HomeMy WebLinkAboutPermit Curb Cut 4-4-21
TOTAL FE~JT FEE: () /_,
I ;..LAVE CAREFULL""- EXA"1INED T~ECOMFLETED AFFLICATION FOR FE~IT, AND DO ~EREB""- CERTIF""- T~.L.TALL
INFORMATION ~EREON IS TRUE A"iD CORRECT, A"lD I FURT,.,ER CERTIF.,..- T~AT AN""- AND ALL WORK FE~ORMED
5~ALL BE DONE IN ACCORDANCE WIT~ T~E ORDINANCE5 OF T~E CIT""- OF SFRINGfIELD, AND T~E LAWS OF T~E
STATE OF OREGON FERTAINING TO T~E WORK DESCRIBED ,.,EREIN, A"lD T~AT NO OCCUFANC""- WILL BE M.L.DE
OF AN.,..- STRJCTURE WITHOUT FE~IS5IONOF THE BUILDING DIVISION. I FURT~ER CERTIF""- THAT ONL.,..- CONTRACTORS
.L.NDEMFLO'rEES WHO ARE IN COMFLIANCE WITH ORS 101-"!;>5 WILL BE USED ON THIS FROJECT.
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5IGNe-C>
~ r-!/! -f f
DATE I
~
L. Co
COMMERICAL DRIVEWA""-S SHALL
HAVE 5' TO 8' FLAIRS
3'- 0" STA"lDARD
x'
",
SIDEWALKS
~1@.@@ + ~@.15/LE
OF WALK
(
x
)
CURB
~
-CUT
o ,0@
+
~.15/L.F. (
x
)
/
WAJ-K X
~
FEE~:
SIDEWALK / DRIVEWA""-
FOR ALL CONCRETE FAVING WITHIN
THE STREET RIG!-lT OF WA""-, TO BE
MADE A-iER ALL EXCAVATING
IS COMFLETE AND FORM WORK
AND SUB-BASE MATERIAL IS
IN FLACE
Ri:QlJIRi:D IN~FECTION~
*" SEE
BOOK
""-OUR Cln- DESIGNATED
EXISTING BUILDING PE~
AFPLICABLE
JOB NO. Isf
TNO.
(
IF
)
9un5c:11
. ~ /
/
"\" CURB / A:-:-7':OAC!-l APRON:
AFTER FORMS ARE ERECTED
BUT FRIOR TO FOURING
/ "" CONCRETE.,
PROCED~ FOR IN:';-;:CTION REQlJE~T:
CALL 12~-31~S (RECORDER) STATE ""-OUR CIT""- DESIGNATED JOB NUMBER, JOB ADDRESS,T""-FE OF
INSPECTION REQUESTED A"lD WHEN ""-OU WILL BE READ""- FOR INSFECTION, CONTRACTORS OR O~R-5 NAi"'!E A"lD
FI-IONE NUMBER. REQUESTS RECEIVED BEFORE 1:00 .L.."1 WILL BE MADE T~E SA"1E DA.,..-, REQUESTS AFTER 1:00
AM WILL BE MADE THE NEXT WORKiNG DA""-
Il10RK TO 6E FE~D "BY:
CONTRACTOR *" 2/-, r OVI /) d'f:1
, ,,-
ADDRESS
If'
h~A
.au <0^-L
Ou.NER \ ~NTRACTOR
vh-iclZ~tIST~TI0N NO.*"
EXFiRES:
PHONE
SIDEWALK: / CURB SIDE
CURB-CUT: -+ RESIDENTIAL
SECOND DRIVEWA""- (SEE TRAFFIC)
REQUIRES APFLICATION FOR A SECOND DRIYEWA'l'("T-4.1a)
OR A COUNn- APPLICATION FOR FA-CILIT""- FE~IT (C SB-203)
IF IN T~E U.6.6.
DATE 0.= APFLlCATION
SIGNED:
DATE:
~~I\;J\ _ ^
4"~' '9:r-= l'l~'
.. -" ,
~ DESCRIPTION:
SUBDIVISION:
OUNER: " At \ CLrv
ADDRESS; I B S
STATE: D"......,
I.U 1=0'S S.
Aut }J · Av-p
ZIF:
0;/477
SETBACK
COMMERICAL
CIT""-: S00\.V\.'V\~t'tAcL
F~ONE NO, 7Q/o:- Y-79 e-; ,
C"ECK r-
'*
CHECKED FOR DELINOJENCIES
JOB ADDRE55: A-!:.....!..-.J". ~
ASSESSORS MAF NO.*" 7
o
~
--)
'Z...-:>.;,
33
BS All cl\) Av-e
"*"
TAX LOT NO. 1 30D
RECEIFT NO:
CASH
\
84D3
;/~o
t='", <:; ~
_ ~5IDENTIAL ~ COMM'~, IAL
~ SIDEWALK / CURBCUT ,
'.,.. APFLICATION / PE~IT"
225 NORT~ FIFTH STREET
SPRINGFIELD, OREGON S1411
ENGINEERING DIVISION
OFFICE NO, 12~'-31!.73
INSFECTION LINE: 12~-31",S