HomeMy WebLinkAboutPermit Plumbing 1998-4-3
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-COM~ ERCIAL/I N DUSTRIAL
PERMIT APPLICATION
.:
~
JOB NUMBER Q.:!l2'&,:;:JR':2
INSPECTION LINE: 726.3769
OFFICE: 726.3759
225 Fifth Street, Springfield, Oregon 97477
LOCATION OF PROPOSED WORK: ,,1"3,16 f')~~
ASSESSORS MAP: / ?'.:f>'<- 3e9.:;r ~
OWNER:
ADDRE~'"
CITY:
TAX LOT' c!'~ -::>.:::::>.:::5
M&/r""'~ "J., tit ~ '5 vt1 'L-'
'":? -:;>~ "5" G'~ s;.-~ ~ C
. 4pp~_
- /" ,
PHONE: .:J..tfl-
."'i;!f.cJ% ~
,.
,
~.?'-? .
ZIP:
~>~~
STAT'"
DESCRIPTION OF WORK: .:L -(J~ If' .S.-C""""')
NEW 7REMODEL. ' ADDITION
CONTRACTOR'S NAME
GENERAl' .. It--{
,
, ~L~~RICAI'
t'
I
I NO,
I
I
I
I
I ,. Storm Sewer
(. 5e 3<1 /3 cJ
I
I
I
I
I
I
I TOTAL PERMIT
ARCHITECT'
PLUMBING'
MECHANICA' .
OUAD AREA'
'.01' BLDGS'
OCCY GROUP'
.. OF STORIE'"
:5.;" 4-<. j e::
..;21{ Q..,..... J4y ~,~ q;
W (-"BaA..<- . .
OTH{R VALUE: . ,tAt)
or 0/::;/1 ~..-....~ '
PHONE
OEMOllSH
NAME
ADDRESS
11 . ADDRESS
N~ 0t1..-& L I
I
V
CON ST.
CONTRACTOR'
(}-o9?;J'7;L
EXPIRES PHONE
7'-,/9-9$ \/tS""- 'Id q.;l.
PLUMBING
M"CH4NICAI
FEE
Nn ~i=~
("I-I.o.R~j:
CHARGE
Single Fixture
Relocated Bld9.
(new fix. addtll
Water ServIce
Furnace/burner & vent
< 100.000 BTUs
Furnace/burner & vent
> 100.000 BTUs
Floor furnace and vent
Suspended wall or floor
mounted unit heater
Appliance Vent
separate
Stationary evap.
cooler
Vent Fan/Single
duct
Vent System aparl
from AC or hlg.
Mechanical exhaust
hood and duct
Sanitary Sewer
ft.
ft.
II.
t./~
Backflow Device
Permit Issuance
$10.00
TOTAL PERMIT
,~,
- OFFICE USE -
HANDICAP ACCESS:
LAND USo.
FLOOD PLAIN'
. OF UNIT'"
ZONING'
LIGHTING POWER BUDGET:
WATER HEATER:
CONSTR. TYPF'
HEAT SOURCo,
SO. FT.
$/SO. FT.
VALUE
SO. FTG MAIN
SO. FTG ACCES~
x
x
SO. FTG OTHER
x
TOTAL VALUE OF,PROJECT
PLAN CHECK FE.E_~Y "5'~
I BUilDING PERMIT
15% Slate
SurcharQe
I MECHANICAL
15 % Stat.e
SurcharQe
I PAVING I G.B. ~
RCPT'
DATF
BY
, PLUMBING
~~. ..0
~ .pI?
/. '20
. DEMOLITION
5% State
SurcharQe
FENCE
VALUE $
SIDEWALK
~'
SUBTOTAL
I PERM ITS
" . SYSTEMS
...., , DEVELOPMENT
/ 11.70
,99~."
FT.
CURBCUT
FT.
TOTAL PERMIT FEES I
EXCLUDING ELECTRICAl
/1~.$!7
.
REQUIRED INSPECTIONS
.
.
