HomeMy WebLinkAboutPermit Sidewalk 2010-6-29
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00848
ISSUED: 06/29/2010
APPLIED: 06/29/2010
EXPIRES: 12/29/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 6100 THURSTON RD
ASSESSOR'S PARCEL NO.: 1702342100400
Springfield TYPE OF WORK: Sidewalk
PROJECT DESCRIPTION: Sidewalk
TYPE OF USE: Repair
Commercial
Owner:
Address:
WILLAMALANE PARK & REC DIST
250 S 32ND ST
SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION I
Contractor Type
Contractor
License
Expiration Date Phone
BUILDING INFORMATION ~
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
#,of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
. Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
:'0 ,of L9t CO,verage:
Total:
Handicapped:-
, !."Compact: -,
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I PUBLIC IMPROVEMENTS II law reqti\re8 you to
Al II:" , ~N: O~egllo ..."'" Oregoo Utility
follow rules acfij~\OOU"l' l'Y~'es are set forth
Notification ce~6&I:~iDA.R 952-001-
in OAR 952-001- bta'n copies of the rules by
0090. You may 0 I ate' the telephone
'I "I r.;I ,.'," calling the cen~r. (~n uiility Notification
lid; ! I! ':" number for t~e r~~00_332-2344).
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
~,-iis 'PERMIT SHAll EXPIRE IF THE uation Descri
'THORIZED UNDER THIS PERMIT I
'MENCEn OR I~~BANDONED FO~ Per Sq Ft Square Footage
Description . lX\l~Q onstruction I ' I'
. C'r) DAY t-'tlil . or mu tip ler or Bid Amount
Value
Date Calculated
Paee I of 2
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CITY OF SPRINGFIELD
B,uilding/Combination Permit
PERMITNO: COM2010-00848
ISSUED: 06/29/2010
APPLIED: 06/29/2010
EXPIRES: 12/29/2010
VALUE:
,"
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
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.:...Litotal S<filue of Project
\1,..,
'''Fees Paid N
$4.40
$88.00
6/29/10
6/29/10
Receipt Number
3201000000000000341
3201000000000000341
Fee Description
+ 5% Technology Fee
Sidewalk Permit
Amount Paid
Date Paid
Total Amount Paid
$92.40
, -,' ~
I f.!an Revie~s I
I"~
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
LReO,~~~e~'Insoections ~
.,,"'-{.~ '4~_'
Sidewalk - Setback: After forms are erecte(j'I;'lkprio~"f~ placement of concrete.
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By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of 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 Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compli,mce with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during constructi . 0'_ ...1. .. ' "
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Date
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
3201000000000000341
Date: 06/29/2010
9:36:36AM
Job/Journal Number
COM20 I 0-00848
COM20 I 0-00848
Payments:
Type of Payment
CreditCard
cReceiotl
Description
Sidewalk Pennit
+ 5% Technology Fee
Paid By
WILLAMALANE
Item Total:
Check Number Authorization
Rec~ived By Batch Number Number How Received
Amount Due
88.00
4.40
$92.40
Amount Paid
Ikw
067606 In Person
Payment Total:
$92.40
$92.40
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Page I of I
6/29/20 I 0
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C':':," DRIVEWAY/SIDEWALK '. ',.,::.' :,PERMITAPPLlCATION . ',"'\~~~7~
225 FIFTH STREET -~~
SPRINGFIELD. OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753 PERMIT NUMBER:
APPLICATION DATE: (. '21- zc,IP DATE ISSUED:
SITE INFORMATION:
LOCATION OF WORK: '\'-' Vt2.-<..-t-O-V> P4~ Inl I'm T1t1, Vl s-to A D_ JJ
APPUCANT '\~~ .~~~~.&Iu..A""'''I~M"_ PHONE "';LJ [- f<,i -4DLI"1
ADDRESS: b Et:> -? _. ....., . TAX MAP:
aTt: 5Pl2.lr\1I-,AIi'UO STATE: t'Jt? ZIP: q"l-'-\":/-B TAX LOT: tv /4-
.
