HomeMy WebLinkAboutPermit Sidewalk 1995-4-18
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::. ,.. reSIDENTIAL - COMMERCIAL
...., . SIDEWALK I CURBCUT ~
, '.- APPLICATION I FERt1IT ~
225 NORTH FIFTH STREET. .'
SPRINGFIELD. OREGON ~'411
ENGINEERING DIVISION .
on=lCE NO. '26~3153
INSPECTION LINE: 126-316<3
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SPRINGFIELD
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JOB ADDREe5: tf '7?~ P If I 6 t/, '
ASSESSORS MAP NO.* I, ~ b 1J.~ ~ 2... </3 TAX LOT NO: W6C
SUSDIVISION:
RECEIPT NO: If e;/760~
CA5l-1
CHECK
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STATE:
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4>?Lf "D~I.s'(
D~ ZIP: Of7l./7tI.
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CITY: tt;pf!..t.,NbR.JfzJL
PI-lONE NO'7/f 1-14;!rk
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CHECKED FOR DELINQUENCl:::S ~
O'J.NER:
ADDRESS:
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UJORK DESCRIPTION: ...
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SIDEWALK: ~ CUSS SID:::.
i CUR;3-CUT: ,/ RESIDENTIAL
i SECOND DRIVEWAY (SEE TRATTIC )
REQUIRES APFLICATlo--l FOR A SECOND DRIY:::WAy(rr.4.1a) ~
1/ R A COUNTY APPLICATION FOR FACILITY Pl::~IT (C ~.2lZl3) L? L
~ IN THE U.G5. -... . SIGNED: -P'Y
DATEOFAPeb.IC~o--l q-I'-fb ~_~-I~4S
X'" .~~F \. y ~--V- --.....-- -- ~ ~
WORK TO 6E FE~D 6)": Ou.N::R v' CONTRACTOR /"#2<1-
CONTRACTOR* ~..>()-t'S V tJ-(...U6..(/ fhl-(~ REGISTRATION No.*9~b73 :::XPIRES:
ADDRESS / 5'" q to /). Lo&..t2 Wo (li? /Z.U t5-E::U"1'" "'7 q.() <.t
5:::TBACK
CO~ERICAL
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REQUIRED 1N5~CTfON5
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eLl I 126-316<3 (RECORDER) STATE YOUR CITY D:::SIGNAT:::D J05 NUM5:::R, J05 ADDRESS,TYPE OF
INSPECTION REQUESTED A"JD Uh-IEN YOU WILL BE READY FOR INSPECTlo--l, CONTRACTORS OR OUNERS NAM::: A"JD
PI-!ONE NUM5ER REQU:::STS RECEIVED B:::FORE 1:00 AI"'! WILL BE MADE THE SAME DAY, REQUESTS AFTER 1:lZ>lZ>
AM WILL BE MADE THE NEXT WOR<.ING DAY tJ~~t7
EXISTING BUILDING PE~IT ~ICABLE )
YOUR CITY DESIGNATED J'a NO. Isf 9'.~6c.,tP0 )
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SIDEWALK I DRIVEWAY f /:-~ I Arrro:.OACH APRON
FOR ALL CONCRETE PAVING WITI-lIN V AFTER FORt1S ARE ERECTE
THE STREET RIGHT or: WAY, TO 5E BUT PRIOR TO PO;.JRING
MADE AC=TER ALL EXCAVATING CONCRETE.
IS COMPLETE AND FORt1 WORK
AND SUB-BASE MATERIAL IS
IN PLACE
* SEE &>oK.
FEE5:
51DEWALK5
CURB-CUT
WALK X'
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OF WALK /()..I(../>.,./. ~c) ~(O
TOTAL FERMIT FEE:
~ 2h. 6 D
~1@.@@ + Y.2?.15/LF. ( X )
=:1(.fO /O~ .If"::: '.1 ~i~~
COMMERICAL DRIVEWAYS SHALL
HAVE 5' TO 8' FLAIRS
3'- lZl" ST A"JDARD
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I I-lAVE .c.i.REt-LJLL Y EXA"1IN:D T~E COMPLETED AFPLICATION FOR PERMIT, A"JD DO HEREBY CERTIFY THAT ALL
lNrORMATION HEREON IS TRUE AND CORRECT, A'ID I FURT;";ER CERTIFY THAT ANY ~'1D ALL WOR<. PER5"ORMED
S;.lALL BE DONE IN ACCORDANCE WITH THE ORDrNA'ICES or: THE CITY or: SPRINGFIELD, AND THE LAUJ5 or: THE
STATE or: OREGON PERTAINING TO THE WOR<. DESCRIB:D HEREIN, AND THAT NO OCCUPANCY WILL BE MADE
or: ANY STRUCTURE W!Tl-lOUT PERMISSlo:-.l or: THE BUIJ...DI~~ Drv!SI01-t I FURTHER CERTIFY THAT ONLY CONTRACTOR5
AND EMPLOYEES WHO ARE IN COMPLIANCE WITH ORS '01-"'55 WILL BE USED ON THIS PROJECT.
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