HomeMy WebLinkAboutPermit Sidewalk 1991-5-28
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RESIDENTIAL - COMMERCIAL
22:' NORTI-l FIFTH STREET .
SPRli'GIELD, OREGON ~1411
ENGINEERING DIYISION
OFFICE NO, 126-31:'3
INSPECTION LINE, 126-316~
SID:ouJALK I CUR9CUT
t.PPL ICt. Tlo.-J I PE!<l'1IT
.
SP.~,HI,NGFIELD " .' I .
~ OF-"
.:_~.t.~-,... ~..VI
';09 ADDRES8. Y} ILl 0CiJttS G! oN ,
ASSESSORS MAP NO,* II n?-, ::YJ t:l4 T.:.x LOT NO, *n4YiJ
5USDIYI~I01JI:
O.l.NER. M(YY J1r11 JP Yl. "
ADDRESS, I t:::7q n ~ K'1Z.AJ
STATE, t:f~ J,qUUL ZIP, t.:D.J..
"-lORK DESCRIPTloI-U
RECEIFT NO, /10 I ~/
CAS+-!
C!-!ECK
CiiY:
'I;
C!-IECK::D FOR DELlNQJENCIES _
P:"';~ NO.
5ID:=I"I' 1 1"". CURS SID:: _ S:ieACK _
CURS.CUT, ~ RESIDENTIAL _ C:::>,y,=RICAL _
SECOND DRI UJA Y (SEE iRt..'-rIC )
REQUIRES A LICATlo.-J FOR A SECOND DRIVEUJt.YI'T-4,:.)
OR A CO'.JN APPLICATION FOR FACILITY PER"OIT (C 'OS-,C3)
IF IN n-IE U.G.5.
SIGNED:
"
DATE OF APPLlCAT[~
OAiE.:
~F<K TO SE t='E~D BY:
CON~CTOR *" if))l Jl fsJJn. )
O~R
l.LJ CONTRACTOR
( *
R:~15TRATION NO.
EXPIRES,
ADDRESS
PHONEI
;-roo;.v....=-URE FOR lNSF:CTION REQUEST.
CALL 126-316~ lREC=ER) STATE YO~R CITY OESI"':--:t.TED JOS NJMSER, JOS ADDRESS,TYPE OF
IN&PECTION REQUESTED .AND l,!.J;.1EN YOJ ~!LL 9E REt..::IY FOR lNSP':CTION, CONTRACTORe OR OUNER5 NAl""iE 4.'1::>
Pi-lOi-o(E NJMSER. REQUEST5 RECEIVED SE:"-ORE 1,,,,", ,(,'1 UJILL SE MADE rrlE 5AME DAY, REQJEST5 AFTER 1,"'"'
AM WILL BE MADE THE NEXT u.oRKING DAY
* SEE SOOK
EXl5TING SUILDING _"""17 NO, ( IF AFPLICASLE )
YOUR CITY DE5IG"<A~~ '~OS NO, 15'!' q \ n435
i"SGlUII'lED lNSF:CTIONS
D
SIDEUJALK I ORIVEWt. Y
FOR ALL ca..lCRETE Pt.YIN~ WITHIN
T~E STRE:ET RiG;..IT OF W.4 '1", TO SE
M.l.DE A=TER ALL EXCAVATlNG
15 GO:1PLEiE A"<D FOR"! u.oRK
4.'-\D &Ll9-845E M..:. TERlt.L IS
IN FLACE
~
CURS I APPROACH t.PROS,
At:'jER FOR:'15 ARE ERECTED
BUT PRIOR TO POJRING
CONCRETE,
==5:
SIDEWALKS
t\0,00 + ~0.1",/L';=. ( X )
OF WALK
CURS-CUT
WALK X'
!10.00 + K:>.I5/LE ( X )
/
CO:-1:"1!ORICAL DRIVEWAYS 5!-!ALL{)O 'I
H~VE ~' TO 8' FLAIRS . .~
3'- 0" STA'iDARO .1
"\
I,
s
TOTAL FEI"t1IT FEE: _
13.o{)
x'
')
. :":~V'E Ct.R;:1='JLLY EXA"'"iINED Tl-!E COi1FL:::TED ~PPLIC4ilo-.: PaR PERMIT, ":'~D DO I-lERESY CERTIFY TI-lAT ":"LL
."'=-O~ATfON l-lEREON 15 TRJE Al",lD CORR:CT. A~D [ P~~i;"';=:R CERTIFY Ti-l.4T A~,..t'( .:o.~D MLL lJ..lOR<. PER=O~ED
5-'-'.LL SE DONE IN ACCORD..:....CE UJITI-! T!-!E O!'01N4"'CES OF T!-!E CITY OF SPRINGFIELD, A"'D Tl-'!O LAt!.15 OF Tl-'E
=7':"TE or OREGON P:RTA1N1N~ TO T!-;E llk:>R<: PE5CRI5E::I ;"';ER:IN, ,l.,-,p ii-lAT NO OCCUP.4'iCY WILL SE M.4DE
~~ 4"''1'' STRJCTURE W1Tt40:.JT PERMISSION O? THE 6UILDINGr DIVISION. I F'J~Ti-1ER CERTIFY 7;";AT O~L Y CONiR.ACiO~S
-=.,,::> Er--~~ ARE :ii.PLIA...CE WITHOR5 ,01.0;,,, WILL 5E USEO ON THI5 PROJECT, /h
~ t:] "'1 ~ J~...g~<t'> ~A,