HomeMy WebLinkAboutPermit Sidewalk 2011-4-14
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,~'~,_, DRIVEWAY/SIDEWAlK. '': ....:::PERMIT APPUCATION. >)i;
225 FIFTH STREET
SPRINGFIELD. OREGON 97477
ENGINEERING DIVISION
OFFICETELEPHONE (503) 726-3753
PERMIT NUMBER:' S 1'-~~2D1\-606 Ie>
DATE ISSUED: L\ ( (q /2.0 \ ,
APPUCATION DATE:
SITE INFORMATION:
LOCATION OF WORK: (,,7<a
Gca<Re.--. - ~ N: So...,
ADOAESS, /,-/y," rfwY qqr-/
STATE: &(L
C.l'lC~v'o;:../\ . .
APPlICANT
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PHONE 5y!-(;''i:f(n02-
TAX MAP'.
mY: f:;. ""l~'~€-
SUSDMSION:
ZIP:
'17'(07- TAX LOT:
OWNER:
ADDRESS:
PHONE:
mY,
STATE.:
ZIP:
REOUESTED PERMITS:
o SIDEWALK: ........._..........:....................... .......................................... $88.00 ......................... = $
AMOUNT OF SIOEVJAlK IN EXCESS OF 90FT. @$O.08 SF. == $
~ SIDEWALK REPAIR:...................................,...................... ................. $15.50 ........................... = $
o CURB CUT/DRIVEWAY: NUMBER OF DRIVEWAYS_ X...................... $88.00 1st Cut = $
. 0 MULTIPLE PERMIT DISCOUNT EA ....:....(MAX 2) ...........................$30.00 2nd Cut =$_(-
(MULTI PERMIT DISCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECTION ..ow
APPUES TO 2nd AND 3rd PERMITS ONLY. NOT SIDEWALK REPAlRl =$
o 5% Technology Fee $ TOTAL DUE WlTI-l PERMIT $
o PROOF OF INSURANCE: $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
CONTRACTOR INFORMATION:
CON1RACTOA: CooA-e." - ~V,;. ~O..., ~ ~~-r
ADDRESS 1'-1'11 1-1 '-"''7 '" C; p./
CONTRACTOR REGISTRAnON NO: . &OVy7
PAOJECT SUPERVISCR {2a" d.'T De+e.A<-"
PHONE:.5Y{0~-7'2-
EXPIRA nON DATE:
PHONE:
INSPECTIONS:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, .toFTER THE PROPOSED WORK HAS BEEN FO AMEO AND MADE READY TO
POUR CURB CUT AND SIDEWAlK INSPECTlONS CALL 720.3769 (RECORDER) STATE YOUR DESIGINATED CfTY JOB
NUMBEA/PERMrT NUMBER, JOB ADDRESS, TYPE OF INSPECTION REOUESTED, AND WHEN YOU WILL BE READY FOR INS PECTlDN, CONmACTOR'S OR
OWNER'S NAME N-lO PHONE NUMBER REOUESTS RECEIVED BEFORE 7:00 A.M. 'MLL8E MADE THE
S,AJ...\E DAY, REOUESTS AFTER 7:00 A.M. WIll BE MADE Tl-iE NEXT WORKING DAY. lNSPECTlONS ARE TO BE CAlLED IN
AFTER EXCAVATIONS ARE MADE AND FORM WORK IS IN PlACE BUT PRIOR TO POURING CONCRETE..
SIGNATURE:
YOU ARE REOUIRED TO CALL
UTILITIES COORDINATING COUNCIL'S
CALL NUMBER" 1-800-332-2344
'B-HOURS BEFORE DIGGING
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AMOUNT AECEIVED: ., ~. e -.z, .
AECEIPT NO, 2.1111 000 7' 7
~TEPAID:
RECEIVED BY:
1-/1"/4/2.0tl
1), YLf (<r:2r=f:J.Jt:
By signature. I slale and agee\ mall have carefully examined the comJ:leled apprrcation and do he feby r:erti/y thai aI inlcrmalicn herein Is ltue
and cortect and I further certifY lhal al1Y and all work p-edcrmed shall bll done in accordance with Ihe Ordinances of
the City of Springfield, applicable City Slanclatd speaficallons and Drawif1Qs, and Ihe laws of the Slate 01 Oregon pertaining 10 !he 'oYCrk desaibed herein. llur1tier
certify !hal only ccnlraclas and emplOVel!S wOo ace in c:anp~ance with ORS 701.055 IMD be used
en this project. .
The Diy may inspect the . e described in Ihis permit at <!flY time during a one year period 10 ftowing the receipt by the Cily at no/Ice of ccm%elion althe
described wcrk and sped . ,t Iy's sole discretion, any additional restoraUcn work reql,Jlred 10lelurn the sile 10 a standard acO!p'!able to Ihe Ci . The
permlnee will be nolified' wnl 0 any w required and wiil haye thirty days (30) Iram the dale cllhe nOlice to ccmplel& the wOrk. Work not camp eled althe end
ot Ihe lhirty days will erfe( 0 the' and Ihe cosls wiD be billed to tlie permlHee. .
I lurther agee 10 .i!:!speclions ar.e~ allhe proper lime. that praj ect add'ess is feac1atie tram the
street, and the appr '. ,ttT.!Sile at all limes (bing ccnstnJclion. .
Sign
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth SI
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-PVV2011-00018
676 LOCHAVEN AVE
permitcenter@ci.springfield.or.us
RECORD NO: 811-PW2011-00018 DATE: 04/14/2011
4i~&4~1"",i;'!i"1':~";r~? {":c&jACeoUN:tcboE.:;'l';:~,~"i :i/' TAMdU.NtduE' "
201-00000~428060 46.50
100~00000~425605 2.33
TOTAL DUE: 48.83
k~~YI\'I!:Nt1X~g~ >, :~~'(oRL'CASHIER' KGREENE.~:;; :..:~tC:;y9I\'lM!:!m:','::> ,./. ~(-':"-:,' ,. AMO,UNTPAID '_;;::~' . :_~~:
Credit Card Randy Determan 48.83
RECEIPT NO: 2011000717
lOESCRI~tldNi ...>\If'.~"",-,f
Sidewalk ~epair
__~~c~no!<:gL~=.J5% of permit total)
TOTAL PAID:
48.83