HomeMy WebLinkAboutPermit Curb Cut 1999-10-27
,.r'
~ .
"-- 'City of Springfield-.,
DRIVEWAY/SIDEWALK . PERMIT APPLICATION
225 FIFTH STREET
SPRiNGFIELD, OREGON 97477
ENGiNEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
~
PERMIT NUMBER:
DATE ISSUED:
'9'q 1414-
o(!.T. 2.7, ("J<jq
APPLICATION DATE:
OCT, 27, l'iqq
SITE INFORMATION:
LOCATION OF WORK: H,(o nlll,^ -:>\-..
1/ -' . I f::. C
APPLICANT ~. \ _,eUIA/ _ rYN'7f.
ADDRESS: / '9 z.t; t("t , ',., ~ /-,
CITY:' '5 ~L:J . STATE: (') f .
r -
SUBDIVISION:
PHONE
Jl
~Af'
.>
'37'(- 3':;.2..0 .-
TAX MAP: t7-,eJ~- x"-42-
22-.00
ZIP:
TAX LOT:
/I
1,1- L 1.1- fI\ r /'^-
ADDRESS: -/./ Z -n ~ LAJ.CITY:
. ~~-<.--A..
"
PHONE: ?d6; ~O 2.- "5 r;f'
oR. 'ZIP: '7;> VCi v
OWNER:
STATE:
REQUESTED PERMITS:
~. DRIVEWAY /CURB.CUT /SIDEWALK: .............sr.Q...l.rr...................................$ 60.00
AMM,2#Nf9J~'D~,VN ~~~~T,ei. T @$0.06 SF. $
o SIDEWALK REPAIR: ...............................~..............................................$ 10.00.
c,tP ,00
o ADDITIONAL DRIVEWAY:
....................................................................$ 30.00
o PROOF OF INSURANCE: $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
TOTAL DUE WITH PERMIT $
00,00
CONTRACTOR INFORMATION:
CONTRACTOR: K, ~~I/vVE= C~"J<::"T. -:-t:
ADDRESS: n...<J3 5. C'1V:1..:: pro ""~.
CONTRACTOR REGISTRATION NO: ~ rJ q % (/ s... . ( f
PROJECT SUPERVISOR: (e:. ~I/I^) _'"(,er/t#h
. r t?/ / ~71- ?C--1
,r');) Cj 7 t(7 3 PHONE: 2!l0 -z::J 7Jy
I . EXPIRATION DATE: ---.t:1~. ~.<?
PHONE: ~ E
~
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 726-376g (RECORDERI STATE YOUR DESIGINATED CITY JOB NUMBERiPERMIT
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 .COORDINA TING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
SIGNATURE:
AMOUNT RECEIVED: 1'-GO,oo DATE PAID: OCT. 27 (q99
RECEIPT NO: 0 3 ~o 2. 4- RECEIVED BY: 130& 7A..~'l..
By signature, I state and agree, that i have carefully exa~ined the completed application and do hereby certii?'that all information herein
is true and correct and I further certify that any and all work performed shall be done in accordance With the'brdinanc~s of
the City of Springfield, applicable City Standard specifications and Drawings, and the laws of the State of Oregon p'ertalning to the work
descr.ibed ~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 Rermit at any time during a one year period following the receipl by the City of notic.
of completion of the described work and specify, at the City's sole descression, any additional restoration work regUlrea to return the sitE
to a standard acceptable to the City. The permittee will be notified in writing of any work required and will have thirty days (30) from the
date 9f the notice to CO'llFlete the work. Work not mpletett at the end of the thirty days Will be performed by
the City and the costs w!1 be billed to t permit . .
I furthor agree to ensure that re dins tions are requested at the proper time, that project address is readable from the
street, ana the approved of pi will r aln on the site at all times during construction. J/) ~ '7 ~ &
Signature Date /U/a /j'1 "/
...
.
.
.....
~
...:.........
..' .......
," . .'. .......
City of Sp~ingfield
225 Fifth St~eet
Spr'ingfield, OR 97477
(503) 726-3753
T~ansact.ion nlln,ber' 036024
Oct.ober' 27, i999 2:36 PM
Received fr'om: I(lRVINE CONSTRUCnON
Cont~act/O~n : CONTRACTOR
Addr'ess: i243 SOUTH 57TH PLACE
CHy:SPRINGFIELD St: OR Zip: 97478
.~....
-Bllilding-
Job t: 99H94
Descr-iption
Fee
Cl1~bcllt
60.00
Total:
Amt Received:
Check t: 5661
60.00
bO.OO Checl:
Thank YOIl, Bob T.