HomeMy WebLinkAboutPermit Sidewalk 1999-11-15
;. - City of Springfield
DRIVEWAY/SIDEWALK PERMIT APPLICATION
225 FIFTH STREET SPRINO.......
SPRINGFIELD, OREGON 97477 ~
ENGINEERING DIVISION A!..
OFFICE TELEPHONE (503) 726.3753 I7JIJ' .
APPLICATION DATE: / l /5-99
PERMIT NUMBER:
DATE ISSUED:
PHONE
99/.70 S-
~
';
SITE INFORMATION:
LOCATIONOF~RK: 17IJ:! r'1/,}/u~ ~V-
APPLICANT r/L.nIAtf7.VS(' L ~('61().,l/Tl
7lcJ 1I1u'(;;-/J'ihJI/ 1//;; r[)/I
sP STATE: OIL
'5 1./ t/ -- f?b 'i l./
ADDRESS:
TAX MAP:
/7/i2 ~&CfZ
?/)t)
CITY:
ZIP:
tf7977
TAX LOT:
SUBDIVISION:
V,rAl (k;BU?_
PHONE:
It; 7;?-/'f;l-}a
OWNER:
ADDRESS:
CITY:
STATE:
ZIP:
REQUESTED PERMITS:
o DRIVEWAY/CURB-CUT /SIDEWALK: .....................................................................$ 60.00
AMMOUNT OF SIDEWALK IN EXCESS OF 90FT. @$0.06 SF. $
~EWALK REPAIR: ..........._............~..........................................................$ 10.00.
o ADDITIONAL DRIVEWAY:
................................,..................................$ 30.00
o PROOF OF INSURANCE' $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
TOTAL DUE WITH PERMIT $
t() 9
CONTRACTOR INFORMATION:
CONTRACTOR: ;:, c. ~CIJ JVJ III
ADDRESS: '7 if 0 /J14(j IVrf ,{}("--'" I /iieMI
CONTRACTOR REGISTRATION NO: ~U:;2;2/
PROJECT SUPERVISOR:
1
PHONE: ?>-N -flZ',<6~
EXPIRATION DATE: / -22 - 2aor~
PHONE: ~'0-(,_
~
INSPECTIONS:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WORK HAS BEEN 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 MADE 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: - //j r cej) DATE PAID: 1"/ - /.s --9'1
RECEIPT NO: 3 (/J .It!: ~ RECEIVED BY: bJ:1 ;:::;'/Iv/tI
By signature, I state and agree, th'atl have carefully exa":'ined the completed apPlicati~n a'n~ do hereby'certiNthat all information herein
is true and correct and I further certify that any and all work performed shall be done in accordance With the Ordinanc~s of
the City of Springfield, applicable Citv Standara specifications and Drawings, and the laws of the State of Ore~on p'ertalning to the work
desor,iced ~erein. I furth~r certify 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 following the receipt by. the City of noticl
of completion of the described work and specify, at the City's sole descression, any additional restoration work re~uirea to return the sitE
to a standard acceptable to the City. The permittee will be notified in writin~ of any work required and will have thirty days (30) from the
date of the notice to complete the work. Work not completed at the end oflhe thirty days Will be performed by
the City and the costs w!" be billed to the permittee. . .
I furthor agree to ensure that all requir """1'"'< 5 ar r.equesteg at the proper time, ttJat project address is readable from the
:~~e:~:u::a :L.:P:I: ; Of;S C al~ on site at all times dUring constru:~~:. I (_ f Co -1 ~