HomeMy WebLinkAboutPermit Sidewalk 2001-12-6
I Job# 01.013~.~.01 I
Page'1 of 2
SPRINGFIELD
~.
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
TRANS#=Ol-0007446
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AMT RECD~2 $ 77~85
CHANGE;
CASHIEH~061
Job Number: 01-01353-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
location Of Proposed Site: 7119 C St Spr
Assessors Map#: 17023531
lot: Block: Addition:
Tax lot #: 06200
Subdivision:
Owner:
Address:
Alice Luizier
7119 C Street
Phone Number:
City/State/Zip: Springfield, OR 97478
Repair Value: $0
Scope Of Work: Sidewalk
sidewalk repair and replacement water line
Office Use
Water Line
# Of Buildings:
Occl!pancy Group:
. "~~~~~"'\sOur~ce:
~\\'<:' ~....:<\.\"
Water Heater: Range: ""~ ,<e~'{e~~'<?) ~~~~ge:
:(\'~ "-0 ~ ~,s c..',,' - ,,",'1
.. ' . 0.0 '^" ').\' ~~~~ ,tJ6.i' r.li: v ,
To request an inspection call the 24 hour recording at 726-376~~n9 ~ 'eut..L~T~.~ ~D~fgre 7:00
a.m. will be made the same working day, inspections requ~~lf€I~~l'~~:rr.::;$'ffi ~'1'rI ~~.~tiecf9110wing
working day. ~~ ,,~\0'f:J ;:""f:.\~::\\ (j ~ r/~\e~ '^.e \e\e.z~\c'O-~
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!-!lo!Jl' 910 ,..p.l..i~ <:5-'''' r{)'~'
- Prior to filling trench. \'~(.)'!J\). ~\{\~ \~\ \'{\0.. \S hJC.~
c~ ~ (\1.0'
Public WCf>J:~ eel' ~
Quad Area:
# Of Units:
Constr. Type:
land Use:
Zoning Code:
Bedrooms:
Sidewalk
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
-Area (Sq. Feet)
Main: Accessory:
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# Of Stories: ~Qei~~:.u~Q€ ~~~~
Current Units: ~~~~~~~~\<O ~
Census Code: Does not apply ~ ~~~C€ ~ ~Y:,.~\O .
CO~ ~~Q~
Total: ~~'-{ '\
Fee
Paid On Receipt#
Plumbing
12/06/2001 7446
12/06/2001 7446
12/06/2001 7446
Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
State Surcharge - Plumbing
Water Service Footage
100
$.00
$4.13
$59.00
..
Fee
Job# 01-01353-01
Paid On Receipt#
Plumbing
12/06/2001 7446
Page 2 of 2
Value/Quantity Fee Amount
Administrative Fee - Plumbing
Total Plumbing
$4.72
$67.85
Sidewalk Repair
Total Public Works
Grand Total
By signature, I state and agree that I have carefully examined the completed application and do
hereby certify that all information 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, applicable City
Standard Specifications and Drawings, and the laws of the State of Oregon pertaining to the work
described herein. I further certify that only contractors and employees who are in compliance with
ORS 701.055 will be used on this project. I also understand the City may inspect the work described
on this permit any time during a one year period following notice of completion, at the City's
descression.
.~~ C\ '6i~ l'--\ ~ D\
Public Works
12/06/2001 7446
1
$10.00
$10.00
$77.85
Signature
Date