICATION DATE: C; - 26 - [) 9
PERMIT NUMBER:
DATE ISSLlED
to}/! (jJt>9;-()07'] 4---
SITE INFORMATION:
lOCATION OF WORK: le.70 I5"UL
APPLICANT ....Ml!J N \V L\1 Kl?"
ADDRESS: --12 ........" h ,c;-t.
CITY: 5PRPLP STATE: OR
SUBDIVISION':
OWNER PAil I SAI\LO LA"-lD
AaaRESS FI.c;.C;ICJ Mf_LoII(ar::R.. CITY ~IM4F1ELD
6"""fREET
PHONE ?4-/" - ?7S?
TAX MAP:
ZIP:
q7+7?
TAX LOT:
PHONE 5"41 -7U -/64t
STATE OR ,"P: q?4-7 S.
REQUESTED PERMITS:
)Q
SIDEWALK: ................
AMOUNT OF SIDEWALK IN EXCESS OF 90FT.
o SIDEWALK REPAIR:.
(if
$88.00
@$0.08 SF.
. $15.50
........ = $
=$
... =$
9.. g,oo
~ CUR8 CUT/DRIVEWAY; NUMBER OF DRIVEWAYS~ X
..... $88.00 1sICul =$
~ P~. oD
o MULTIPLE PERMIT DISCOUNT EA: ..... ...(MAX 2) . .. .. ..........$30.00 2nd Cui =$J
(MULTI PERMIT DISCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECTION ~
mI APPUES TO 2nd AND 3rd PERMITS Qt;iL y, NOT SIDEWALK AEPAJAJ. . . =$
~5%TechnologyFee $ W'~~U TOTAL DUE WITH PERMIT $. K
o PROOF OF INSURANCE: $500.000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
CONTRACTOR INFORMATION:
r\(4,(fU
CONTRACTOR LvKJ::: FAM I L Y. LLv
ADDRESS 'Z_.';~.?' "D II 6"lRee. I .
CONTRACTOR REGISTRATION NO:
PROJECTSUPEAVlSOR: MtJNI'f
PHONE: 74-t. -775i
EXPIRATION DATE:
LUKE.
PHONE: 741D-71Si
INSPECTIONS.
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE. Af;TER THE PROPOSED WORK HAS BEEN FO RMED AND MADE READY TO
POUR, CURB CUT AND SIDEWALK INSPECTIONS CALL 726-3769 (RECORDER) STATE YOUR DESIGlNATED CITY JOB
NUMBER/PERMIT NUMBER, JOB ADDRESS. TYPE OF INSPECTION REQUESTED. ANDVVHEN YOU WILL BE READY FOR INS FECTION, CONTRACTOR'S OR
OWNER'S NAME AND PHONE NUMBER. REOUESTS RECEIVED BEFORE 7:00 AM. WILL BE MADE THE .
SAME DAY, REOUESTS AFTER 7:00 A.M. Vv'ILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE CALLED .IN
AFTER EXCAVATIONS ARE MADE AND ~ORM WORK IS IN PLACE BlIT PRIOR TO POURING CONCRETE.
YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
aATEPAID: S -..z....{" - 0 l
RECElVEa8Y:~_ /
By signalure, I slale and agree, lhall have carefully examined lhe completed application and 00 he leb)' cerlily lhal all infamalion herein is !tue
and COIrecl and l.lurther certifY that any and all workfler1ormed shall be done in accordance with Ihe Ordinances of , .
the Citv of Spllngfleld. applicanle City Slandard speCifications and Dr:al'linqs. and Ihe laws of the Slale 01 Oregon pertaining 10 Ihe work described herein. I further
certify thai ,only contraclors and employees who ale in compliance "",Ih ORS 701,055 Will be used .
on lhlsprolecl. -
The City may inspect .the work site described in this permit at any lime during a one year period 10 Ilowif'lg Ihe receipt by the City 01 nolice 01 com~lelion o~ [he
described work and, SPecify. af, the Oly's sole discrellOllany additional, reslorallOl'1 work reqUired 10 relurn the site 10 11 standard acceRlable to the Ci . The
permltlee will be nOI!lied In wri1lng. of any work required and Will have .lhlr1y days (30)lrom the date of the nollcs to complere the work. Work not comp eled at the end
ollMe (~1I1y days Will be performed by tlie City and the COSIS will be billed 10 the permlllee. "
I further agree to ensure (hat all reqyired inspectioos are requesled althe proper time. that proj eel address is readable from the
street, and Ihe approved sel oj plans WIll remain on1he site at all limes during construclion. .
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25. Fifth'Street
pringfield, Oregon 97477
41-726-3759 Phone
lb/Journal Number
OM2009-00734
OM2009-00734
OM2009-00734
ayments:
ype of Payment
heck
cReceintl
RECEIPT #:
Description
Curbcut Penn it
Sidewalk Permit
+ 5% Technology Fee
Paid By
LUKE FAMILY
City of Springfield Official Receipt
Development Services Department
Public Works Department
3200900000000000394
Date: OS/26/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
ew ] 723 In Person
Payment Total:
Page J of]
2:13:12PM
Amount Due
88.00
88.00
8.80
$184.80
Amount Paid
$184.80
$] 84.80
5/26/2009