It Is the responsibility of the permit holder to see that all Inspections are made at the proper time. To request an Inspect;on, call
726.3769 (recorder), state your City designated Job number, job address, type of Inspection requested and when you will be reaoy
for InspectIon. Requests received before 7:00 a.m. will be made the same working day, requests made after 7:00 a.m. will be made
the lollowlng work day.
SITE INSPECTION: To be
made after excavation, but
prior to setup of forms.
UNDERSLAB PLUMBING,
ELECTRICAL &
MECHANICAL: To be made
before any work Is covered.
ROUGH PLUMBING,
ELECTRICAL &
MECHANICAL: No work Is to
be covered until these
inspections have been made
and approved.
v
PAVING: After gravel Is In
place but prior to placing
asphalt or concrete.
FOOTINGS & FOUNDATIONS:
To be made after trenches are
excavated and forms are
erected, all steel in place, but
prior to placing concrete.
FiREPLACE: Prior to placing
facIng materials and before
framing Inspection.
FRAMING: To be made after
the rool, all framing, fire
blocking and bracing are In
place and all pi pes, chimneys
and vents are complete and
the rough electrical, plumbing
and mechanical are approved.
SPECIAL INSPECTIONS: In accordance
Section 306 of the State Specialty Code
a special Inspector'shall be employed
by the Ownerl Contractor during
construction of the following work. A
copy of the special testing reports shall
be lurnlshed to the Building Division.
ATTIC DRAFT STOPS &
CURTAIN WALLS
STRUCTURAL CONCRETE: In
excess of 2500 PS.1. (306 a.1)
CONCRETE SLAB: To be
made after all Inslab building
service equipment, conduit,
piping, accessories and other
ancillary equipment Items are
In place but before any
concrete Is placed.
/ UNDERGROUND: Plumbing,
electrlcall gas, sanitary sewer,
<"St't>rm sewe1;)water and
draInage lines. To be made
prior to covering or filling
trenches.
STRUCTURAL WELDS:
Performed on the job. (2722 f)
iNSULATION & VAPOR
BARRIER: To be made after all
Insulation and required vapor
barriers are In place but
before any lath or gypsum
board Interior wall cove~[ng Is
applied.
HIGH STRENGTH BOLTING:
During all bolt installation and
tightening operations. (306
a.6)
SPRAYED ON
FIREPROOFING: UB.C.
Standards 43.B.
UNDERFLOOR: Plumbing,
electrical, mechanical. To be
made prior to Installation of
floor Insulatlon, decking or
floor sheathing.
FIRE & SEPARATION WALL:
Located and constructed
according to plans.
SPECIAL GRADING,
EXCAVATION AND FILLING:
During earthwork. (306 a.11 &
Chapter 29)
POST & BEAM: To be made
prior to Installatlon of floor
Insulation, decking or floor
sheathing.
LATH AND/OR GYPSUM
BOARD: To be made after all
lathing and gypsum board,
Interior and exterior, is in
place but before any
plastering Is applied or before
gypsum board Joints and
fasteners are taped and
finished.
GLU.LAM BEAMS: Inspection
Certificate by an approved
agency, furnished to the City's
Building Division belore
beams are placed. (2501 U.B.:::.
STDS. 25.10,11).
FLOOR INSULATION &
VAPOR BARRIERS: To be
made prior to Installation of
decking or floor sheathing.
STRUCTURAL MASONRY: (306
a.7)
MASONRY: Steel location,
bond be~ms groutlng or
vertlcals ln accordance with
UBC 2415.
SIDEWALK & DRIVEWAY:
Requ I red for all concrete
paving within street right of
way, to be made after all
excavatlng complete and form
work and sub-base material In
place.
*In addition to the Inspec-
tions specified, the Building
Official may make or require
other Inspections of any
construction work to ensure
compliance with the Building,
City or Development Code.
ROOF SHEATHING AND
NAILING: Prior to Installing
any roof covering.
CURB AND APPROACH
APRONS: After forms are
erected but prior to placing
concrete.
