HomeMy WebLinkAboutPermit Building 1999-3-22
... '., ~", , .. ~:_ City of Spl'in~i~I~(
This Side To 8e Filled Out by Applicant
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,'-" This permit is required for any site activity in the flood plain and everywhere site alteration consists of
.' fifty (50) cubic yards of material or more andlor if a drainageway is affected, within City limits and
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Date of Application :5,. /q ~99 Permit expiration Date:
Property Owner ~ ~QgeS~ Phone: ""7i/1f, -~~
Address: Ii, (' A/, t./qT~ Clty.6P~ State~i~ ~
Site Address: '. b 9/) if
;::-9TZ-S~nHA-
,Springfield, Oregon
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UGB Tax Map No: / ~ pz, 0 Z-
Journal number eppllcable Land Usa Application
T~x Lot: .~B<!)O
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FILL, Quantity IsO YD5 ,Source Location ,5~L.D
Suppller.s~~!l-t2~ ,Materlal~ ~
GRADING, Quantity s1J Y.05
EXCAVATION, Quantity 1cS1> VO~ Destination: -to ~t..- .n.l71Ea.n1-.lAf-S~_
Suppller:~ ~~~roject Suparvlsor '
Address' -' ,Phone 7-Z-~7J"7
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SITE PLAN Required Data:Quantity of material, Property lines and descril!tlons, Tax map and
lot number, Site address, Existing contour lines, Proposed contour lines, existing drainage
ways, Prol!osed drelnage ways, Significant trees and follage, Ground cover, son types,
Buildings, Septic systems, Sewers, Areas subject to flooding, Utilities, Areas subject to land
slides, Proposed site improvements,
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CROSS SECTIONS,
SOILS & GEOLOGY PLAN,
DRAINAGE, POLLUTION AND EROSION CONTROL PLAN
REPLANTING PLAN
ADDITIONAL INFORMATION,
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COMPANY NAME: ~JJ1' ,~ ,.\, ,II........... ,PHONE ., J?-r -/VO v
PROJECT SUPERVISOR: ~-/("L~-o.-',~./ "
ADDRESS: / 2-~~ ~./ ~ CITY ~ STATE~
COMPANY NAME: , PHONE
PROJECT SUPERVISOR:
ADDRESS:
CITY
STATE
,4Yh'" -<d~ ~9.-~". ~m~
J<4'",V//v -d~L PHONE '7Z-6 -i97<J
Registration Number: qq~, . Expiration Date: :3 - 7 - 0 I
ADDRESS: "Z- 'Z--7 .5tJ if~ ~ ' CITY: ..s; ,~- -%>
STATE: t'7J-t..-, ZIP: C/7l/f<( OFFICE PHONE_"7U-~f7/ FAX
MOBILE PHONE:~ /~-,O~~ , EMERGENCY PHONE:~/l"-- ~
CONTRACTOR NAME:
PROJECT SUPERVISOR:
I understand that I. or my SUCCB88or' may have futurs plans for my property which may be anticipated or unanticipated at
thll time. I understand that 8uch futurs plans may require permits and developement approvals from the City of Springfield.
I understand that notwithstanding .ny approval 01 this Lsnd and Drainage Alteration Permit ILOAP), that at the time 01
application of future pennlta or approvals the City may review and recon.ider all actions which I or my .ucce88ors have
undertaken persuant to this LOAP. I understand that the City may as 8 condition of any future app'roval" require the
und'!lng, changing, or modification of any actions which I have undertaken as a result of the City . approval of this LOAP.
By algnature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
Information herein 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.thls project. .
The City may inspect the work site described in this permit at any time during a one year period following the receipt by
the City of notice of completion of the described work and specifY. at the City's sole desecration, any additional restoration
work required to return the site to a standard acceptable to the City. The permittee will be notified In writing of, any work
required and will have thirty (30) days from the date of the notice to complete the work. Work not completed at the end of
the thiny doyo will be perlormod by the City ond the costs will be bmod to the pennlnoe,
I further agree to ensure that all required inspections are requested at the proper time, that project address is readable from
the lire t, ond e opprov~-'M ;~ on the site at oil times during conatruction,
,~Ign.t.ur _~~, Dote 3--22-99
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1/6/1998
o DRAINAGE, CI Stonn. CI Ditch, CI Culvert, CI Natural
~ WETLANDS, Description N7>rx2~
~ FLOOD PLAIN, Zone: i!. . , FEMA Community Panel No,: 4-/155q 2- ~A
o FLOODWAY, FEMA Community Panel No,: , Date:
PLAN CHECK FEES:
UP TO 100 CUBIC YARDS
101 TO 1,000 CUBIC YARDS
'1,001 TO 10,000 CUBIC YARDS
10,000 TO 100,000 CUBIC YARDS
100,001 TO 200,000
200,001 CUBIC YARDS OR MORE
GRADING PERMIT FEES:
UP TO 100 CUBIC YARDS
101 TO 1,000 CUBIC YARDS
1,001 TO 10,000 CUBIC YARDS
,10,000 TO 100,060 CUBIC YARDS
100,001 TO 200,000
$20.00
$30.00
$40.00
$40.00 For the first 10,000 cubic vards, plus
$20.QO for e~ch additional 10,000 cubic yards or fraction thereof.
$220.00 For the tirst 100,001 cubic vards, plus
$20.00 for esch additional 10,000 cubic vards or fraction tharaof,
$340 For tha first 200,001 cubic vards, plus
$6.00 for each additional 10,000 cubic yards or fraction thereof.
$30,00
$30.00 For the first 100 cubic yards, plus
$14.00 for each additional 100 cubic yards or fraction thereof.
$156.00 For the first 1,000 cubic yards, plus
$12.00 for each additional ',000 cubic yards or fraction thereof.
$264.00 For the first t 0,000 cubic vards, plus
$54.00 for each additional10,OOO cubic yards or fraction thereof.
$750.00 For tha first 100,001 cubic vards, plus
$30.00 for each additional 10,000 cubic yards or fraction thereof.
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Received By: <-U~lUvtt~ J <l \ I9u.r
$5B~
Grading Permit fee:
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Estimated Volume:
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'Plan Check Fee:
Receipt No: b?3 '2-'2-\ Date: ~/1-1,,/1i
Date: ~h,7.J-rc1 .
Receipt N-O: 03~ 'fL Date: 3/3//'19
Date:
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Received by:
g/' Planning
~gineering
o Building:
o Maintenance:
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Date:
Date:
Date:
Date
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Permit Number
Issued by:
'Date:
BaQ..u.jr.o.,i Ci"'QI In~pp.r.tinn~'
Planning:
Date
Engineering:
Date
Building:
Date
Maintenanc'e:
'Date:
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Land and Drainage activity as outlined in this permit has been completed in accordance with
the provisions of this permit.
L8tnd and Drainage ac.tivitv as outlined in this permit has not been completed in accordance
wltn tne prOVISlllnS Of tnis permit,
Land and Drainage activity was performed prior to application for this permit,
Accepted by:
Date:
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