HomeMy WebLinkAboutPermit Sidewalk 2009-11-25
Status
Issued
CITY OF ~rK.H\iL.FIELD
Building/Combination Permit
PERMIT NO: cOM2009-01699
ISSUED: , 11/25/2009
APPLIED: 11/25/2009
EXPIRES: OS/25/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
54,1-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1282E ST
ASSESSOR'S PARCEL NO.: 1703351404600
Springfield TYPE OF WORK: Sidewalk
PROJECT DESCRIPTION;: Repair 01'25' of setback'sidewalk
TYPE OF USE: New
Residential
Owner:
Address:
JANE WISTAR STARUB REVOCABLE TRUST
1282 E ST "
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
General
cflntractor
THOMAS MARC ROGGE
License
11 0976
Expiration Date .Phone
05/1112011 541-741-8134
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Gro~p:
Primary Constrnction Typ~
Secondary COllstruciion Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1 st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMEN,T INFORMATION I
REQUIRED PARKING
Front yard Setback: Overlay Dist:
Side I Setback: . # Street Trees RqdN
Side 2 Setback: I Paved D,'ive Rqd: T o TtCE'
Rearyard Setback:' . % of Lot Covera~eii~S PER'
Solar Setbacks ATTENTION: Oregon.la~ re9.U1re~ .Y~~.~. :1}!.'HOR/7~~r.~HALL lOlIn,
. N~~tfi~a;~~C~~t:r:vTh~~~';~I~itiR'j.~tiiiilkoVEMEri:fS:I,NCED ~R~~R THts'1~;:HE WORK'
Street 1m roJ~a,952-001-00,19 through \_"-\" ".......... ,- . -, DA~Siail\>'lk;W~~iDON IT IS NOT
.. p 0090. You may obtam caples of the rules by . "vD. ED FOR
Storm Sewer A'llIilftl1!J~he center. (Note:.~he telephone ' Downspoutsmrains:
Special Instructiumber for the Oregon Utility Nollltcatlon
Center is 1-600-332-2344).
Total:
.', Handicapped:
Compact:
,
N9tcs:
~
I Valuation D~scriDtion I
Description
Tvpe of Construction
$ Per Sq Ft
or mnltiplier
Square Footage
or Bid Amount
Value
Date Calculated
,:,c':
Paee I of 2
Status
Issued
225 Fifth Slreet, Springfield, OR
541-726-3753 Phone '
541-726-3676 Fax
541-726-3769 Inspection Line
"
Fee Description
+'5% Technology Fee
Sidewalk Repair Permit
Total Amount p'aid
11
Amount Paid
$2.33
$46:50
$48.83
Total Value of Project
Fees P~id I
Date Paid
Plan Reviews I
CITY OF SPRINGFIELD
Building/C~mbination Permit
PERMIT NO: cOM2009-01699
ISSUED: 11/25/2009
APPLIED: 11/25/2009
EXPIRES: OS/25/2010
VALUE:
Receipt Number
11125/09
11/25/09
3200900000000000772
3200900000000000772
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
workday.
I ~efl'~ir,~d I~sl'ectioos I
Sidewalk - Setback: After forms are erected but prior to placement of concrete.
By signatnre, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and 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 arein compliance with ORS 701.005 will be used on this project.
I I'urther agree to ensure that all required inspections are requested at the propcr time, that each address is readable from the
street, that the permit card,is located at the front of the property, and the approved set of plans will remain on the sile at all
times d'uring construction. j .
Owner or Contractors Signiature
Paee 2 01'2
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1699
COM2009-01699
Payments:
Type of Payment
CreditCard
,..
cRcceintl
RECEIPT #:
Descript;ion
Sidew~lk Repair Permit
+ 5% Technology Fee
Paid By
THOMAS ROGGE
City of Springfield Official Receipt
Development Services Department
Public Works Department
3200900000000000772
Date: 11/25/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
njm
035260 In Person
Payment Total:
Page I of I
8:21:57AM
Amount Due
46.50
2.33
$48.83
Amount Paid
$48.83
$48.83
] ] /25/2009
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._~.: " ,:~ ~. / <:::~ " :", . ::,-' ;. :.:,; ,.:~ .\' , . ~'~'.~ :";'" ,.:;~~,rC?,J. . '.' . ~ . .: ::~: ".; . '~)'~: "i.;':/ . ~ it ,:~ '~ :'. ~ -~:;.:~. ..~~.: t;~~t~j
>~".;" PRIVeWAv/SIlJEWALK .:: '.', ';~; ::"'PERMIT APPLICATION':: ;:),;i~
225 FIFTH STREET
SPRINGFIELD,OREGON97477
ENGINEERING DIVISION
OFFICE TELEPHONE 1503) 726.3753
,
~~
, 1-;)5 -err
Cr:; ~()/~ CI c.1'
PERMIT NUMBER: ~ I .
