HomeMy WebLinkAboutPermit Sidewalk 2001-3-9
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FEB.15.01 11:14;
P4GE V2
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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:
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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
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OWN!!!":
SAMF"
PHONE:
AOORESS,
on:
; STATE:
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ZIP:
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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. $500,000 MINIMUM IF WORK IS cciNf BV PROPfRTYOWNER
TOTk.OUEWlTHPERMIT. ~- ":;<()" <10
CONTRACTOR INFORMATION:
CONTllACTOR: (~ODIlUJ - l+i\~";
ADDRESS: ~ I I-\w~" q~.,
CONTRACTOR RBGIS11IATION NO, r;,?' '1/1 1
PROJECT SUPERVISOR, ~ ~~"".lAl
INSPECTIONS:
.... INSPECTION I\EQUSST SHOULD BE MADE ""'OR TO POURING CO~CRETE. AFTER THE PIlOPOSEo WORK HAS BEEN FORMED
""0 MADE REAoYTO POUR. .
i
CURB CUT AND SlDEWAUI INSPECTIONS CALL 7lWlfi IfIECOR1m' STATE YOUR QESIQINATED CTTV JOB NUMllEAIPERMIT
NUMBEf.l, J08 ADDRESS, TYPE OF IN.PECTlON REQUESTED. AND N YOU W1J.Le. ReADY POR INSPECTION, CONTRACTOR'S
OR CWNIiR'S NAME AND PMONE NUMBER. REOUESTS RECEIVED BE RE 7'00 A.M. WILL BE MADE THE
SAME DAY, REQUESTS AFTER ):(10 A.M, Wlu BE MADE TtlE N!XTW~RI<JHG DAY,lNSPEcnONS ARE TO ae CAU.EC IN
AfTER EXCAVATION. ARE MACE AND FORM WORK IS IN PlACE BUTf"lIOR TO I'OU~NO CONCRElE.
,
OlAls1-. ('.Il
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P~ONE: 68'1 -77hZ
E""'RAllON DATE: 5 '"1 . 0 Z.
PHONE, 6eq "IhZ.
YOU ARe: fl!QU!1O CAI.I.
THE LANE UTILmES. .COO INATING .COUNCIL'S
MONE CALL NUMBE 1.800.332.2344
... H~URS B&FO . lJlGGING
SIGNATURE:
,
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!J.AOlJN1 RECEIVED: OATEPAID:
I
RECEIPT NO: RECEo/!:D BY:
8Y ."notul'. I.tot. .nd ..~e. 111., '-havo '''''''11y 'E' lnod tho ,,",,,,~,; ,d 'P""~' . .nd ~ ""'b~inllv Ih" .11 inlo",,,,;on h...ln
.~lnJ9I1l1dOOrreclend.IIU rCerllfvJhat.ny.an!;t I worlcperformeo. lIbOdone nacco a~w wOrtlnal'l:HaI
t ,C;,./ of S"iIlll1lll1d,'" I. City Stand,ra .pe< -atiOn. ..d 0.. . ""nd tho wlOftno 'ItO _. ""'""'010 the walk
MC"bctd I)treln, I fun~r certify rh.( only CDntrllctorll!l ncI ornp:oyee$ 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
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Page 1 of 2
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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
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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
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