HomeMy WebLinkAboutPermit Building 4-11-15
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.J~?'~i1~IDENTIAL - COi1ME~IAL
. ,'. '. ~>t/ ' SIDEWALK / CURBCUT
" AFPLICATION / PEP-'IT
NoT~: ~ec:.e-IPT tf11t-t:>E" OUT To
',' ,J-tAC~A BUT WORK
lS BEfIJ6 DoIJ~I1B<-r'OA f
5-rA-7ZJ/U e.LJ!J5 (fC.-VCT IV
MILL -~EIPT NO; 6 t S 4-~'
TAX LOT NO~"*' 3-00 CA&I-I
225 NORTl-HIFTI-I STREET
SPRINGFIELD, OREGON~141'
ENGINEERING DIVISION
OiTICE NO. 126-311;3
INSPECTION LINE: 126-3'6~.
J06ADDRE5e:' 1~/'7 ~l i'~ . ".-'=." D~
ASSESSORS MAP NO."*' (7-t)-3'" z.~ ~3 '2.
SUBDIVISION,
CHECK
/
OUNER: .H 4r: ,.<; A-
ADClRESS: . \ '3 C{) (.(j). t=a i hJ ie t.( )
STATE:. ()~E ZIP: Q74'71
~ DESCRIFTIClN:
SIDEUJALK: l/'" CU~ 51DE ~
CURB-CUT, ~SIDENTIAL ~
SECOND DRIvEWAY (SEE TRAlTlC )
REQUIRES APFLICAtiON FOR A SECOND DRIVEWA,(("T-4.1a)
OR A COJNTl APPLICATION FOR FACILITY PER1IT (C ~-203)
, IF IN T't-lE U.G5. .' 'J") .
DATE oF APFLICATION . /1, 11/1'1 r" '.
I
CITY: <\p t-I d/
PI-IONE NO.'
*'
CHECKED FOR DELINQUENCIES
-
SETBACK
COMMERICAL
SIGNED:
~T~'
\\/t ~/94-
I
DATE:
WO~ TO BE FE~DB""':
CONTRACTOR*' . ~ TA-lDil" C-ol1 '5., it:' jI) C ~
ADDRESS ;;"1-194- B A'IYf'i-t, RJ
Ou.N:::R
Y:
I CONTRACTOR .
R:GISTRATiON NO.*' (J:j371 EXPIRES: 3/'d/ /qS- .
'~'~Q -f'11€. 01(15 'Q7 '/6 d- P;";ONE: 110 I-(j 0'4 ~
I I
PROI-t:vURE FOR INU-=CTION RfQUE5T:
CALL 126-3'6~ (RECORDER) STATE ,(OUR CIT'( DESIGNATED JOB NUM5:=R, JOB ADDRESS,TlPE or:
INSPECTION REQUESTED A"lD WHEN '(OU WILL 5E READY FOR INSPECTION, CONTRACTORS OR OLlNERS NAME AND
Pl-lONE NUMBER. REQUESTS RECEIVED BEFORE 1:0" AI1 WILL BE MADE TI--IE S.4I'1E DA'(, REQU:=STS AFTER ':0"
AM WILL BE MADE TI--IE NEXT. .WORKING DA,(
.*' SEE BOOK
EXISTING BUILDING PER1IT NO. ( IF APPLICABLE)
. YOUR CITl DESIGNATED JOB NO, Isf q 44 7 S<1
REQUIRED 1N5FSCTIClN5
"". SIDEWALK / DRIVEWA'(
V FOR ALL CONCRETE PAVING WITI--IIN
TI--IE STREET RIGI--IT or: WAY, TO BE
MADE AFTER ALL EXCAVATING.
15 COMPLETE A"lD FORM WORK
AND SUB-BASE MATERIAL 15
IN PLACE
CURB / A. , "OAO-l APRON,
kiER FORMS ARE ERECTED
BUT PRIOR TO POURING
CONCRETE.
FE~5:
SIDEWALKS
~10.00 + S.0.1S/LF. ( X )
OF WALK'.
CURB-CUT
/ 0 '. S.10.0e1 + s.@;1S/L.F. ( X )
WALK X'
/ ~
TOTAL FE~IT FEE:
~.
( I.SO
Cv, " ,ERICALDRIYEWA'(S SI--IALL
I--IAVE 1;'TO 8'FLAIRS
3'_ "" ST A"lDARD
x'
i
. .
II--IAvE CAREFULL'( EXA"1INED TI--IE COMPLETED APPLICATION FOR PER1!T, ,j,ND DOI--IEREBY CERTIFY TI-{AT ALL
INFORMATION I--IEREON IS TRUE AND CORRECT, A"lD I FURTI--IER CERTJF'( THAT AN'( AND ALL WORK PEf';FORHED
51--1ALL BE DONE IN ACCORDANCE WITI--I TI--I~ ORDIN,j,NCES or: TI--IE CIT'( or: SPRINGFIELD, AND TI--IE LAWS or: TI--IE
STATE or: OREGON PERTAINING TOTl-JE WORK DESCRI5ED I--IEREIN, A"lD TI--IAT NO.OCCUPANCY WILL BE M.L.DE
OF AN'( STRJCTURE WITI--IOJT PER1ISSION of TI--IE BUILDING DIVISION. I FURTl-JERCERTIF'( TI--IAT ONLY CONTRACTORS
AND EMPLOYEES WHO ARE IN COMPLIANCE WITI--I ORS '''1.01;1; WILL BE USED ON Tl-JIS PROJECT.
~~, J{/~_
SIGNED -- . "-'~'r .'
/ { //4'-/ C;d
I
DATE.;..:.