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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