HomeMy WebLinkAboutPermit Curb Cut 1995-9-19
-.......... "'~_'
. .Lf'A5IDENTIAL - COMME,6CIAL
'-i ...... SIDEWALK I CURBCUT ~
APPLICATION I PERMIT .
~ '~R"S.PR";"'~C'FIEc.n
11~
225 NORTH FIFTH STREET
SPRINGFIELD. OREGON 'i\1411
ENGINEERING DIVISION
OR'ICE NO. 12&.3153
INSPECTIoN LINE, 12&.31&'i\
JOB ADDREOO, I ~ () ~
t.5SE550RS MAP NO.*
( :50 U"1 H We.s.1 c:.ol<.Nex.\ 1/ ':\
Mn./I-i VD.t_ tiff f1/JP./-JIdt_ 1&' 'lnu4f)
TAX LOT NO:"*
RECEIPT NO,
01 qo(o7
5USDIVISION,
CASH
CHECK
~
ADDRE55,
EVA-/...J(~LlN.~ ?V~\(..AL-
l-, 1/", ~. 1",1t; IE.
ZIP, Q747f<'
CITY, gul-/bF/l;4;)
PHON:: NO. I~ .tJ~~r:;-
of.
C1-l::=CKED FOR D::=LlNQ:J~C;::5 _
CUf;;s-CUT, ~ RESIDENTIAL _
S=COND DRIYEUJt.:r (SEE i~IC )
REQUIRES APFLICATlO--: FOR A S=COND DRIVEWA'f('T.4.1.)
OR A COUNTY hPPLIChTION FOR FACILITY PERMIT (C '08.203)
IF IN THE U.G.5.
OJNER.
STATE:
1111-
lIJOi<!<. DE5CRIFTION,
S!:?EW.4.LK:
CU'.'5 SIDE
DATE OF APFL ICA Tlo--l
4/vl1s
WORK TO BE PEF<f'v1'<l IcD BY,
CO--:TRhCTOR*/OH/LL;(7 tiJetJ{..J D
~ '('"
ADDRE55 ./ ,fZfL-t1(fY; '/ G 1 Oqx1e-R
f-f"';V....."'vURE FOR IN5FECTION REQUEST,
SEiEACi< _
CO~ER1C.AL
SIGNED,
8d:r~
o/t ~ y.r <;
Ou.N:R
DATE:
~TRACiOR
REGISTRhTlON
NO."*.......-jO f8/ EXPIRES,VJ.f-U' ~
-. PHO",E'5fS)..J71t1 ..
Oil
CALL 12&.31&'i\ (RECORDER) STATE YOUR CITY DESIG~TED JOB NUMBER. JOB ADDRESS.TYPE OF
INSPECTION REQUESTED A"-lD Wi-{EN YOU WILL 8E READY FOR IN5PECTI0'-l, CONTRACTO~5 OR Ou.N::R5 NAME t..."'ID
PHoNE NUMBER REQUESTS RECEIVED BEFORE 1,0'" .1.'1 WILL BE MADE THE SAME DAY. REQUESTS hFTER 1,=
A:1 WILL BE MADE THE NEXT WORKING DAY
"* 5EE BOoK
EXISTING BUILDING. PERMIT NO. (, IF APPLICABLE)
YOUR CITY DESIGNATED JOB NO. Isf Cj 5' I i~ Ocr
&IDEWALK I DRIVEWAY
FOR ALL CONCRETE PAVING WITHIN
THE STREET RIGHT OF WAY. TO BE
MADE AFTER ALL EXCAVATING
IS COi"'iPLETE AND FO~ WO~
A"lD SUB.BASE MATERIAL IS
IN PLACE
REQUIRED INSPECTIONS
D
FEES,
SIDEWALKS
.10.00 . .0.15/LF. ( X )
0;= WALK
TOTAL PERMIT FEE,
$
/s- .:2~
~RB I APPROACH AFRO:
AFTER FO~5 AF<E ERECTI
BUT PRIOR TO FO~RING
CONCRETE.
CURB.CUT
WALK X'
/ ~
I. x' t
., .,
.10.00 . ~.I5/LF. ( X )
COMMERICAL DRIVEWAYS SHALL
HAVE 5' TO 8' FLAIRS
3'. o' ST.I.'lDARD
I f..lAVE .CARc-=-J:uLL..,.. EXA"1INED TJ-!E COMPLETED AF'PLlCATlOO FOR PE~IT, ~t.,JD DO 1-l:EREBY CERTIFY 71-1.L. T AlL
'~r-O~ATION ~EREON 15 TRUE A~D CORRECT, A~D 'FURTt-!ER CERTIFY THAT A~Y ~"lD ALL u.o~ FE~ED
SHALL BE DONE IN ACCORDA"lCE WITH THE ORDN"-'JCE5 OF mE CITY OF 5PRNGFIELD. AND THE LAWS OF THE
5TATE OF OREGON PERTAINING TO THE WORK DESCRIBED HEREIN. A"lD THAT NO OCCUFA'JCY WILL BE M"-DE
OF A."-lY STP.JCTUR,E UllTi-lOJT FE~155100 OF THE 8UILD!NG DIYI5Iot-l I FURTI-lER CERTIFY 7t-l~T ONLY COSTRACTOR5
.<.ND EMPLO ES 0 ARE IN COMPLIANCE WITH ORS 1"'1~5 WILL BE USED ON THIS PROJECT.
SIG -
l/ cr - / 1 ~ 'l.5
DATE'