HomeMy WebLinkAboutPermit Sidewalk 2001-5-24
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
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PERMIT NUMBER: 01- oO'Sl/:, -0/
DATE ISSUED: ~- 2:1-01
APPLICATION DATE:
<::-2.N-(Jl
SITE INFORMATION:
LOCATION OF WORK: /0 </0
t3 6-/<. ;U (if! f) t/VS
APPLICANT ."\ A IlA f' 'ilA 'S ~71ZA- c..r-~
AODRESS:
PHONE ':{ 1- (""(10
TAX MAP: (~?,",,, 'iJ-
TAX lOT: 6 :) 6l>
CITY: STATE: ZIP:
SUBDIVISION: 0.....,(. Ii"\"- e-A D vw'::'> Lv T I "
OWNER: 'bllLlC ~1e."DArJt'\S.
ADDRESS: -;;21 =t ~1- L >6tt< 7"r (l. "-IV CITY: FlJI'. F /JF
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PHONE:
STATE: 61'L ZIP: i-7?2l/
REQUESTED PERMITS:
o SiDEWALK:.................................................................................$ 65,00......... = $
AMOUNT OF SIDEWALK IN EXCESS OF 90FT. @$0.06 SF. = $
lla SIDEWALK REPAIR:.........................................:............................$ 10.00.......... = $ In t5i)
o CURB CUT/DRIVEWAY: NUMBER OF DRIVEWAYS
x.............$ 65.00.......... = $
o MULTIPLE PERMIT DISCOUNT EA: ....(MAX 2) ...............................$ 30.00.......... = $J-_~(
IMUL TI PERMIT DISCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECTlON..Ql:IlY
APPLIES TO 2nd AND 3rd PERMITS ONLY. NOT SIDEWALK REPAIR[
TOTAL DUE WITH PERMIT $ I ~ . N
o PROOF OF INSURANCE: $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
CONTRACTOR INFORMATION:
CONTRACTOR:IJI'-A'A/lc... r?AI,~ ~}((;qf...lA"1'f/()h
ADDRESS: B6x ~o84,o t:::l.L<j E'LJ~ o~
CONTRACTOR REGISTRATION NO: I 0 ~ 0 ~ '7
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PROJECT SUPERVISOR: '1-1 "Ol.>". ,', c:: (' ~ ll:.-~
PHONE: 3~1 1910
EXPIRATION DATE: 11- 2.o5'-D2.-
PHONE: '"S'1 f I 'II '-'
INSPECTIONS:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WORK HAS BEEN FORMED AND MADE
REAOY TO POUR. CURB CUT AND SIDEWALK INSPECTIONS CALL 726-3769IRECORDERI STATE YOUR DESIGINATED CITY JOB
NUMBERJPERMIT NUMBER, JOB ADDRESS, TYPE OF INSPECTION REQUESTED, AND WHEN YOU Will BE READY FOR INSPECTION,
CONTRACTOR'S OR OWNER'S NAME AND PHONE NUMBER. REQUESTS RECBVED BEFORE 7:00 A.M. Will BE MADE THE
SAME DAY, REQUESTS AFTER 7:00 A.M. Will BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE CAllED IN
AFTER EXCAVATIONS ARE MAOE AND FORM WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE.
YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL' S
II ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
SIGNATURE:
AMOUNT RECEIVED:
RECEIPT NO:
DATE PAID:
RECEIVED BY:
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By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all Information herein 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
hersh:,. I further certify tliat only contractors and employees who are in compliance with OAS 701.055 will be used
on thiS proJect.
The City may inspect the work site described in this permit at any time during a one year period following the receipt by the City of notice of
completion of the described work and s~cify. at the City's sole discretion. any additional restoration work required to return the site to a standard
acceptable to the City. The permittee Will be notified in writing of any work required and will have thirty days (301 from the date of thei9tice to
complete the work. Work not completed at the end of the thirty days will be performed by 3: --I
the City and the costs will be billed to the permittee. --I'=':::I:I
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I further agree t nsure that all required inspections are r~quested at the proper time, that project address Is readable from the f:g rM &5
street, and the a roved set of plans will re~'n 0 e' at all times during construction. C"'J _ _ **=
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