--Y-FINAL~UMBING---------- Y--SITE~LAN~EVIEW~OARD:Mus~~requ:te;~ay~~:::~
of the date you wish inspectlon. All project conditIons such as
landscaping, parkIng lot striping, etc. must be completed before
re~~ thls).'speCtlo?;;
r FI~~{" B'UIL~f:1(~est:f~;he final plumbing, electrical,
mechanical and Fire Department Inspections are made and
approved. No occupancy of the premises can be made until a
Certificate of Occupancy has been Issued by the Building DivisIon
and posted on the premises.
FINAL ELECTRICAL
FINAL MECHANICAL
FINAL FIRE DEPARTMENT
ADDITIONAL COMMENTS'
PLANS REVIEWED BY ,..-----~~
''?-
DATF
0-/-,96
By signature, I state and agree, that I have carefully examined the completed application and 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
01 the City of Springfield, and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY
will be made of any structure without permission of the BuildIng Safety DivIsIon, I further certify that only contractors and employees
who are In compliance with ORS 701.055 will be used on this project.
I further agree to ensure~ha t:!qu r nspectlons are requested at the proper time, that project address Is readable from the
street, that the perm t c s ed a the front of the property. and the approved set of plans WIII;;?;emaln~the seat al/
times durIng co .
Slgnatur~ t& .- /-"'_ Date ~/ C;J'ff
- / F /?"/ - 1/
VALlDATI~j ? ~M~T RECEIVED: .ill /~ 2. ,..!l.,? DATE PAID: ~- 3! '? 8'
RECEIPT ': ~~ ;o,~l RECEIVED BY' ~
.
. JOB NO. /'m j9.;l
ATTACHMENT A
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE'
WORKSHEET
NAME OR COMPANY: ~~/0 -/"15 I~
LOCATION: :JJ~;} DI/hv4; '(~
'/ i.
DEVELOPMENT TYPE: ft~ k. M Lo f !lv /;.-4
(Jf
BUILDING SIZE: lOT SIZE SQ. Ft.
1. STORM DRAINAGE #6I<J /~e~HU- - (30Y'1'o) f- {I;t~ ><~ = ~..200
L/ '';?''
IMPERV IOUS SQ. FT. / . ;UJD X $0.226 PER SQ. FT. $ 9 r9 -
2. SANITARY SEWER.CITY
NO. OF PFU'S
(See Reverse Side)
X $46.86 PER PFU
$
3. TRANSPORTATION
'NO OF UNITS X TRIP RATE X.COST PER TRIP
X
X $472 49
$
X
X $472. 49 .
$
X
X $472.49
$
4. S8NrrARY SFWFR.MWMr
NO. OF FEU'S
. X
PER FEU + $10 MWMC/ADM' FEE $
. MWMC CREDIT IF APPLICABLE (SEE REVERSE)
$
TOTAL-MWMr. SDC
$
"Rd
$ 999-
SUBTOTAL (ADD ITEMS 1.2,3 & 4)
5. 8ill1TNTSTRATTVF FFFS
'. .
$ 7"7 '1" .
BASE CHARGE (SUBTOTAL A80VE) X .05
r 1/0 .'
/ s~rdi nator .'
Date: 10~.
C,r;
TOTAl SDC $ . CJf&;,~
. rl^ I vna.:; Villi I I"HLI"VL+III I HOLt:: Number 01 New t'ixtur. Unit t:qulvalent = Fixture Units
(NOTE: For remodels, caiculate only the NET additional fixtures) . ..
NUMBER OF UNIT FIXTURE
FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS
Bathtub,..,....,.....",:,.....,..,....................,......,...,......... .
Drinking. Fountain.....,........,......................,........",.,..
Floor Drain...,..:....",...,..",.,.,. .......,. "......,..',..,.,.".,.... .
Interceptors For Grease/Oil/Solids/Etc.................
Interceptors For Sand/Auto Wash/Etc..................
Laundry Tub/Clotheswasher...........,........,.....".......
Clotheswasher. 3 Or More.................,....................
Mobile Home Park Trap (1 Per Trailer)..,......,........
