HomeMy WebLinkAboutPermit Sidewalk 2000-6-12
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225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
APPLICATION DATE: t-,/ h / Q l.J
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PERMIT NUMBER: (9-() - ~c; 72 - 0 (
DATE ISSUED: ~ - I '2.--00
SITE INFORMATION:
"I ~OCATION O~ \VORK:
APPLICANT A tti2Uv.
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PHONE 30,;l. - YIJ't"s-"
ADDRESS: ~b S- >q ,.4 / rhl2h /'Cbt-..J-....
TAX MAP:
CITY: ;::;PellA]
SUBDIVISION:
.ST ATE: I)/L
ZIP: e{'7L(,,/)-3
TAX LOT:
OWNER:
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PHONE:
ADDRESS:
CITY:
STATE:
ZIP:
REQUESTED PERMITS:
~ DRIVEWAY ICURS.CUT /SIDEWALK: .................?:~~~.....f)(I:!.'t.~~~."!...~t~~.*:I....$ 60.00
AMMOUNT OF SIDEWALK IN EXCESS OF 90FT. D @$0.06 SF. $
o SIDEWALK REPAIR: ................................................,.........,.........................$ 10.00.
o ADDITIONAL DRIVEWAY:
... ..................... ........,'............ ......................$ 30.00
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60 .00-...o'D 000'-
Q PROOF OF INSURANCE: $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
TOTAL DUE WITH PERMIT $
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CONTRACTOR INFORMATION:
COf'JTRACTOR: J}J:: \, <).ffr-t.1!.et/.:.
ADDRESS: C:~:>o.i11(/ @,<,
CONTRACTOR REGISTRATIO~N, 0:
PROJECT SUPERVISOR: /....f-ri/Li/I.-.
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INSPECTIONS:
PHONE: :J-D). - Y/:fv~
EXPIRATION DATE:
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PHONE: s;-~'~
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WORK HAS BEEN FORMED
AND MADE READY TO POUR.
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CURB CUT AND SIDEWALK INSPECTIONS CALL 726-3769 (RECORDER) STATE YOUR DESIGINATED CITY JOB NUMBER/PERMIT
NUMBER, JOB ADDRESS, TYPE OF INSPECTION REQUESTED, AND WHEN YOU WILL BE READY FOR INSPECTION, CONTRACTOR'S
OR OWNER'S NAME AND PHONE NUMBER. REQUESTS RECEIVED BEFORE 7:00 A.M. WILL BE MADE THE
SAME DAY, REQUESTS AFTER 7:00 A.M: WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE CALLED IN
AFTER EXCAVATIONS ARE MADE AND FORM WORK IS IN PLACE BUT PRIOR TO POURING C0NCRETE.
'SIGNATUR~~ , _.L ,C;::~
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AMOUN I nCl.,;t:IVED:
YOU ARE REQUIRED TO CALL
THE LANE UTILITIES ,COORDINATING C,OUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING I
RECEIPT NO:
DATE PAID:
,RECEIVED BY:
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By signature, 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 Standara specifications and Drawings, and the laws of the State of Ore..9.on p'ertaining to the work
.desc~ibed ~erein. I furth~r certify that only contractors and employees who are in compliance with ORS 701.q55 will be used
on thiS prOJect. f
'rhe City mpy inspect the vyork sit~ described ifl this perm}t 9t any time duril)g a one year period foffow:ing the receipt by' the City ,of notiCI
of completion of the descpbed work and speCify, at the City s sole descresslon, any additional restoration work re~U1red to return the site
to a standard a.cceptable:'to the City. The permittee will be notified in writing of al)Y work required and will have thirty days (30) from the
date Qf the notice to cO'1)vlete the work. Work I)ot completed at the end of the thirty days Will be performed bV
the City and the costs wjWbe bllled:to the permittee,' )
I furthor agree to ensure ~at all required inspections are requested at the proper time, that project address is readable from the
.:!~eet, ana the approvep pet of plans will remain on the site at all times d.uring construction. ;
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