HomeMy WebLinkAboutPermit Curb Cut 1994-12-8
1IbENT~I;;AL:-1 C~~E~IAL
APPLICATION I PER'1IT
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22 S NORTJ.1 F IFTJ.1 S TRE E T
SPRIN6FIELD. OREGON .,1411
ENGINEERING DIVISION
Oi'FICE NO. 12& -31S3
INSPECTION LINE. 12(,-31&"
JOB ADDRE55. I()S"
ASSESSORS MAP NO.*'
6/YM/Jir.
I -
l"7l'?~ 7_"1 41
5U6DIYISION,
0ll.NER>
H Acs A
ADDRESS. _~()n (A, _Fair-v/c;{J)
ST"-TE, OiEfrorJ ZIP, q7477
UJORK DEOCRIPTI~,
DATE Of' APPLICATION
/~/fo! q1
l::ORK TO BE F'E~D BY:
CONTRACTOR* STAToJJ COII.d. TI'tG.
=!:>1<:55 :1'1391 -J( Ai ....port 'ReL
"""-,,,-;DURE FOR IN&FECTI~ REQUE5T,
RECE IpT NO,
.*
TAX LOT NO. ~(')f)
CA5J.1
SPRINCFIEL.D
/~~95""
I/"
clrrSf":~Jf.i.clJ
pJ.1ONE NO.
/
CJ.1ECKED FOR DELINQJENCIES* .,/'
*' SEE COOK
E:'<ISTINC:s e.UILDrN~ p=~rT NO. ( IF APPLICABLE)
'14/150
CJ.1ECK
5ET9ACK _
CO:"1:'1ERICAL
&1C:sNEDI
DATE:
Oll.N:R
~
CO~T~CiOR
SIDEWALK, CU~ SIDE _
CURS-CUT, '-- I'<:SIDENTlAL _
SECOND DRIVE:.:J.t..,.. (SEE TR,t..;::;::lC )
R:QJIRES APPLICATION POR A S:COND DRIY:WAYI'T-4.1o)
OR A COUNiY AFP'~ICATION FOR FACILITY P:R'1IT IC ~-2"3)
IF IN TJ.1E U.c;.9.
I'<:GISTRA TlON
*
NO. 0337/
'17LfO:L
1'"f/J';'j 11.
it{elq'-{
:;':PIRES,..1' b./ / qS-
. .,
p;';ONE, %/ .-06-~
C.t...LL '26.;.,'6~ (R:CORi:>ER ) STATE YOUR CITY P:5IuNATED J09 N:.f."'i5ER, JOS ADDRESS,TYPE OF
INSPECTION REQUESIED ~"-l:::> Uh-iEN YOU l:,JILL 9: RE.4:)Y FOR INSPECilo-.l, CONT~CiOR5 OR O\.l..NERS Nt.ME t...~D
P~E NUi"'i5ER REQUESTS R:CEIYED 8EFORE 1:00 .!..""i l!JILL 9E MADE Tf.;= SA""iE DAY, REQUESTS t.FTER 1:0C'
AM WILL 9E MADE TJ.1E NEXT !lOR<:ING DAY
E"'(51P; OE,t~
. YOUR CITY D:SIC,~kT:D J09 ~O. 1St
SIDEWALK I DRIYEt:.1A.,..
FOR ALL GO~C:RE'iE PAYING WITHIN
TI-I: STR.:ET RIGHT or: WA.,.., TO 9E
MtDE kiER /..lL =XCAYt.TING
15 =MPLETE A"D FOR'1 !lOR<:
4l-,JD sue.SA5E Mt.TERIAL IS
IN PLACE
REQUIRED lN5PECTI~5
o
FEE5.
SIDEWALKS
110.00 . 10.1~/LF. ( X )
0;: WALK
TOTAL FERMIT FEE.
~ /2.40
[21
CURB-CUT
110.12'0 + ~.I~/L.;=. ( X ) /~
CO:-1MERICAL DRIVEWAYS. SMALL
1-It.\IE 5' TO &' FLAIRS
3'. 0" STt..."I~ARD
CURS I AF'F'ROkCJ.1 APRON,
k'ER FOR'1S ARE ERECTED
BUT PRIOR TO POURING
=NCRETE.
WALK X'
/
I.
;,
'"
X' 1..
! i-lAVE CAREFULL.,.. EX":"~NED T~E COMPLETED ':"PFLICATlo-.l FOR PER1fT, ~"IP DO i-lER.ES.,.. CERTIF.,.. 71-lt.T ~LL
IN;::O~AT10N ""'EREON IS TR:.JE 4"'-:D CORRECT, A"ID I FURT;";ER CERTIFY TI-l~T ":"~Y ~"'D ..:..LL L!..OR<. PER=O~ED
SMALL 5E DONE IN .!.GCORDANCE Wlii-l TI-I: ORDIN":'''ICES or: TI-lE CIT.,.. OF SPRNC:tFIELD. .:..ND Tj../E L~L:.)S OF Tl-iE
ST~TE OF OREGON FERT41NING TO TI-1E WORK DESCRISED HERE:I~, ':""'D T;";..4T NO OCCUP4NC.,.. WILL 5E M.!.DE
Of' ANY STRUCTURE WITJ.10JT pER'1ISSION Of' TJ.1: BUILDING DIVISION. I FL:RTl-iER CERTIFY Tl-i.; T ONL Y CONTRACTORS
':"'lD :MpLOYEES U);..IO -'-RE IN Co.'1pLIA~CE WITJ.1 ORS ''''I.o:.S WILL 9E USED ON TJ.1IS PROJECT.
. ~ ~ ./31.-.iA _
SIGNED r~7
/-2/rI/?tJ
DATE '