HomeMy WebLinkAboutPermit Sidewalk 1995-1-4
n5 NORTH FIFTH STREET
SPRINGFIELD, OREGON <:11411
ENGINEERING DIVISION
OiTICE NO, 126-3153
INSPECTION LINE, 126-316<:1
-.8i.6IDENTIAL - COt1MERCIAL
n,_. SIDEWALK I CURBCUT .
APPLICATION I PERMIT
SPRINGFIELD
Il~
JOB ADDREe5. Y I;}. LI yY\~ s-l,
ASSES50RS MAP NO,*' TAX LOT NO: '*
RECEIPT NO, 15~'1r
CA5I-l
5USDIVISION,
CHECK
..---
OJ.NER, 1{\J..tJvl( - /~~ t'V\.{.V'1,
ADDRESS, ? () BeN.. I.J 2. 7 b
STATE, f)...u... ZIP, 97<.rJ:
lJ..IOR<. DE5CRIPTION.
SIDEWALK, ~ CUSS SIDE
CURB-CUT, RESIDENTIAL _ ,
SECOND DRIVEWAY (SEE TRtJ'TIC )
RECl\JIRES APFLlCATlo.--l FOR A SECOND DRIVEWAn'T-4.1a)
OR A COUNIr .l.PPL]CAT]o.--l FOR FACILITY PERM]T (C <:18-203)
]F IN TI-lE U.G5,
G"
CITY, /JJ ; I'VAA rJdle
PHON:: NO, HIOO.3 6 ) '3~~
*
CHECKED FOR DELlNQ'UENCI::S
CO:-1M::RICAL _
Jf
e/J~
I-LIAs -==
5:iBACi<.
.SIGNED,
DATE OF APPL]CATION
/- 4-C,!i1
DATE:
WORK TO BE FERFv"" Ir::D BY.
CONTRACTOR* 'P~t.\C\'t.. Jl>>~
ADDRESS (D)(I n..."""",\,,,_,_ "rl.(:\
""" .. -, 'URf: FOR INSFl:CTION REQUEST.
Oi.tNER J CONTRACTOR
&V\rQl."'-"l~ISTRAT]ON NO,* ::XPIRES,
(C,^c.\.J~~ WC\., PI-lON::, X)&47~'2Z.lj5
, (I f'-l-04 'f"d
C.l.LL 126-316<:1 (RECORD::R ) STATE YOUR CITY D::SIGNAT::D JOS Nu:-.S::R, JOS ADDRESS,TYPE OF
]NSPECTION REQUESTED A~D l1.\-IEN YOU WILL S:: READY FOR INSP::CTION, CONTRACTORS OR OUN::RS Nt.M:: A~D
PI-lONE NUMSER REQU::STS RECEIVED 6~rvr= 1,00 A'1 W]LL S:: MADE TH:: SAME DAY, REQUESTS AFTER 1,0(;)
t.M W]LL 6E MAD:: TH:: NE'XT WO~IN6 DAY
* SEE 600K
EXISTING SUILDINC:s P2~1T NO. ( fF APPLICA6LE )
YOUR CIIr D::SIGNATED JOEl NO, ]sf-
19'1 tJ~? ~
REQUIRED INSFtCTIONS
~SIDEWALK I DR]VEWAY
FOR ALL CONCRETE PAVING WITH]N
TH:: STREET R]GHT or WAY, TO S::
MAD:: A:=jER ALL EXCAVATING
]S COMPLETE AND FORM WO~
A~D SUS-SA5:: MATER]AL IS
IN PLACE
D
CURS I APPROACH APRON
A"TER FORMS ARE ERECTE
6UT PRIOR TO POURING
CONCRETE,
FEES.
SIDEWALKS
.\@,@@ . .0.15>/LF, ( X )
or WALK
CURB-CUT
.1@,0@ + ~.15>/LF. ( X )
TOTAL FtRMIT FEE.
70..
