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HomeMy WebLinkAboutPermit Sidewalk 2001-3-9 } 54173e'C2'; r FEB.15.01 11:14; P4GE V2 .J 226 FIFT~ STREET SPRINGFIElD. OREGON 97477 ENGINEERING oMSION OFACE THEPHONE 15Oa1 726.3153 APPLICATION DATE: SITE INFORMATION, LOCATION OF WORK: ':1-8"1 nAUJniAlMwS APPLICANT .:::rOHN N~.A'u~ . ADDRESS: I ~ 'II W,MBI.9IlN PC CTTV, ~br-IW STATi, IHL SUBDIVISION: ()A~.Z." - L.O. I P~MIT NUMBfFl: 6 ( - eXy, I ...... () I Il~TE Issuell: i Pu.u ': P~ONE_.G8" ~ BBB'l ! TAX MAP: f:r-u~f....;.J- ~P: ! '1"'l~'''' 't'A>ClO'f: --rL 5?:'b 1-=10331{1., 1 s;Jal ) OWN!!!": SAMF" PHONE: AOORESS, on: ; STATE: ....~,-- ZIP: ;. REQUESTED PERMITS: .. i /1 CJ ~:~:~V~;~~=~~~:~~;'~;~:...."..l:f6"1"(.@SO:08SF:"'..: 80.00 '-S.6l> CJ SIDEWALK REPAIR: ......"...........".............,."........",......,........i.,.,....,,,.,...$ 10,00. CJ ADDITIONAL DRIVEWAY, ..................................."..""......!..,.........,....s 30.00 ; Cl PHon. OF INSURANCE. $500,000 MINIMUM IF WORK IS cciNf BV PROPfRTYOWNER TOTk.OUEWlTHPERMIT. ~- ":;<()" <10 CONTRACTOR INFORMATION: CONTllACTOR: (~ODIlUJ - l+i\~"; ADDRESS: ~ I I-\w~" q~., CONTRACTOR RBGIS11IATION NO, r;,?' '1/1 1 PROJECT SUPERVISOR, ~ ~~"".lAl INSPECTIONS: .... INSPECTION I\EQUSST SHOULD BE MADE ""'OR TO POURING CO~CRETE. AFTER THE PIlOPOSEo WORK HAS BEEN FORMED ""0 MADE REAoYTO POUR. . i CURB CUT AND SlDEWAUI INSPECTIONS CALL 7lWlfi IfIECOR1m' STATE YOUR QESIQINATED CTTV JOB NUMllEAIPERMIT NUMBEf.l, J08 ADDRESS, TYPE OF IN.PECTlON REQUESTED. AND N YOU W1J.Le. ReADY POR INSPECTION, CONTRACTOR'S OR CWNIiR'S NAME AND PMONE NUMBER. REOUESTS RECEIVED BE RE 7'00 A.M. WILL BE MADE THE SAME DAY, REQUESTS AFTER ):(10 A.M, Wlu BE MADE TtlE N!XTW~RI<JHG DAY,lNSPEcnONS ARE TO ae CAU.EC IN AfTER EXCAVATION. ARE MACE AND FORM WORK IS IN PlACE BUTf"lIOR TO I'OU~NO CONCRElE. , OlAls1-. ('.Il . w&.~~ \ OIL . , P~ONE: 68'1 -77hZ E""'RAllON DATE: 5 '"1 . 0 Z. PHONE, 6eq "IhZ. YOU ARe: fl!QU!1O CAI.I. THE LANE UTILmES. .COO INATING .COUNCIL'S MONE CALL NUMBE 1.800.332.2344 ... H~URS B&FO . lJlGGING SIGNATURE: , l' !J.AOlJN1 RECEIVED: OATEPAID: I RECEIPT NO: RECEo/!:D BY: 8Y ."notul'. I.tot. .nd ..~e. 111., '-havo '''''''11y 'E' lnod tho ,,",,,,~,; ,d 'P""~' . .nd ~ ""'b~inllv Ih" .11 inlo",,,,;on h...ln .~lnJ9I1l1dOOrreclend.IIU rCerllfvJhat.ny.an!;t I worlcperformeo. lIbOdone nacco a~w wOrtlnal'l:HaI t ,C;,./ of S"iIlll1lll1d,'" I. City Stand,ra .pe< -atiOn. ..d 0.. . ""nd tho wlOftno 'ItO _. ""'""'010 the walk MC"bctd I)treln, I fun~r certify rh.( only CDntrllctorll!l ncI ornp:oyee$ wtlCi ef~ In tomplllnte Wll: OR , .Q6~ will De usfd on Ihls project ~ Th" City mllV 1n1P4tCt the "l'00l..s1te cI~$Crlbecl='h" ~.