HomeMy WebLinkAboutPermit Sidewalk 2009-10-2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01465
ISSUED: 10/02/2009
APPLIED: . 10/02/2009
EXPIRES: 04/02/2010
VALUE:
.
225 Fifth Street, Springfieldi' OR
541-726-3753 Phone
541-726-3676 Fax. ,. .
541-726-3769 hispection Line
SITE ADDRESS: 235 S 41ST PL 237
ASSESSOR'S PARCEL NO..: SKYCHIEF PARKSUB S
Springfield TYPE OF WORK: Sidewalk
TYPE OF USE: New
PROJECT DESCRIPTION:' Driveway approach and 30 feet of sidewalk
Residential
Owner: DON. HAASE
Address: 1960 GILHAM ROAD .,
EUGENE, OR 97401
Phone Number: 541-484-2326
I CONTRACTOR INFORMATION I
Contractor Type'
Applicant
Contractor
DON HAASE
License
Expiration Date Phone
484-2326
"
BUILDING INFORMATION I
.,
,
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:.
. Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type,
Secondary Construction Type:
# of Bedrooms: '
n/a
I, DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks: .
, "
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
NnTlrJ:.
fjToTENTiON: Oregon I PUBLIC IMPROVEMENifS'IPERMIT SHALL EXPIRE IF THE WORK
" . w ltiles ad i",. "'l.jlllre I-\U I HORI7~F:\ '"'12-''' T"IS
Street Improvements:itication C Opted by the 0.0 s you to "Sidewal mype:J PERMIT IS NOT
in n4t:j enter. Tho 1"90n Uti/it COMMENr.FD OR ,~ /l~MlnONED FOR
Storm Sewer Ava~l'!Ji~e: 952-001-0010 th/e rules are setfor~ ANY 1.80 r?o)"nspoutblDrairis':
Special Instruction:'al'.. You may obtain oUgh OAR 952-001 A) t-'t'KIU .
c tng the copies of th -
Notes: numbe~for t%~ng:~9~~0~i/he tel:;~~~~ by
. enter is 1-8nn_~o:I~Notificati()n
l!
I V al~ation DescriDtion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2e I of2
CITY OF SPRINGFIELD.
Building/Combination Permit
Status
Issued
PERMIT NO: COM2009-01465
ISSUED: 10/02/2009
APPLIED: 10/02/2009
EXPIRES: 04/02/2010
VALUE:
. 225 Fifth Street! Springfield, OR
541-726-3753 Phone
541-726-3676 Fax.
541-726-3769 Inspection Line
Total Value of Project
;.,
.~;
Fees Pairl I
Fee Description
Curbcut Permit
PW Disc - 2nd Permit
Sidewalk Permit
Amount Paid
Date Paid
Receipt Number
. , $88.00
$-30.00
$88.00
10/2/09
10/2/09
10/2/09
1200900000000001113
1200900000000001113
1200900000000001113
Total Amount Paid
$146.00
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
I Reonir..rllnsn..dions I
Sidewalk - Curbside: After forms are erected but prior to placement of concrete.
Curbcut - Standard: After forms are erected but prior to placement of concrete.
By signature. I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true 3;,od correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that tbe permit card is located at tbe front of the property, and the approved set of plans will remain on the site at all
times during construction.
/(J- 2-- () <?
Date
Paee 2 on
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal,Number ;~
COM2009-0 1465
COM2009-0 J 465
C0M2009-0 1465
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
. J;?esc.ription
Curb cut Permit;
. Sidewalk Permit
PW Disc - 2nd Permit
.Paid By..;
"DON HAASE
. .~
.:
"
City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000001113
Date: 10/02/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How;Received
Ikw 61201B In Person
Payment Total:
Page I of I
2:06:16PM
Amount Due
88.00
88.00
(30.00)
$146.00
Amount Paid
$]46.00
$146.00
10/2/2009
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;:;<':.:.DRIVEWJ.\V/SIDEWALK . . i.;>:;. PERMIT ApPLICATION ;<:;;:::.~~E~
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHON~ (503) 726-3753
.,.R,:O=-LD, '~
~~I .
PERMIT NUMBER: Ctrnw '7-
DATE ISSUED: /0 -,,-0'1
. .--
0,1./-0':)
APPLICATION DATE:
II) - J..-Oi
SITE INFORMATION:
LOCATION OF 'vYORK:
APPlICANT
ADDRESS:
PHONE :) fA! ~tI. '2 "32.6
TA:XMM'/7..02 -:{?-3J'-~'~ Q...
