HomeMy WebLinkAboutPermit Sidewalk 1992-5-11
11~
22!; NORTl-l FIFTH 5TREET
5PRiNGFIELD, OREGON <:\1411 .
ENGINEERING DIVI510N
OFfiCE NO, 126-31!;3
INSPECTION LINE, 126-316<:\
~;;;71Vi::r" 11.....1- - '-'V1-II-Ji::~I""'I-,
OID~I CURaCUT .
(AFPLicAT~U'PE~1J!
SPRINGFIELD
.
.
Joe ADDf<E&&s Z.C;qo /lJ1/-/JJ ST,
A55E550RS MAP NO,*' i7-0r 3~- 4/
RECEIPT NO:
LI(po3
TAX LOT NO, *' (000
CA5!-I
CHECK
1070
5UElDIVI5ION,
OUNER. U OD DOMMl:
ADDRE5S, P.O, &?K 7fi73
5TATE, .ct2B, ZIP, Q740 (
CITY, EUC;;ENe'
PHONE NO, ?2-.b-,a:)2...,8
CI-IECKED FOR DELINQ,JENCIES. X
co:"1I'1i:RICAL _
*
UJOfO!K DESCRIPTiONs
51DEUJ.ALI<, ~ CURS 51DE _
CURS-CUT, RE51DENTIAL _
5!:COND DRIveWAY (5!:E TRAfFIC)
R!:QUIRE5 APPLICATION FOR A 5!:COND DRlvEWAYI"T-4.1.}
OR A COUNTY APPLICATION FOR FACILITY PE~IT (C <;\6-203)
IF IN TI-IE U.a..5,
5ET5ACK _
DATE OF APPLICATION
~/tl/"f~
5IGNED,
~~
{;I/t/~
, i
DATE:
WORK TO BE F'EFO:Fu"", It:D BY, X OUN:R
CONTRACTOR. IIVOUSTRIA<- INSTALLATioN
ADDR!:55 2910 /tf1'tflJ 5r;
CONTRACTOR
R!:c;,15TRATION NO! 7 I 5'<:0 I
EXPIRE5, 2/l /1 5
P.-lONE, '7 zG,,-a?c g
~""..,URS FOR INeFECTION f<EQ\JE&T,
CALL 126-316<:\ (R!:CORDER) 5TATE YOUR CITY DE51c;,NATED JOEl NUMElER, JOEl ADDR!:55,TYPE OF
1N5PECTION R!:QUE5TED AND WHEN YOU WILL ElE READY FOR 1N5PECTION, CONTRACTORS OR OUN:RS NAI.,E A'ID
PHONE NUM6ER REQUE5T5 RECEIveD ElEFORE 1,0f2) t.I1 WILL 6E MADE TI-4E 5AME DAY, REQUE5T5 AFTER 1,0f2)
AM WILL 6E MADE TI-4E NEXT WORKING DAY
*' 5!:E 600K
EXI5TING BUILDING PE~IT NO, ( I!' APPLICABLE) No
YOUR CITY DE51c.NATED JOEl NO, 15f q 2~f57
f<EGlUIf<ED INSPECTIONS
~
~EWALK I DRlvE~
r-ur<: AU_ CONCRETE PAVINc;, WITI-4IN
T1-IE 5TREET RIc;,HT OF WAY, TO ElE
MADE AFTER ALL EXCAVATINc;,
15 COMPLETE AND FO~ WORK
AND 5U6-6A5E MATERIAL 15
IN PLACE
D
CURS I APl"'ROACH APRON,
AFTER FORJ15 ARE ERECTED
BUT PRIOR TO POJRINc;,
CONCRETE,
FEES.
SIDEWALKS
CURS-CUT
TOTAL ""''''' liT FEE,
~ ,%,70
co:1MERICAL DRlvEWAY5 5HALL
HAvE 5' TO 8' FLAIR5
3'- O' 5TA'iDARD
WALK x'
/ ""
I, x' I.
'. 1
.10,00 . .0.1E;/LF, ( X ) I7S iF.
OF WALK
.10.00 . ~.IE;/LF. ( X )
I'HAvE CAREFULLY EXA'1INED THE COMPLETED AFI"L1CATION FOR PE~IT, A'iD DO HERE6Y CERTIFY THAT ALL
1N"".-o~ATION I-IEREON 15 TRUE A'ID CORRECT, A'ID I FURTI-IER CERTIFY TI-IAT A'iY A'iD ALL U;O~ PE!'il'O!':'1ED
SI-IALL 6E DONE IN ACCORDA'iCE WITI-I TI-IE ORDINA'iCE5 OF THE CITY OF SPRINGFIELD, -"'D TI-4E LAUJ5 OF THE
STATE OF OREc;ON PE~NING TO TI-IE WORK DE5CRIElED HE:REIN, "''1D THAT NO OCCUPA'lCY WILL ElE MADE:
OF=STRUCTURE WIT T PE!':'1IS5ION OF TI-IE 6UILDING DiViSION. I FURTHER CERTIFY TI-IAT ONLY CONTRACTO!'!S
.l.N EMPLOYEES WHO IN COMPLIA'lCE WITI-4 ORS 101,O!;5 WILL 5E U5E:D ON TI-I15 PROJECT,
---~~ -^k~ . 5-1/47
;,IC:NED '-----'" ~ . DATE -_