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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 -_