HomeMy WebLinkAboutPermit Sidewalk 1991-12-4
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22!; NORTH FIFTH aTREET
aF'RINGFIELD, OREGON 'il1411
ENGINEERING DIVlalON
OFFICE NO. 126-31!;3
lNaPECTION LINE, 126-316'il
RESIDENTIAL - COMMERCIAL
. alDEWALK I ctJRBCUT .
AFR.ICATION I PERMIT
SPRINGFIELD
IlI'il0
JOB ADDRE&&. l,Q [) \
AaaeaSORa MAP NO..
td~~
~ TAX LOT NO."
~':IPT NO, DO \ ~~
CHECK r:p
atJBDIVlaION,
OUNER. N\).. , ~C\. '5\.fu ~ l.J... ,
ADDREaa,
aTATE,
crTYJ
.
CHECKED FOR DELINGlUENCIEa _
ZIP,
, PHONE NO.
~ DEecRlPTION.
alDEUJALI<, CURB aiDE _
CURB-CUT, REalDENTIAL _
aeCOND DRIveWAY (aeE _IC)
REQUIREa APPLICATION FOR A aeCOND DRlvEWAy(or-4.1a}
OR A COUNTY APPLICATION FOR FACILITY PERMIT (C 'i\8-21Zl3)
IF IN THE U6.B.
aeTBACK. _
COMMERICAL _
DATE OF APPLICATION
aIGlNED,
DATE,
tAlJJUJ
0'f-.J. n .C{ (
WOfIi!K TO BE r-c.........,.... IcD BY, Oll.NER
CONTRACTOR. b Q 0 rt 0 1(\ < ~)("n '3..-..
ADDRE'il8 6L J2 \.0 ~D ~ '
CONTRACTOR iA I. /
REGlaTRATION NO.mOQ'7 EXPIREa,I!J.('-r I q
PHONE'Co 'is In-- q+.~t
r-__~.Ji'ilS FOR IN&FI:CTJON REGllJE&T.
CALl. 126-316'il (RECORDER) aTATE YOUR CITY DEalGNATED JOB NUMBER. JOB ADDREaa,TTPE OF
INaF'ECTION REGlUEaTED AND IIA-IEN YOU WILL BE READY FOR lNaPECTION, CONTRACTORa OR OUNER!! NAME AND
PHONE NUMBER REGlUEaTa RECEIveD BEFORE 1,1Zl<Z> AM WILL BE MADE THE aAME DAY, REQUEars AFTER 1,1Zl<Z>
AM WILL BE MADE THE NEXT tlJC>Rl<1NG DAY
.. aeE BOOK.
EXlaTING BUILDING PERMIT NO. ( IF APPLICABLE )
YOUR CITY DEaIGNA~~ JOB NO. laf q I ()C::x5J'J
REQUIRED INSFl:CTION&
D
alDEWALK I DRIveWAY
FOR ALL CONCRETE PAVING WITHIN
THE aTREET RIGHT OF WAY, TO BE
MADE AFTER ALL EXCAVATING
la COMPLETE AND FOI<M tlJC>Rl<
AND atJB-BAaE MATERIAL la
IN PLACE
p
CURB I APPROACH APRON,
AFTER FOI<Ma ARE ERECTED
BUT PRIOR TO pOURING
CONCRETE.
FEE&. SIDEWALKS CURe-CUT WALK x'
.10.00 + .e>.I5/LF. ( X ) .10\1) .e>8/L~ / ""
OF WALK . f\P\ '
\ ~.\oO ~COMMERICAL DRlvEWAya ALL I. x' l-
HAve !;' TO 8' FLAIRa
TOTAL FER"lIT FEE. $ 3'- IZl' aTANDAI<D " d.41
I HAve CAREFULLY EXAMINED THE COMPLETED APPLICATION FOR PERMIT, AND DO HEREBY CERTIFY THAT ALL
INFORMATION HEREON la TRUE AND CORRECT, AND I RJRTHER CERTIFY THAT ANY AND ALL 1lOF<!< PEf<FORMED
aHALL BE DONE IN ACCOI<DANCE WITH THE ORDINANCEa OF THE CITY OF SPRINGFIELD, AND 7HE LAU5 OF THE
aTATE OF OREGON PERTAINING TO THE tlJC>Rl< DEacRIBED HEREIN, AND THAT NO OCCUPANCY WILL BE MADE
OF ANY aTRUCTURE WITHOUT PERMISalON OF THE BUILDING DlVIalON. I RJRTHER CERTIFY THAT ONLY CONTRACTORa
~O/:RE~ OR!! 11Zl1~5 WILL BE UaED ON THIS PRO;~7~ 3 _? /
P / -
DATE