HomeMy WebLinkAboutPermit Sidewalk 2001-7-16
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I Job# 01-00721.01 I
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Page 1 of 2
TRANS#:01-0006151
DATE:JUL 16 2001.
AMT RECD:2 $ 65.00
CHANGE:
CASHIER: 062
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00721-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 1056 Oakmeadows PI Spr
Assessors Map#: 17033422
Lot: Block: Addition:
Tax LoU: 06100
Subdivision:
Owner:
Address:
Fred Hample
3426 Srookview Dr
Phone Number: 541-484-7076
City/State/Zip: Eugene, OR 97401
New Value: $0
Scope Of Work: Sidewalk
Sidewalk required for completion of Subdivision
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,
Required Inspections
Public Works
Sidewalk
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
,Area (Sq. Feetl
I Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
Fee
Paid On Receipt#
Public Works
07/16/2001 6151
Value/Quantity
Fee Amount
New Sidewalk
Total Public Works
Grand Total
60
$65.00
$65.00
$65.00
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I Job#01-00721.01 I . Page20f2
By signature, I state and agree that I have carefully examined the completed application and do
hereby certify that all information is true and correcto and I further certify that any and all work
performed shall be done in accordance with the Ordinances of the City of Springfieldo 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
on this permit any time during a one year period fOllowing notice of completion, at the CityOs
descression,
.
Signature
Date
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (5031 726-3753
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PERMIT NUMBER: Of -6r1J;;;D-01
DATE ISSUED:
DI-t:Oy~l-ol ,
IS 1- 00" i'b- 0/
APPLICATION DATE: t-'-/~-Ol
SITE INFORMATION:
LOCATIONOFWDRK:_~ At\.. ~ \1::l2..'-l
APPLlcANT,r-,nD1'lCAI ./~1"".v r.dNS'/. C(),
ADDRESS: 14'-/1 J-!w\/ 'fq N
1
CITY: WC,f;tJ1; STATE: () fL
SUBDIVISION: 0 PrI/ J)/l.J;..c.7(
OWNER: ~.o 'L-I1lMPuL
\() <:;,.
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PHONE GfY'J - I 7 c:, 2-
.T AX MAP:.1..'+-o",,- :0.'-/ ~~ , l. ? 'f OD)
'100, 6~
0<. '<-I'Y\.\.~O"
ZIP:'
11l{o(..
TAX LOT:
'pHONE:
ADDRESS:
CITY:
STATE:
ZIP:
REQUESTED PERMITS:
III SiDEWALK:..,....,........,....,.,........,.................................,..............$ 65.00......... = $ ~
AMOUNT OF SIDEWALK IN EXCESS OF 90FT, @$0.06 SF. = $
o SIDEWALK REPAIR:......................,..................:............................$ 10.00.......... = $
o CURB CUT/DRIVEWAY: NUMBER OF DRIVEWAYS X.....,.......$ 65.00..,....... = $
o MULTIPLE PERMIT DISCOUNT EA: ....{MAX 2) ...............................$ 30.00.......... = $j_
IMUL TI PERMIT DISCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECnON.illIl.Y
APPLIES TO 2nd AND 3rd PERMITS ONLY. NOT SIDEWALK REPAIR!
TOTAL DUE WITH PERMIT $ I q ~. tJ
o PROOF OF INSURANCE: $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
CONTRACTOR INFORMATION:
,
CONTRACTOR: h(')t')\)//A) -/JI?\U< ~Il~
ADDRESS: 141.{( Uti..!" qq N '
CONTRACTOR REGISTRATION N~: C, r~ '-i 41
PROJECT SUPERVISOR: I\)~""" ,_
INSPECTIONS:
PHONE: ('81-/76?.
EXPIRATION DATE: ") -7-0?
PHONE: .50 I . z.. 7 "i.!J...
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WORK HAS BEEN FORMED AND MADE
READY TO POUR. CURB CUT AND SIDEWALK INSPECTIONS CALL 726.3769IRECORDERI STATE YOUR DESIGINATED CITY JOB
NUMBERIPERMIT 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 RECEIVED BEFORE 7:00 A,M, WILL BE MADE THE
SAME OAY, REQUESTS AFTER 7:00 A,M, WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE CALLED IN
AFTER EXCAVATIONS ARE MADE AND FORM WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE,
YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL' S
" ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
SIGNATURE:
AMOUNT RECEIVED:
RECEIPT NO:
DATE PAID:
RECEIVED BY:
By signature, I state and agree, that I have carefully examined the completed application end 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
herein. I further certify that only contractors and employees who are in compliance with GRS 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 fallowing the receipt by the City of notice of
completion of the described work and specify, at the City's sole discretion, any additional restoration work re~uired to return the site to 8 standard
acceptable to the City. The permittee WIll be notified in writing of any work required and will have thirty days (30) from the date of the notice to
complete the work. Work not completed at the end of the thirty days will be performed by
the City and the costs will be billed to the permittee.
I further agree to ensure that all required inspections are requested at the proper time, that project address is readable from the
. street, and the approved set of plans will remain on the site at all times during construction.
Signature
~{l~~
Date
f-It.-rJl
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