HomeMy WebLinkAboutPermit Sidewalk 1992-5-7
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22S NORT~ FIFT~ STFCEET
SPRINGFIELD, OREGON ~1411
ENGINEERING DIVISION
OFFICE NO, 126-31S3
INSPECTION LIN!:, 126-316~
.
SIDEWALK I CUR5CUT
APPLICATIoN I PER1IT
..
JOB ADDP<Ee&. , 0.1) 3 0 I "/Yl p, r.
ASSESSO~ MAP .'10.* / 7 -O.J ~Z ~ - -I I
SUBDIVISION, }(;.~/'I1"tj' 5 / 5..T Aid
ou.NERo fJ//,;{an ~11"r/(' St-/d,....n~
ADDRESS, ID 5" J () 14 fY1 PI L
STATE. 6((. ZIP, 97 If 7 7
RECEIPT NO.
1-5' 7 7
'*
TAX LOT NO. /O/JoS"
C~
C~ECK L
clm .sIP F D .
~ONE NO.
*
~ECKED FOR DELINQUENCIES _
U.iOI"iK DEecRlPTIONs
SIDEUJALK,...JS- CURS SIDE _
CURB-CUT, RESIDENTIAL _
SECOND DRIVEWAY (SEE TRAfFIC)
REQUIRES APPLICATION FOR A SECOND DRIVEWAY("T-4.1.)
OR A COJNT'( APPLICATION FOR FACILITY PER:1IT (C ~-2"3)
IF IN ~ U.Go.e.
SETeACK ---A--
co:1MERICAL _
DATE OF APPLICATION S--1.-'i7..-
SIGNED, ~ttd/~d___
,-7- c?:z..-
DATEs
UJORK TO BE F'E~ I~D BY,
ou.NER
>(
CONTRACTOR
.'10.* $'Sb2.Z
EXPIRES, 10 - , P,-c, L
PI-lONE, Y F?!:-7'f 7 <:;
CONTRACTOR'*' .)eJlQtJn'In.,,,,,/.. TAJ TEJf'P4'lx,REGISTRATION
ADDRESS 32. Cj 7 I 'K a nmt 'S C t'
.-.-...~.Jf<E FOR IN&FECTION !'<SGlUE5T.
CALL 126-316~ (RECORDER) STATE YOUR CITY DESIGNATED JOB NUM5ER, J05 ADDRESS,TYPE OF
INSPECTION REQUESTED AND IIA-IEN YOU WILL BE READY FOR INSPECTION, CONTRACTO~ OR ou.NERS NAME A'ID
~ NUM5ER REQUESTS RECEIVED B"r~>= 1.= AM WILL 5E MADE THE SAME DAY, REQUESTS AFTER 1,=
AM WILL BE MADE THE N!:XT WORKING DAY
'* SEE BOOK
EXISTING BUILDING PER11T NO. ( IF APPLICABLE)
YOUR CITY DESIGNATED J05 NO. Isf 12.. C? 6 7 C
!'<SQUIRED IN~CTIONS
w
SIDEWALK I DRIVEWAY
FOR ALL CONCRETE PAVIN'" WIT~IN
THE STREET RIGHT OF WAY, TO 5E
MADE AFTER ALL EXCAVATING
IS COMPLETE A'ID FOR:1 WORK
AND SUB-BASE MATERIAL IS
IN PLACE
D
CURS I AF'l"ROAC~ APRON.
AFTER FOR:1S ARE ERECTED
BUT PRIOR TO POURING
CONCRETE.
FEES. SIDEWALKS CURe-CUT WALK x'
.10.00 + ~.I5/LF. ( X ) .10.00 + .o.l5/LF. ( X ) / '\
OF WALK
COMMERICAL DRIVEWAYS SHALL l X' I.
-0 HAVE !>' TO 8' FLAIRS
~ 3'- 0" ST "-'1::lARD ., ,
TOTAL FEF<t1IT FEE. / /, ..l_
I ;..lAVE CAREFULLY EX"-"'IN!:D THE CqMPLETED APPLICATION FOR PER1IT, ':"'1D DO I-IEREBY CERTIFY TI-IAT ALL
1N,=OR:1ATION HEREON IS TRUE A'ID CORRECT, A'ID I FURTI--1ER CERTIFY THAT A'iY AND ALL u.:oRK PERFOR:1ED
S;..IALL BE DONE IN ACCORDANCE WIT~ THE ORDINA'ICES OF THE CITY OF SPRINGFIELD. ':''iD T;..!E LAl:JS OF THE
STATE OF OREGON PERTAINING TO THE WORK DE5CRI5ED HEREiN, A'iD T;..IAT NO OCCUPA'iCY WILL 5E M"'-DE
OF ANY STRJCTURE WITHOUT PER:1ISSION OF THE BUILDING DIVISION. I FURTHER CERTIFY 7HAT ONLY CONTRACTORS
AU; 77Z2R5 101D!>!> WilL 5E USED ON THIS ;J~C; _ 7 L-
5!GNED C/ DAlE