SUBDMSION:
OWNER: PHONE:
-
ADDRESS: aT(: STATE: ZIP:
REOUESTEO PERMITS:
,/,: . $88.00 ......................... ~ $ . '3'0, ---
(] SIDEWALK: .,.................. ........................ ,........,.................... ..,........
AMOUNT OF SIDEWAlK IN EXCESS OF 90fT. @$OOB SF. =$
0 SIDEWALK REPAIR:...................................,... ... ..... ....................... . $15.50 ........................... = $
0 CUR8 CUT/DRIVEWAY: NUM8ER OF DRIVEWAYS - x............ ......... $88.00 1stCut=$
0 MULTIPLE PERMIT DISCOUNT EA: .....c...(MAX 2) ...........................$30.00 2nd Cut ~$j' 1
(MULTI PERMIT DISCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECTlON..ill:lI...:i =$
~PPUES TO 2nd ANa 3rd PERMI~NL Y. NOT SIDEWALK REPAIR). '1d. Lf()
5% Technology Fee $ Lf-. TOTAL DUE WITH PERMIT $
o PROOF OF INSURANCE: $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
CONTRACTOR INFORMATION:
CONTRACTOR: \A ), u...AW\A l.#V~ ?.-<l'lVL j. '~IL.L PI'iT!Z.ILl
.
, PHONE;7&;-LtoY"f
ADDRESS: 2~O SOI}7!+- ?;z...N? 5.l2..R..lVI
CONTRACTOR AEG1STRA~~ NO: EXPIAATlONOATE:
PACUECTSUP~SOR: ~~ v ~ ':i2'iLC~.A . "
PHONE:
INSPECTIONS:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE. Af:TER THE PROPOSED WORK HAS BEEN FO RMED AND MADE READYTO
POUR. CURB CUT ANQ SIDEWAlK INSPECTIONS CALL 726-3769 (RECORDER) STATE YOUR OESIGINATED CITY JOB
NUMBER/PERM1T NUMBER. JOB ADDRESS, 1i'PE OF INSPECTION REQUESTED, mD WHEN YOU WILL BE READY fOR INS PECTlQN. CONTRACTOR'S OR
OWNER'S NAME AND PHONE NUMBER. REOUESTS RECENED BEFORE 7:00 A.M. WILL BE MADE THE
SAME DAY, REQUESTS AFTER 7:00A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE CAlLED IN
AFTER EXCAVATIONS ARE MADE AND FOAM WORK IS IN RACE BUT PRIOR TO POURING CONCRETE.
o 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: DATE PAID:
RECEIPT NO: RECEIVED BY:
By signalure. t slate and agee\ Ihall have careluRy examined the completed apprtcalion and do he reby certify thai aft inlormation herein is lfue
and correct and I further c~ fila a~ and an WOI'k ~ed()(med shan be done in accordance wlll1 Ihe Ordinances of
the Ci~ of Springfield. appfi Ie Cil~ landaId speC! lcalions and Dra.....;nw. and Ihe laws oIlhe Slate of Oregon perlaining 10 Ihe wcrk descibed herein. I further
certify al.only conlfaclors and emp oyees who aie In COOlpliance wilh 0 S 701.055 will be used
on IhlsplOjeCl. .
~e City may inspeclthe 'NOrk sile desCl'lbed in Ihis permit al any lime during a one year period 10 ROW'ing Ihe receipt by tl'1e City 01 nollee 01 corn~elion cllhe
descnbed Work and SPe9!Y. al the City's sole discretion any addillonal restoration work required 10 return Ihe sile 10 a slandard acceRlable to the Ci . The
perll1lnee will be no!ilied In writing of any WOO\ 'i:auired and will haye Ihirty days (30) Irom the dale 01 the notice to complete Ihe wa1<. Work not comp eted allhe end
of Ihe (hlrty days will be per10rmec by Ihe City an Ihe cosls win be billed 10 Ilia perTTl.ltlee. .
I further agree to ensure Ihat allleqyired inspections are r~uestad at the proper time. Ihat proj ect address is leadatie /rom the
streel. and the approved sa! 01 plans will remalf'l on Ihe sile at I timeJ:! dUling construc~on. .
SigmltlJl'e Dale
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