HomeMy WebLinkAboutPermit Sidewalk 2010-3-26
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. h<.: I;"DRWEWAY/SIDEWALK ..' .';..'~' PERMIT APPLICATION :".+,i-:~
225 FIFTH STREET .~':" ~
SPRINGFIELD. OREGON 97477 .~.
ENGINEERING DIV1SION
OFFICE TELEPHONE (503) 726.3753 ~
APPLICATION DATE: :rOliPr J-.o]V
PERMIT NUMBER: trm...~JO - 00 ;Jf<::;
DATE ISSUED: '3 - d Co" ~l 0
SITE INFORMATION:
LOCATION OF WORK, c2. I :, (,oj' U ,a.... i'-7'V\. (
~.~5>
otic:, lU ~........"...' .J)
DeL
APPUCANT
PHONE
54/- 741- 3'707)
ADDRESS:
TAX MAP:
OTY -2f-frJ
SUBOlVlSION: .
STATE:
ZIP:
0(141 ~
TAX lOT:
ONNER:
ADORESS:
PHONE:
CITY:
STATE:
ZIP:
REQUESTED PERMITS:
o SIDEWALK: .,....................... ..................
AMOUNT OF SIDEWAlK IN EXCESS OF 90FT.
$88.00 ......................
@$O.OB SF.
. $15.50 .................
.. =$
=$
......... =$
~::::::::~~:...~~~~~~.~;.~~;~EWAYS_ X
... $88.00 1st Cut = $
1,."t.
-
o MULTIPLE PERMITDISCOUNT EA: .. .......(MAX2) ...........................$30.00 2nd Cut =U'
(MUL 11 PERMIT DISCOUNT GOOD FDA ONE sITE AND ONE SITE INSPECllON...ill:lLY
APPUES TO 2nd AND 3rd PERMITS ONLY. NOT SIDEWALK REPAIFlJ. =$
Q/5% Tecl1nala9Y Fee $ l( '+-0 TOTAL DUE WITH PERMIT $ qd ' cj.o
o PROOF OF INSURANCE: $500.000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
CONTRACTOR INFORMATION:
CONTRACTOR:
OU.J\A..QJl...
ADDRESS:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERVISOR:
PHONE:
EXPIRATION DATE:
PHONE
INSPECTIONS:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE. ,AfTER THE PROPOSED WORK HAS BEEN FO RMED AND MADE READYTO
POUR.'CURB CUT AND SIDEWAlK INSPECTlONS CAlL 726-3769 (RECORDER) STATE YOUR OESIGINATED CITY JOB
NUMBER/PERMIT NUMBER, JOB ADDRESS, IYPE OF INSPECTION REQUESTED, AND Vv'HEN YOU WILL BE READV FOR INS PECTlON. CONl'RACTOR'S OR
OWNER'S NAME AND PHONE NUMBER. REOUESTS RECElVED 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 FOAM WORK IS IN PLACE BUT PAIOR TO POURING CONCRETE.
Single driveways serving'single -family and duplex dwellings shall
be paved for the first 18 feet when abutting a curb and gutter. 4.2-2(3)
You are required to call utility notification center "one call number" 811 before digging
SIGNATURE:
AMOUNT RECEIVED:
$, '7), 'f-G
1)-010-':"(,'5
DATE PAID:
RECENED BY;
3-~G-/O
J-.-~'
RECEIPT NO:
and ~~~~a~~~'II~~~~ ~~W~\ ~at ~~:II~~~UI~~~~~~h~lebc;xJ~:I~da~~a~~ ~~ d~~b[~~a:;~~lyojhat aU lnformaUon he-ein is true
the Olv of Springfield, applicable Cill ~8ndard speCl~cations and Dra'Mnqs. and the laws o( the Slale 01 Oregon pertaining 10 !he work described herein. I fumier
certify [hal.only contractors and empoyees who are in compliance 'Nilh ORS 701.055 will be used
OFlthisproled. . .
The Oty may il1specllhe work s~e described in this permil at any lime during a cne year period 10 nowing the receipt by the City 01 noflee 01 com~e!ion ollhe
d.escribed work and SPe9Iy, althe City's sole discretion any additional. restoration work reqwred 10 return the site 10 a standard aecep'!able to lhe Ci . The
permillee wilt be notined In wflting 01 any work required 8nd 'Mil have thirty days (30) Irom the date ollne l10llee 10 complele the work Work not camp eled allhe end
of Ihe Ih.irty days witt be per1ormeo by ttie City and the cosls witt be billed to llie perrruttee. .
I lurther agree to ensure lhal aU required irispecl10ns are requesled at the proper time 'lhat proi eel addess is readable from the _
~:gn::' 'P~Md '" 01 pl=' com"o", ':. ,no ".,""" 'w09 c~"rucuooS r5- ~I t/?.D/[J
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Iirii
~~~"""''''",'",,,.''-
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000265
Date: 03/26/2010
2:58:39PM
Job/Journal Number
COM20 I 0-00315
COM20 I 0-00315
Payments:
Type of Payment
Cash
cRcceiotl
Description
Curbcut Pennit
+ 5% Technology Fee
Paid By
ANTONIO CAMPOS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
88.00
4.40
$92.40
Amount Paid
Ikw
$92 .40
$92.40
In Person
Payment Total:
I., ,\'."
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3/26/2010