~ 10
~~7{)
CO:-1MERICAL DRIVEWAYS SHALL
HAVE 5' TO 8' FLA]RS
3'.0" 5TA'iDARD
WALK X'
/ ""
t X' I,
" II"
~
I :-iAVECAREFuLL l' EXA'1INED T~:: COMPLETED Af'f"LICATiON FOR PERM]T, "'~D DO HERE6Y CERT]FY TH.l.T ALL
IN""rORMATION HEREON IS TRUE A'ID CORR::CT, A~D I FURTi-'::R CERT]FY THAT "''11' "'''D ALL WO~ PERFORMED
S:-iALL 6E DONE IN ACCORDANCE W]TH THE ORDIN"'~CES OF THE CIIr or SPRINGFIELD, AND THE LAW5 OF THE
STATE or OREGON PERTA]N]NG TO THE llJORK DESCRISED H::REIN, A'ID THAT NO OCCUPA~CY W]LL 6E MADE
OF ANY STRUCTUR:: WITHOUT PE~IS5ION or TH:: 6UILD]NG DIV]S]ON. I FURTHER CERTIFY ,}-lAT ONLY CONTRACTORS
AND EMPLOYEES UJI-lO ARE IN COMPLIANCE WITH ORS 10]_5 W]LL SE US::D ON THIS PROJECT.
W0--1"^ 11 B~ '1- Cf - crs-
SIGNE'D
DATE
.
.
BACKFLOW PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759,
INSPECTION LINE: 726-3769
Assessors t4ap
Ltl7 Lf mAl N
II: \'lO~0d Cf).
Tax Lot II:
O(~cO
Job Location:
Owner:
Pi:~l-\ ~ l { , ?it.1 p~ _'
Address: Lf \ 7_ 4 rY\ Po- \ "J Phone 0:
City: S?K..\I\/l-6 ~l--D State: 612...
zip:Q7Lj-78
Backflow Permit is $15.00 + $0.75 State Surcharge
Contractor: '~..:l,N\,(>~o-N l...Awo(Gl"\"Pf, C.,
.
Address: Yo I~"'- II~", Phone
City:
EU~f"JL
State: DT7
O:.1a~Ca.-:14{,.,~ _
Zip: 11 Y-l.fu
EXPires:~
Construction Contractors Registration 0: \ \ ~l.\-"""2-
By signing this permit/application, I agree to call for an inspection once the
backflow prevention device has been installed and is visible for inspection
(726-3769). I al st that all information on this application/permit is
correct.
Sigiu~'
~l~
-'7
Uate
I, It:]}
I I
FOR OFFICE USE
D, 'oofApp 1i ,,"oe, .,1) \;\. q':). } Job.', Cf"i()'\C\ y:)
Receipt II: \ \lLC(;~ Issued By: t7'\ \ I:;:rt )
Tot,' Am",' Co""," ltb fJS ~~ ~4Jl~~
Q- G~ 0\~~'o,.
.
Ci~y of S~~1~9fi~ld
225 Fifth Street
Sryringfjcld~ OR 97471
(503.) 726-37~3
Tr';;mS'.lC'';:',OIl lIur,ber' O;~2E,3
AUl)'..t~';'. C9~ 19'34 .L33 ~'r'
,ecc~.'~'0d .cr'om: BA:"LAF:P S~C\1 :::3~PA:-l,
COII',r ilO'::/OI;lIl , TRUAX HARRiS
Addr-,:ss:: 2511~ F'HR~;;""AY
c::,,'y' e!:,-SONVYLLE St, OR Z"." S"?303
~ \_\~~~~ 01
:ob ;;, S4~20 - -b
resorip'",ol\ ~\S)~ FEe
Bo;ord oT A:JP""l~\~\.'()'(\.. 20e.CO
Total:
200,00
2DD.Oe r~,,('~~'
~,ll'~ ~c:-elv~-:d~
,"eok c', 7067
T".;,)(\t: YOll, r:2ve P.
-....