HomeMy WebLinkAboutPermit Sidewalk 1994-11-14
11~
~5IDENT11~;AL:-1 ~~EiCIAL
APPLICATION I PERMIT
SPRINGFIE.LD
22!; NORTI-I FIFTI-I 5TREET
5PRINGFIELD, OREGON "11411
ENGINEERING DIVISION
OFFICE NO. 126-31!;3
INSPECTION LINE, 126-316"1
J06 ADDRE85.
ASSESSOR!> MAP NO.*
4~?
M-(. \I ee.t-ID\..L
'tAX LOT NO:"*
RECEIPT NO, \ ~
CASH ._____
CI-IECK V
5USDIVI5ION, M-(. \!tcR/'lDN WrY-.D4
OJ.NER, ~ALlc.. \C.L..E..1-l.S...n::./H
ADDRESS, 3q t".J7 '-I- ~S1l -f.'10;.J L-H
STATE, t>fL. ZIP, Cl7Q7'%
lI.IORK DE5CRIFTION.
SIDEWALK, ~
CITY, 6Pi.l NIcFtELJ:>
PI-IONE NO. ,'-11-0/1'>(\
*
CI-lECKED FOR DELlNQJENCIES _
CUSS SIDE _
SETSACK _
CURS-CUT, RESIDENTIAL _ . COMMERICAL _
5ECOND DRIVEWAY (SEE iR.4F1C )
REQUlRE5 APPLICATION FOR A SECOND DRIVEWAYI'T-4.1a)
OR A COUNTY t.PPLICATlON FOR FACILITY PE~IT IC "l8-203)
IF IN TI-lE U.c;.s. . I I /.
DATE 0.= APPLICATION .J.t.LI<f((;K( ________
./"
UJORK TO BE FEl'iiTv"", It:D 6"'-. OUNER
CONTRACTOR *-&~ k:L..1CH6-r~\ J-./
ADDRESS ~ cr/4 ~Ll.9"1'r1J-l LJ-.I
SIGNED,
!bb~
11/ I?/pcf
DATE:
CONTRACTOR
REGISTRATION NO.* 1'Y)!:71r:;I/~ EXPIRES, V? h)
PHONE, 747~h"lC)
,.,.......""t:.....URE FOR IN5FECTION REQUEST. 7'17 -~'f-!15
Ct.LL 126-316"1 lRECORDER ) STATE YOUR CITY DESIGNATED JOS NUM9ER. J09 ADDRESS,TYPE 0.=
INSPECTION REQUESTED A'lD \l.\4EN YOU WILL 9E READY FOR INSPECTlo.-l, CONTRACTORS OR OUNER5 NAME ,l.'lD
PI-lONE NUM9ER. REQUESTS RECEIVED SEFORE 1,00 J..'1 WILL 9E MADE TI-IE SAME DAY, REQJESTS t.FTER 1.00
A'1 WILL SE MADE TI-IE NEXT ~ING DAY
* SEE B<:>oK.
EXISTING 9UILDING PERMIT NO. I IF APPLICASLE) q-'l\ \.0\ q
YOUR CITYY:!?I~'I',."'ED JOS NO. Isf ~
--
~WALK I DRIVEWAY D
FOR ALL CONCRETE PAViNG WITI-IIN
TI-lE STREET RIGI-lT OF WAY, TO SE
MADE AFTER ALL EXCAVATING
IS COMPLETE AND FOi'<l1 WOR<
A'lD SU9-9A5E Mt.TERIAL IS
IN PLACE
CURS I APPROACI-l APRON
AFTER FO~S ARE ERECTE
SUT PRIOR TO POURING
CONCRETE.
REGlUIRED INSPECTIONS
FEES.
SIDEWALKS
TOTAL PE~IT FEE.
~10.00 . ~0.1:;/LF. ( X )
or WALK "q. 4~ IOJ-n...
ZO .4'-
CURB-CUT
~10.00 . ~.1:;/LF. ( X )
s
COMMERICAL DRIVEWAYS SI-lALL
I-IAVE !;' TO 8' FLAIRS
3'- 0" STA'lDARD
WALK X'
/ "'"
t X' I.
;, 1
I :-l.t.\I'E .CAR:::.~LL Y EXA-"INED TJ..!E COMPLETED AFPLrCATIOO FOR FE~IT. ..:.c"'JD DO t-lEREBY CERTIFY T~..t..T ALL
1N".-oRMATION I-IEREON IS T~E A'ID CORRECT, A'ID I FURTfJER CERTIFY TI-lt.T A'IY A'lD ALL WOR< PEl'l"O~ED
SI-IALL SE DONE IN t.CCORDANCE WITI-l TI-lE ORDINt.'lCES OF TI-lE CITY OF SPRINGFIELD, AND TI-lE LAUJ5 OF TI-lE
STATE OF OREGON PERTAINING TO TI-lE WORK DESCRIBED I-lEREI'l, t.'ID TI-IAT NO OCCUPA"lCY WILL BE Mt.DE
OF ANY STRUCTURE WITI-IOJT PE~ISSION OF TI-lE 9UILDING DIVISlo-l I FURTI-lER CERTIFY TI-IAT ONLY CONTRACTOR5
AND EMPLOYEES WI-IO ARE IN COMPLIANCE WITI-l OR!> 101~!; WILL 9E USED ON TI-lIS PROJECT.
O~ ,L J:/<._~
/
SIGNED
/
// - 1<(' - .5'9'
DATE