DATE ISSUED / /:;:;5/09
APPLICATION DATE:
SITE INFORMATION:
LOCATION OF ~ORK: \ A. ~ 2
~
APPUCANT ': Ir::.>-/V\
1'l7'~
OTY S~e-U ..
SU8DMSION:
OWNER: -\ t:tJV
l::
Sl-
ADDRESS'
\2.x .
IL~t<>-
PHONE
""-15-10"
TAX MAP:
STATE:
L'i-L.
ZIP;
TAX lOT:
~c.~~
PHONE:
ADDRESS:
CITY:
STATE:
ZIP:
REOUESTED PERMITS:
o SIDEWALK: ..,............ .... ..............
AMOUNT OF SIDEWAlK IN EXCESS OF 90FT.
IjiI SIDEWALK REPAIR:....
.....................d-5:.~:t..
$88.00 ...
@$0.08 SF.
.. $15.50 ....
.. = $
=$
......... =$
o CURB CUT/DRIVEWAY: NUMBER OF DRIVEWAYS_ X
......... $8B.00 1st Cut = $
o MULTIPLE PERMIT. DISCOUNT EA: ....... ..(MAX 2) . .... ....$30.00 2nd Cut =U'
(MULTI PERMIT DISCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECTION..ow .
APPLIES TO 2nd AND 3rd PERMITS ONLY. NOT SIDEWALK REPAIR! =$
o 5% Technology Fee $ TOTAL DUE WITH PERMIT $
o PROOF OF INSURANCE: $500,000 MINIMUM IF WORK is DONE BY PROPERlYOWNER
CONTRACTOR INFORMATION:
CO~CTOR ~ . ~2~y-- . t2'Jci<-
ADDRESS \l7~ 1-\w.;\WL q
j:l1~~ I'K'
((M."-.j",,, U..,(,
PHDNE, 51 ~- JOt '<;:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERyISOA:
rt'(1..,
EXPIRATION DATE:
PHONE:
INSPECTiONS:
AN INSPECnON REOUEST SHOULD BE MADE PRIOR TO POURING CONCRETE AFTER THE PROPOSED WORK HAS BEEN FO AMEO AND MADE READY TO
POUR. CURB CUT AND SIDEWALK INSPECTIONS CAlL 726-3769 (RECORDER) STATE YOUA DESIGINATED em' JOB
NUMBER/PERMIT NUMBER, JOB ADDRESS, TiPE OF INSPECTION,REOUESTEO, AND lM-lEN YOU WILL BE READY FDA INS PECTlON, CONTRACTOR'S OR
OWNER'S NAME AND PHONE NUMBER. REOUESTS RECEIVED BEFORE 7:00 A.M. WILL BE MADE THE
SAME DAY, REQUESTS AFTER 7:00A.M. VvlLl BE MADE THE NEXTWDAKING DAY. INSPECTIONS AAE TO BE CALLED IN
AFTER EXCAVATlON~ ARE M4.0E AND FORM WORK IS IN PLACE BUT PRIOR TO POUAIN~ CONCRETE.
c::::J Single driveways serving single -family and duplex dwellings shall
be paved for the first 18 feet when abutting a curb and gutter. 4.2-2(3)
YDU are required_to call utility notification center "one call number" 811 before digging
SIGNATURE: CI "'" {i-yJo,
AMDUNT RECEOIf.il/ 0 0 }).'1
/I j'd-y/07
RECEIPT NO:
DATE PAID:
RECEIVED BY: ---1' rt/Yl (~i/'l .
I
. i
By signalurell state an.d agee, lhatl have carefully exa. mined !he c.ompleled application and do he reqy cerliry thaI all information herein is true
and correct and further certifY Ihal an-y and all work Qedormed shall be done In accordance with the OrditiGJJces 0(
the City of S. pringfield, applicable City Standard speClficallans and Dfawinq5, and the laws of the Slate of OregCitfpertainlng to the v.ork described herein. I furltier
certify fhat only contractors and employees who are in compliance with GRS 701.055 will be used
OIlthlspl"Olea. ' .
The Cltymay inspecl_the work sHe described in this permit at any time during a lYIe year period fo ncrwing Ihe receipt by the City 01 notice of com~leHOIl cllhe
descnbed work and,spool)'. Bllne ory's sole discretion any addilionalrestoration work required to return the slle to B standard accep.table to the a . The
permnee will be notified in wilting of any work required and will have Ihll1y days (30) from lhe date of the notice to complele the work. Work not camp eted allhe end
ollhe lhirly days Will be pertormed by the City and (he costs will be biiled to Ilie permittee. - ,
I further agree to ensure thai all reqUired Inspections are reouesled al the proper time that Prol ect address IS readable tram the
street, and the approved sel oj plans WIll remain on Ihe 511e at aJllimes during construction
ct::Y'\. f2r~^ - Dale (!- JS' ~
dO
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