HomeMy WebLinkAboutPermit Sidewalk 1999-11-18
'Ciiy of Springfield "
DRIVEWAY/SIDEWAl PERMIT APPLICATION
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726.3753
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PERMIT NUMBER:
DATE ISSUED:
q~/5 :S9
APPLICATION DATE:
JI-/9J-9'7
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SITE INFORMATION: /70:(.:3 3 ~ d.. (J 3qn
LOCATION OF WORK: Z;/J 24 >>;7/17,;{/\:/;
APPUCANT O~b~ ?A///:;:):,( 'PHONE
C;/J'2.4. d~) :sr
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ADDRESS:
7~--'L/7/
TAX MAP: / 7~2..r~ i"2:1!
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CITY:
5~"
STATE:
ZIP:
97<<j..7~
TAX LOT:
e:; S '7.1nJ
SUBDIVISION:
OWNER: G-100tz- &1t~
PHONE:
"'i!
ADDRESS:
CITY:
STATE:
REQUESTED PERMITS:
J!. ~:~~~~Y~~~I~:;~~~~~~~~~~~~~.""''''''':''''''''''''''''''''''.@$o:;i;;.s;;:.....: 60.00
o SIDEWALK REPAIR: ...................................................................................$ 10.00.
o ADDITIONAL DRIVEWAY:
.................................'..................................$ 30.00
o fRnn~ nF INSURA~Ir:~' $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
TOTAL DUE WITH PERMIT $
~(70
CONTRACTOR INFORMATION:
CONTRACTOR:
ADDRESS:
J;; i:J+-T L..d~ 7lkt Aj
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PHONE:
EXPIRATION DATE:
PHONE:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERVISOR:
INSPECTIONS: C-L.!/f4CHr I 5/lJB:.d>f-tk...
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WORK HAS BEEN FORMED
AND MADE READY TO POUR.
j
CURB CUT AND SIDEWALK INSPECTIONS CALL 726-37~9 (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 REQUIRED TO CALL
THE LANE UTILITIES ,COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
SIGNATURE:
AMOUNT RECEIVED: $/40, - DATE PAID: 1/- / '( . '7 '7
RECEIPT NO: ,,~ '" ~ ~ U RECEIVED BY: 9'< /.0
!lY Si~nature, I state and agree, ihatl. have carefully examined the comoleted application and r: hereby cenifv that all information herein
Ie tr~ and l:orrecl. and I further certlfyJhat any ana aU wQrk performed ,halT be 'done In aCCQr er\lla wllh the Ordlnenc,a Of
the C 1Y of Sprln9f1eICl, eppllceble City StenClarCl speCIfications and Drawings, and the laws ot testate of OreJlon Renalning to the work
des~~itied ~erein. I funhpr cenify 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 followjng the receiPf by the City of noflc'
of completion of the described work and specify, at the City's sole descrqssion, any additional restoration work re~u red to return the s t.
to a standard acceptable to tha City. The permittee will be notified in writln~ of any work required and will have thirty days (30) from the
date 9f the notice to corop. lete the work. Work not completed at the end oflhe thirty days Will be performed by
the City and the costs w!1I be billed to the permittee. '
I furthor agree to ensure that all requirel! inspections are requesled at the proper time, that project address is readable from the
street, ana the approved set of plans Will remain on the site at a I times during construction.
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