HomeMy WebLinkAboutPermit Sidewalk 1995-6-22
225 NORTH FIFTH STREET
SPRINGFIELD, ORE6ON ':\1411
CNc.INEERING DIVISION
Ofi'ICE NO. 126-3153
IN5P::CTION L1N::, 126-316':\
RESIDENTIAL -
.
COMMERCIAL
1100
51DEWALK I CURBCUT .
AF'PLlCA TION I P::RMIT
SPRINGFIELD
JOB ADDRES5, I / ~ () L <( J1I/ P / c...
-'-S5::550RS MAP NO.*' J 7 6:>;, 2-1 4/
5U3DIVI510N,
REC::!:"T NO, /1f'v//
T-'-X LOT NO: *070"
CASH
CH::C<
~
O.:N::R, \--\ J>.<S c.. A
ADDRE'55, ~Ob W.
5TA,=, DR-.
ll.IC>R< DE5CRIFTICN,
5!D~K, ~
r::;;A/e\/~
ZIP, q1Lf7J
CITY, ~etd..b!.(q:;JIr-'-1?
P~ON= NO.
'/;
,,- . - - -, .., ,-' /
CT"'!:Ci<ED :-OR D:...JNQ...::NC,=5 _
CURS 51::>:
=EBACK
CURa-CUT:
~51D:N7IAL _
CO,-r.-ERICAL
5ECOND DRIY::WA Y I 5:::: TRAfT'IC )
RE'OUIRE5 APFLICATlo--I rOR A S:C= DRIY::WA':'/rr-4.1.)
OR A COJNT'( t.PPLICATlo--I rOR rACILlTY PE'RMIT IC ':l8-203)
Ir IN THE U.G.3.
DA 7:::
fJJJ.-K:..
- In - U--9S
;:lA,= or AF':='L1CATlo--I
rA/uhs
.SIG~::;:
lLOR< TO BE PERrv"", leD BY,
Oi.l.N.:R
t../' CONTRACiOR
*'
RE'C:15TRATION NO. ~"11
::X;='I;<::5, ?2/ / '7t,
CONTRACTOR*' &-1 tJ~oJ..l CbJ.J5'7l.U""t?ON
A9DRE55 -t.,q M4- e, pfJZ;art' .erl
r-~"'e....URE FOR lN5A:CTICN REGlUE5T:
CALL 126-316':\ lRECORD::R) 5TA,= YOUR CIT'( D::51C:~T::D J03 !'-/J:-1=::R, J09 A9DRE55,TYP:: or
1N5PECTI0l\I REQUESTED At...lD ~EN YOJ WILL 9: ~.AD"'" FOR rN5PEcTl~, CONTRACTORS O~ Ot:..NERS Nt..:--:= .l..'ID
P>-IONE NU1'1=::R. REOU::5T5 R::CEIVED 9=c~r= 1,00 :""1 WILL 9:: MADE THE SAME DAY, R::OJE5TS :"=,=R 1,00
,0.."1 WILL BE MADE THE NEXT UOR<.ING DAY
P.....O~=: ~/ -~.c::O;?
Exr5TI~ 5:1IUJING: PERMIT NO. ( IF APPLICABLE)
'" 5EE BOOK
YOU~ ClrT" DE51GNAlED JOB NO. Isf
9.5"/Oh'l
REQUIRED lN5PECTION5
G--;IDEWALK I DRIVEWAY
FOR ALL CONCR::TE PAVING WITHIN
THE 5TR::ET RIC:~T or WAY, TO 9E
M.4D= ,l.FiER ALL EXCAVATING:
IS COi'1FLETE AND r=ORM l1.k:>~
A~D SUB-BASE MATERIAL IS
IN PLACE
D
._ CURS I APPROACH APRe:
AFTER ~S ARE ER.:C7:
BUT PRIOR TO PO"RIN6
CONCRETE.
FEE5:
SIDEWALKS
~1@.@@ + ~0.15/LF. ( X )
OF WALK
CURB-CUT
TOTAL PERMIT FEE,
s
!f
COMMERICAL DRIVEWAYS SHALL
HAVE 5' TO 8' FLAIR5
3'- O' 5TA"DARD
UJALi< X'
/ ""
I. X' J
.,
~1@.@@ + l-0.15/LF. ( X )
.' (
I :-lAVE .CAREA.JLL Y EXA~JNE:D TJ-JE COMPLETED AF'PLICA7iON FOR F'E~IT. ,.~...".JD DO l-lEREe.,.. CE::<::ilr=y 7t--:t.T ALL
IN""rO~ATION I-IEREON IS TRlJE A~D CORRECT, A'ID I FURT;";~R: CERTIFY T~AT A"lY ,j."'D AlL ll.OR<: PE~O~ED
5;-IALL 9E DONE IN ACCQRDA"CE WITH THE ORDN-'-"CE5 or THE CIT'( or 5PRI"-lC:FIELD, AND T;..IE LAI1I5 or THE
5TATE or OR::GON PERTAINING TO THE WORK DE5CRI9ED I-iER::I"-l, A"D THAT NO OCClJPA"CY WILL 9E M-'-DE
or: ASY STF11CTU~ llJITHOJT PER:"'1JSSIOO OF Tl-lE 9U1LD!N(; DrVISIOt.t. I FuR,~=R CERTIF'T" 7f.4..lT o-.:L Y COSTRACTO~5
,"-ND EMPLOYEES WI-IO ARE IN COMPLlA"CE WITH ORS 101J2>55 WILL BE U5::D ON THI5 PROJECT.
51C:NED
DATE