HomeMy WebLinkAboutPermit Sidewalk 2000-8-25
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
APPLICATION DATE:
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PERMIT NUMBER:
DATE ISSUED:
fln -' 0 Cr/l~ -0 (
SITE INFORMATION: F-., 77 U
LOCATION OF,WORK: .~,' b"'6 fY/.At.(j ~.
APPLICANT -.f], Jf!M..\bA~~+ ( ([
ADDRESS: '2..(4 ( ~ (1~\C _ f=,1-,
CITY: ~ VliP&J STATE: CJ'l:-
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Q./,^ ~/,./W'i'^^e:t- l...Lc..
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ADDRESS: }1"l"7 CJ{~"",^'" fit-. CITY: ~'^tP.~.f',)
SUBDIVISION:
:EPeI~lgW , OL- 9 '7 L/7 7
PHONE 'MAW < (f-, (boO $;7<7 C{?7?... '
TAX.lMAP: ~
4r
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ZIP: 471:(77
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TAX LOT:
OWNER:
I ~-
PHONE:
7q~-b?~)-
ZIP: 97<f77
STATE: O(Z
REQUESTED PERMITS:
~ DRIVEWA Y/CURB.CUT /SIDEWALK: ..................:..:...............................................$ 60.00
AMMOUNT OF SIDEWALK IN EXCESS OF 90FT. @$0.06 SF. $
D SIDEWALK REPAIR: ...................................................................................$ 10.00.
,.
fIJ ADDITIONAL DRIVEWAY:
................................,'..................................$ 30.00
l:I PROOF OF INSURANCE' $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
TOTAL DUE WITH PERMIT $
CONTRACTOR INFORMATION:
CONTRACTOR: b f"A'lK ~ (1 .
ADDRESS: ql4 \( (b?i J('(y iLt::>.
CONTRACTOR REGISTRATION NO: /20 ??O .
PROJECT SUPERVISOR: ~;:-:-..- t>f-/I<P~T
.PHONE 73ft,-- rr-IS""
,EXPIRATION DATE:
PHONE: c;'7o,~q?7L
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INSPECTIONS:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WORK HAS 8EEN 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 REQUESTED, AND WHEN YOU WILL BE READY FOR INSPECTION, CONTRACTOR'S
OR OWNER'S NAME AND PHONE NUMBER. REQUESTS RECEIVED BEFORE 7:00 A.M. WILL BE MADE THE
SAME DAY, REQUESTS AFTER 7:00 A.M. WILL BE MAOE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE CALLED IN
AFTER EXCAVATIONS ARE MADE AND FORM WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE.
YOU ARE REOUIRED TO CALL
THE LANE UTILITIES ,COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1.800.332.2344
48 HOURS BEFORE DIGGING
SIGNATURE:
AMOUNT RECEIVED:
RECEIPT NO:
DATE PAID:
.RECEIVED BY:
~y signsture, I state snd l!ilree, that I hsve carefully examined the completed applicatipn and do hereby cartifv thpt all information herein
IS tru~ and correct and I further certify that any and all work performed shall be done In accordance With the Ordinances of
the CIN of Spripgifeld, applica\>le City Standard specifications and Drawings, an,d the la'Vs of th~ State of Ore,gon p'ertaining to the work
desc(llied ~ereln. I furthencertlfy that only contractors and employees who are In comphance With ORS 701.055 Will be used
on thiS project. .
The City may in~pect the work site described in this permit at any time during a one year period following the feceipt by the ~ of noticl
of completion of the described work and specify, at the City's sole descression, any addillonal restoration wor~ relluirea to reltrl~itE
to a standard acceptable to the City. The permittee will be notified in writing of any work required and will have thirty days (3llM'~e
date pf the notice to complete the work. Work not completed at the end of the thirty days Will be performed bV rrlrrl CD
the City and the costs will be billed to the permittee. . C":l .. "*
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I furthor agree to ensure tI1at all required inspe,tions are (equestecj at the proper time, t~at project address is ieadable f~ tlii !:B i3
street, ana~hea vePfetOf~""' ?:j:i'"._..""~.'"""'._."." \'::C I
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