Receptor For Refrigerator/Water Station/Eic........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single StalL..........,.....................................
Shower, Gang............,..,....:.....,.".,."...,., ,..,.."..., ,...,
Sink: Bar, Commercial, Residential Kitchen........,.........,......
. Urinal, Stall/Wall..""..,....:.,.,. ...,. ,......,.......,..,............
Wash Basin/Lavatory, Single.........:.................,......
Toilet, Public Installation........ ... .......,..,...,......,..,....
Toilet, Private..........,............. ...:.......,............,.,..,.
Miscellaneous:
TOTAL FIXTURE UNITS
2
1
2
3
6
2
6
6
1
3
2
l/Head
2
2
1
6
4
=
CREDIT CALCULATION TABLE: Based on assessed value, If improvements occurred after annexation date in table,
calculate credits separates.
Year
Annexed
Rate per $1,000
Assessed Value
Year
Annexed
1979 or before
1980
1981
,1982
1983'
1984
1985
1986
$3.97
3.89
3.83
3.70
3.55
3,39
3,20
2.91
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
Credit for Parcel or Land Only If Applicable
X $
(Rate X Assessed Value)
X $
(Rate X Assessed Value)
.'
Improvement (if after annexation date)
=
=
CREDIT TOTAL = $
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
(For Estimating Purposes Only)
. Residential...:....,..............;... 0.4
CommericaL,...........,........... 0.9
Indusirial............,............... 05
GovernmentaL..................... 0.5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
Rate per $1,000
Assessed Value
$2.56
2.17
1.73
1.31
0.92
0.74
. 0.61
0.45
0.31
0.17
,
!I
.226 F!l'TH'S"'REET
SPRING'IELD. OREGON 97477
ENGINEERING DIVISION
O'FFICE TELEPHONE (503) 726-3753
~
ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER:~ ~~.
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE '
APPLICATION DATE: f-36.-9/
"
DATE ISSUED:
,LOCATION OF WORK
APPLICANT I ~.k,,'-IA ,J C,,,,...rt
SITE ADDRESS: ~ =n q 6 () L..-:::;~;'-,
CITY: ~, STATE: r1~..."",^-
SUBDIVISI61'l ./
OWNER: . ~.#"H /"u..::. ';'~A( .
ADDRESS: CITY:
CONTRACTOR: J/--,-,.wr:,~ ADDRESS:
CONTRACTOR REGISTRATION NO: .5 9'9' c:;;!
PROJECT SUPERVISOR: tJ\ l:fIX. . ?'? t, '7CJ
,PHONE
q<.t'J-.'2 J'ltjO
, TAX MAP: I:/...p,z ~- ~ C,-! .
TAX LOT: b>?7~
ZIP:
.PHONE:
STATE:
,"-97~{~-",_-(}.(... ~cl.
v ..
EXPIRATION .DA TE:
7""'/.3~
ZIP:
PHONE: 99D ;1{/fjo
. €fo.3-of'CL
REQUESTED PERMITS: .....CTIONS..llUIJWl,
o ENCROACHMENT PERMIT NO: ........,............,......:,;t. I
VALID FOR SIXTV leal DAYS FROM DATI 0' ISIUAHCI
Q CUT STREET Q BORE Q OTHER 0
Q DUST CONTROL (TYPE OF CONTROU
Q CONSTRUCTION. STORAOe. STAOING nO.
Q~~ '.n. O.
~PHAL T DEPOSiT........................,................................................................................... O.
TVP~ n~ .c:~r.1 IRITY DEPOSIT
Q BLANKET SURETY BOND Q SURIITY BOND Q CASH / CHECK 0 .
PHONE:
AmJeATlOH FE! IOEl'OSrr
ACCOUNT NO:
o $20.00 /
Ot
o CURB CUT PERMIT NO: .................... FT._. 0
lN~u.M1nN. CURB I "rPROACH AFT!R FORMa ARI WCTED BUT M.UR TO POURlNQ CONCAErl.
. VALl) FOR 110 DAn FROM DATI 0' ISSUANt!.
