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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 rATC.nC(~ r)L ~n~i o !Lr.UL~ 'u LUU~ 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-~ r .~I \ '^ v'" , -\.. . - c . \), ....\0" ffj'\ov,. v\\. .,~."" ~\\; ~e. _....... R . c. ~ ~lt,\"" t.t,\\-' .~.~~'" .u"'" ..;n, .',. equlre \\~pep 'Ion.~\ v- . ,'. \J..... ~.:r . ~""\\' ~~o"'.n~ .-e\-' ....f, _n;(.' I P'~I .;--.....J.t' ,,~ ~ \" :Ilr.'\\\; ":i;-;:~v '1;.")V !-!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: , . ~O~~ ~f'~~\S~'t ~~ ~~\N O~ ~\C~O <o~~~ ~~\<O~ O~~Q(( # 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