. ~f
9'74'757' TA:XLOT;L/rJO :VOl .~
,
,
ow 2f7" t.._. . STATE: rY fi?_
SU8DMSlON: 51i--,;('t.,t<L7' P?""k
OWNER: .f7t9ff .4L-rd'S'....)l
ADDRESS: <";? -?A A .J? CITY:
ZIP:
PHONE:
STATE:
ZIP:
REQUESTED PERMITS:
o SIDEWALK: ...........
AMOUNT OF SIDEWAlK IN EXCESS OF ro::T.
o SIDEWALK REPAIR: .....
$88.00 .
@$O.08 SF.
.......... $15.50 .....
............ = $
=$
.............. = $
Il!l: CUR8 CUT/DRIVEWAY: NUMBER OF DRIVEWAYS
x
....... $88.00 1st Cut = $
o MULTIPLE PERMIT DISCOUNT EA: :.... ...(MAX 2). ........$30.00 2nd Cut =$J
(MULTI PERMIT DISCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECTION..Qt::IJ...X
APPUES TO 2nd AND 3rd PERMITS ONLY. NOT SIDEWALK REPAJRl =$
o 5% Technology Fee $ TOTAL DUE WIll-l PERMIT $
o PROOF OF INSURANCE: $500,000 MINIMUM IF WORK IS DONE BY PROPER1YOWNER
CONTRACTOR INFORMATION:
CONTRACTOR: .
/3;//
ft. L t(~d--/
I
ADDRESS:
CONTRACTOR AEGISTRATION NO:
. PAOJECT SUPEFMSOR: .Do AI J.j d 0 <" ,,_
INSPECTIONS:
PHONE:
EXPIRATION DATE:
PHONE:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO PoUAlNG CONCRETE.. AFTER THE PROPOSED WORK HAS BEEN FO AMED AND MADE READY TO
pouR. CURB CUT AND SIDEWALK iNSPEcnONS CALl 726-3769 (RECORDER) STATE YOUR DESIGINATEDCITY JOB
NUMBER/PEAMIT NUMBER. JOB ADDRESS, l'YPE OF INSPECTION REOUESTED, AND VVHEN YOU WILL BE READY FOR INS PECTION, CONTRACTOR'S OR
OWNER'S NAME AND PHONE NUMBER. REQUESTS AECENEO BEFORE 7:00AM. WILL BE MADE THE
SAME DAY, REOUESTS AFTER 7:00A.M. WILL BE MADE THE NEXTWOAKlNG DAY. INSPECTIONS ARE TO BE CAlLED IN
AFTER EXCAVATIONS ARE MADE AND FORM WORK IS IN PLACE 8lJT PRIOR TO POURING CONCRETE.
YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
" HOURS BEFORE DIGGING
SIGNATURE:
AMOUNT RECENED:
RECEIPT NO:
J;ilc.
.,
DATE PAID:
RECEIVED BY:
/O..!Fo 7
L~.J
>
By signature, I state and agee, thai I have carefuRy examined the compleled appUcation and do he reby cerlify lhat aD infamalion herein is true
and c:orreCl and I further cerliWthat af1Y and all work oertormed sha~ be doo8 in aa:ordance with the Oldinances 01 .
the City 01 Springfield, applica6le City Slllndatd speaTlC8lions and DrawinQs, and Ihe laws 01 the Slale 01 Oregon pertaining 10 Ihe v.ork desaibed he-en. I fuMe!
Cerllfy lhal.only contradors and emplOyees wtlo are in ccrnpliancev.'lth ORS 701.055 W1U be used
on lhlsprOjed. .
Th, ',City may inspecl ,Ihe work sile described in this permi1 al,any tim, e during a one year period to nowing the receipt by the City 01 nollce ot com~lelion or the
descnbed work and speaty, 81 the City's sole disC/elion, MY additional restoration work required to return the sile 10 II slandafd acceRlable 10 Ihe CI ,The
perllllnee will be notified in wriling of any work required and will have thirty days (30) from the dale of Ihe nolice 10 complete lhe work Work not com eted at the end
of Ihe Ihlrty days wiU be perlormed by the City and the costs wi! be billed to \tie perrnillee. ,
I further agree 10 ensure that aU reqUlfed IIlSpec:llonS are requested lllthe proper llme that prO) ect adaess IS readable trom Ihe
"'..~,:::' 'P,~' ,,., "m" dw09 00"'''"0''00 D~' IO~ ;<.~{) q
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Oor; tftt.a S'.f!..
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