HomeMy WebLinkAboutPermit Curb Cut 1994-12-8
~IDENT~';;AL:-I c~~E'iIAL
AFPLlCATION I PER'1IT
!:/C?lO'
n5 NORT~ FIFT~ STREET
SPRINGFIELD. OREGON <;\141'
ENGINEERING DIVISION
OFFICE NO. 116-,15,
INSPECTION LINE, 116-,16<;\
JOB ADDR!;e5. / ~
ASSESSORS MAP NO,*
o IYMJ1'lr,
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1'1 ~tl, 2.1 <JI
SUBDIVISION,
OUNER, I-f A (. s A
ADDRESS, _:<nn I..A.J, Fair-v/e(1)
STATE, Qf,f.fr.nt.J tiP, q74T7
WORK DESCRIPTION:
DATE Of' AFPLICATION
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WORK TO BE FEF<R)RMED BY,
CONTRACTOR '*" Sf A To IJ
AD!:>RE55 :J.'fd<J1 -J(
COII.d, TYlc.:..
Ai~
PROCEDURE FOR IN&PECTION REQUEST.
RECEIPT NO,
'"*'
TAX LOT NO. 1~'1" ()
CASH
C~ECK
SPRINCFIELD
15/DQS
v'"
CITYSPh'tjf1clJ
PMOf\J.E NO.
C~ECKED FOR DELINaJENCIES* L..
[&
CUR9-CUT
110.00 . ~.I:;/L.F, ( X ) /&
CO:-1MERICAL DRIVEWAYS S"ALL
"AVE 5' TO 8' FLAIRS
3'~ O~ 5T,4.~OARD
DATE
-(ie.O'() /0'1:
/"Z../'8/q'-l
, I
EXPIRES,.?/;)./ /qS-
~t .,
PMONE, fiI2./ -OO~
CALL 116-316<;\ lREC=:R ) STATE YOUR CITY DESIGNAT:D JOS NW:-;S:R, JO:l A!:>DRESS.TYPE OF
INSPECTION REQ'JE57ED ,4.~D Uh1EN '(OU 1.:JILL 9: RE.4:;'Y FOR rN5PECTlo-..l. CONT~CiORS OR ou..NERS N.t...."""!E .l..~D
p~= Nl..lM9ER FCQ:.J:Si5 RECEIVED BEFOR: 1:0" ..!..""i WI!..L BE MA:i: r;";E S'!"""iE DAY, REaJESTS ..:.F~R 1:""
AM WILL :IE MADE T"E NEXT lOC>R<ING DAY
SEneAc.K _
CO:-1:'1ERICAL
SIGN:::'D:
DATE:
01.!Jx:R
'/..
CONTR.AC70R
SIDEUJALK, CURS SIDE _
CURS-CUT, ~ RESIDENTIAL _
SECOND DRIYEW,,"Y I 5:E TRA'TIC )
REaJIRES AFFLlCATION FOR A SECOND DRIVEWAYI.,.-4.1o)
OR A COUNTY ,l.,FPUCATlON FOR FACILITY P:R'11T IC '08-10,)
IF IN T1-lE U.c..s,
REGISTRt. TlON
*
NO. 0337/
97'1-02..
* SlOE soo.<
EXf5TtNU :=..~ILDtNC:J PERS'"'iIT ~O. ( IF ","PPUCASLE )
YOUR CITY D:SIG'iA7ED JO:l ~O, ,sf <141 tJ8~
SID:U!ALK I DRIVE!:!AY
FOR ALL CONCRETE PAYIr-.iG LUITr-IlN
T~: 5iREET RIG1-lT or= WAy. 70 9::
M.L.DE t.FTER .c.LL EXCAVt. TING
15 COi'1PLETE A~D FO~ WOR<
A~D 5Ue~!3t.5= Mt.. iER1AL 15
IN PLACE
REQUIRED INSPECTIONS
D
FEES.
SIDEWALKS
110,00 . !:2),I:;/LF, ( X )
OF I.!.JALK
TOTAL PERMIT FEE:
s /~.C;{)
El.XJ~p Oi€.P
I '
CURS I APPROAC~ APRON,
A,.,:R FOR'1S ARE ERECTED
BUT PRIOR TO POURING
CONCRETE,
WALK X'
/
J.
x'
""
t
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I i-lAVE CAREFULLY EX":""'1NE:D il-JE COMPLETED ..c..FPLICAilo-J FOR PE~ii. ,..:'."":0 DO i-lERE9Y CERTIFY 71-lt.T ':"LL
!NFOR'1ATlON ~EREON IS TR:.i: A'iD CORRECT, A'iD I FURT":R C:RTIFY ,"'" T "'NY A'iD "'LL "'DR< P:R'OR:'1:D
S"ALL BE DONE IN ACCORDANCE WlTfoI T~E ORDIN':''iCES OF TfoI: CITY Of' SPRINGFI:LD, .:.ND T"E LAI1'5 OF T"E
ST-'-TE Of' OREGON P:RT-'-INING TO T"E lOC>F<l< DESCRIS:D H:REIN, "''ID T"AT NO OCCUP-'-'iCY WILL S: M':'DE
OF "-NY STR'JCTURE WIT"OJT P:R'1ISSION OF T~E BUILDING DIVISIO'i, I Fl87"ER CERTIFY T"AT ONL Y CONTRACTORS
':''iD EMPLOYEES UJ;-IO ARE IN C~"'PLI-'-NCE WIT" ORS 101.o~5 WILL :IE USED ON T"IS PROJECT,
/ d-/~/ 95/
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SIGNED cr