Q SECOND DRIVEWAY CSEE SEPARATCAPPUCATlONl
a SIDEWALK PERMIT NO:.................... FT.
VALID FOR 110 DAYS FROM DATI 0' ISSUANCI.
Q NEW 0 REMOVE I REPAIR 0 PAVE PLANT STRIP
Q'SETBACK Q CURBSIDE Q LENGTH
."'!l:PI"/"'Tll"l..... RIOEWAlK I DRIVEWAV FOR AU. CONCMTI PAYINQ WITHIN THE STREIT RJOHT 0' WAY, TO BE
MADI A"ER ALL lXCAVATINQ IS COMPLfTI, AND FORM WORK AND IUI-BASI MATtRIA1.IS IN .-uCl.
o SANITARY sewER CONNECTION PERMIT:................n
VALl) FOR IIXTY ,aOI DAya FROM OAT! OP ISSUANCe:
o TO STUB 0 MAIN UNE CEASEMENT-R/Wl Q OTHER
o STORM SewER CONNECTION PERMIT: ....................Ii"
v~ ~ SOOV lSOI DAY' PROM DATI OP ISSUANCI
JjjftATCH BASIN I BUBSLEII Q STUB 0 MAINUNE
PROO~ OF INSIIRANCE' 1500,000 MINIMUM
. Q ATTACHED Q REQUIRED AMOUNT
o tl0.00H.16/FT.
n
o tl0.00:fot.16/FT,
o $6,0'0/.
~
DESCRIPTION OF PROJECT:
TOTAL DUE: .
TOTAL DUE WITH PERMIT .
PERIOD OF USE OR TIME OF CONSTRUCTION:
o PLANS (TWO SETS) ATTACHED
AREA: LENGTH:
TYPE OF WORK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEI'v1ENT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UTI~IZED:
NAME OF'OTHER UTILITIES IF THIS IS A JOINT PROJECT:
WARNING DEVICES TO BE UTILIZED: .... .
Advlnc' .5gnfng ,nd work lon' protlctJon to bel" oompll.nc. wit., tne M.nual on Uniform TIIU!c Control CIvic.. (MUTeDI.
"') - (I. ~ X ('r;~ ,57:;......., A......~ <I'lL :r;:t;,.".// .
,
FROM DATE: ..s; - :27- 1./ -:1 7
TO DATE:
WIDTH:
DEPTH:
TIME:
TIME:
HEIGHT:
BORE:
BACKFILL MATERIAL:
DESCRIPTION:
J.d.;...,~
r./
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 6 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD .
ReVISIONS 1/241ll5 FORM , III '
,
I _
PLAN REVIEW COMMENTS I SPE~ INSTRUCT/ONS: . ...
RESTORA110N WORK SHALL BE IN CONaANCE WITH EXlS11NO CITY CODES ANdWt:bMPUANCE WITH CURRENT
STANDARD SPECIF/CA110NS, EXCEPT AS NOTED BELOW. . - r
- 001 Backfill with.. minus rock. - 019 Mlnumum 4' cl..ranCI Itlny point. Iwlng-.w.y. ..
. - -
.. 002 ComplCl.vlry lB"loo.. dlpth. _ 020 Concrltl minimum 4" dlpth. 3.0000.1.
.. 003 Rlqulro. completion with I .tlll rolll.., _ 021 Tranch to bl "T. out.
.. 004 A.C.to mltch thl grolt.. of Ixlstlng dlpth or 4". _ 022. Nlld. Stltll County plrmlt.
.. 00& All cutl ...lld lor IInlllnsplcilon. 023 No .bOYI ground Incloalng. In .Idlwllk 0' h.ndlc.p romp..
. OOB, Tlmpor.ry pitch m.y bl u..d It thllnd 01 th. dlY. :I- 024 Ollmond out A.C.ltoncrotl Vllul boxu to grad.,
.. 007 Slgnlng Ind Zon; protlctlon to comply with MUTCO 02& Fro.h 011 .Ign. I Gradld.