~;t . IIny. limO~lfll)g 9 Olllt "Y~[ perj~""Iowj~ ehe rocolpl bv the CiIv 01 notle- ofl:omprel'lOnonh.~CnbedWr1c..Dld. .at. lsolfldtllcr "OI"!.~ny. illOna re 10'..110 TI",I'tIAl.li"citaf'llt\JlTith8I!t~ II:) llI5bi'ldllrd ~C:OP'lIOitlto the I;;lty. Th(l r;M:tfr:rl "WI I be atihcdfn w, rll Cf 'I)I( 'MJ feClU ang w I 4\10 tnlfWClays 130/ from the dateofthlJ I1Dtlce~D co pktl;'t~ll work.. Workr)~ compla~ed.lh8 on the thirty ~W111 be..._.& . 't1'/ thl!l City 800 the coat; II be bilte 10 thl!l permittliHl. 1''''''''10: ogrwtc r th I vi Ir'iGDClGtlons are leo.ue~at th~ oro;MIrtim..it\.at proiect4ddrMe I. I1'adGbltfrom lhe 411IQQt, .....olhea s Ir.I'n'lno"tt';eIibl.~a tmet~\ltln9COn$IfUC1JOIL SllilnaMIl '-....,. ' -...........~~. l 0111 5-("'-"0 I r-" . - ---- 1 " ~ . ~ .' Page 1 of 2 . I Job# 01-00213-01 I CITY OF SPRINGFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 01-00213-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location Of Proposed Site: 987 OAKMEADOWS PI Spr Assessors Map#: 17033422 Lot: Block: Addition: Tax Lot#: 05100 Subdivision: Owner: Address: JOHN NEPUTE 1491 WIMBLETON PLACE Phone Number: 541-686-8889 City/State/Zip: SPRINGFIELD, OR 97477 New Value: $0 Scope Of Work: Sidewalk NEW CURBSIDE SIDEWALK 180FT TOTAL Quad Area: # Of Units: Constr. Type: Water Heater: Office Use Land Use: Zoning Code: Bedrooms: Range: # Of Buildings: Occupancy Group: Heat Source: Sq. Footage: 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 working day. SW-Curbside Required Inspections I Public Works I -After forms are erected but prior to placement of concrete Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? 0 ,Area (Sq. Feet) I Main: Accessory: # Of Stories: Current Units: Census Code: Does not apply Height (feet): Proposed Units: Total: Fee Paid On Receipt# Value/Quantity Public Works l 03/09/2001 4637 180 New Sidewalk Total Public Works Grand Total Fee Amount $70.40 $70.40 $70.40 , r . I Job# 01-00213-01 I . Page 2 of 2 By signature. I state and agree that I have carefully examined the completed application and do hereby certify that all information 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, applicable City Standard Specifications and Drawings, and the laws of the State of Oregon pertaining to the work described herein. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I also understand the City may inspect the work described .::pJ" oy II :""0' ~ :::"""'" 101Owi", """ of rompl,.,", " Ih, CitY' ? '0 j. 0 I Signature' Date :r> :x -< -<<:::l:;O :r> :D :;o-<:z rr1 rr1 CIJ C"J-.:a::a: ~ '::$0 ~ ......."":;O~ >-<n ...cc rr1:C~ ....00, ::::OD 0" 0 "ZU1c.nr-.J..p.. aen- . 00" 0-. m 0 .p.. ca..... 1"..)..00.......-=3