. 008 Cut concrete only on Icor, IIn.. or: cold lolntt. . 026 Comply with Amlrlc.n. with Oll.bllltl.. Act.
009 Sldlw.lke Ind drtVlwlYI min. 3.000pIL 027 COnctltl a1.bl. 72hrl. CUMg tlml, 4500p.l.
. -
010 Curbing mln 3,800pall No p.tchworl< 1..1 th.n 3'. _ 02B Concrotl Illbl raqulra Jolnt...1 mltlrlll,
r) 011 Milt min. requlrem.nll on curb Cutl. Spld. codl. 029 OrlvIWlY raqulr.. dOWllllv,ry lB".
. 012 Rutoro pl.nlld....... Spld. codl 208.3.05 030 Submlttralllc control pl.n prlor to Ixc.v.tlon.
. 013 Sp.c.to Boro I J.ck I No A.C. cutl. 031 NOllly Traffic OM.lon blloro IXClvaUpn,
. 014 MachanlClI compacting raqulred. 032 Cora drlll main IInl,lna.rt too. 2% min. grado,
. 018 No petchwork IIIOWld. 033 Mu.t comply with thl provl.lon. of ORS 757,541 to 757.871.
018 Lator.1 CutltO havI control dlnsltY 1111. 343 S" Clrcul.r hoII1H2D-VIC.
.
017 Cut. to bl polymorlzod crack ,,"lod 'or IlnollnspoCllon.
: ' 018 Mlnlnum 2- crushed rock ". mlnu..
.. . ,-...
.l.
-
Commonts:
.
t.
YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS 8EFORE DIGGING
l
INSPECTIONS:
'0
CURB CUT AND SIDEWALK INSPEC110NS CALL 728-3769 (RECORDER) STATE YOUR DESIGINATED CITY JOB
NUMBER/PERMIT 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 DAY, 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 WOFjK IS IN PLACE BUT PRIOR TO POURING CONCRETE,
o SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726-3761.
SIGNATURE:
AMOUNT RECEIVED:
RECEIPT NO:
.~ ;),5', -
d-'1.~d- I
l-
DATE PAID:
RECEIVED BY:
~-3-7g
-K,...J
By sign sture, I .tata and agraa\ that I have csrefully examlnad the complatad eppllcation and do hareby certify that all information
haraln Is trua snd correct, end further certify thaI any and all work peiformed shsll ba done In accordance With tha Ordinancas of the
. City of Springfield. epplicable City Standerd speclflcetlons and Drawlngshand tha laws of the State of Ore.ll,on partaining to tha work
described heraln. I further certify that only contractore end employeel w 0 are In compliance with ORS 701 ,056 will be usad on this
. project.
The City may inspect tha work site dascribed In thl. Ilermlt et;any time during a ona year period following the receipt by the City of
notico of. completion of the delcrlbed work and ,pac:!fy. at the City's 1010 desore'slon, any additional rostoretion work're~uired to
. return thr site to a standard acceptable to the City. Tile permittee will be notified In writing of any work required and will have thirty
'. dsy.130 Irom the date 01 the notice to complete the work. Work not completed at the enll of the thirty daYBwill be performed by the
City and the costs will ba billed to the permittee, .
. I furthor agree to ensure that I require pectlons are requtlsted at the proper time, that project address iB readable from the Btreet,
and.the approved se of P~I re!" n n the Bite at all times during construction. . , /
Slgnaturo _, -h/~, ~ Date 71//,ht
VALlDATIONf t./
a TRAFFIC REVIEWED BY:
o ENGINEERING REVIEWED BY:
a MAINTENANCE:
o PERMIT ISSUED BY:
/
,
DATE:
DATE:
DATE:
DATE:
. FOR "SIDEWALK AND CURB CUT PERMITS PLACE A COpy (COMPLETED) IN PERMIT ORA WER.
INSPECTION:
:. INSPECTION:
WORK IN PROGRESS
AT TIME OF COMPLETION:
ELEVENTH MONTH:
DEPOSIT RETURNED:
DATE:
DATE:
DATE:
DAT~:
DATE:
DATE:
,-