HomeMy WebLinkAboutPermit Sidewalk 1999-10-13
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City of Springfield . .
DRIVEWAY/SIDEWAL PERMIT APPLICATION
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PERMIT NUMBER:
DATE ISSUED:
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225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726.3753
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APPLICATION DATE:
SITE INFORMATION:
LOCATION O~ORK: z::.7r-2. 7 lir,..j~. ""{'-'" '!--
APPLlCANTr-' if ;110 _./-.<..,j,i [I
ADDR~: 9t/u d'j V?A)
CITY: .t.M.rJ, . STATE: fL
SUBDIVISION: /l~~<- .f..~_ l~r', (parT
OWNER: ~"l 15 (j,-o, (' .\ -
ADDRESS: q ~ lid 9(-1J
PHONE
TAX MAP:
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4700
ZIP: C(7f,/rJ;:)
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TAX LOT:
CITY:
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PHONE: 0PK- J?R9r
STATE('l_ ZIP:0'~~~
REQUESTED PERMITS:
M, DRIVEWAY leURB.CUT ISIDEWALK: ........,.........,..'.......................... ....................., $ 60,00
AMMOUNT OF SIDEWALK IN EXCESS OF 90FT, @$0,06 SF. $
o SIDEWALK REPAIR: ........,,,,,,,,,..,,.,,.....,..,..,..,,,,....,...,,,.....,,,..,..,,,,,,..,,,,,,,,,$ 10,00,
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&>0,00
o ADDITIONAL DRIVEWAY:
,.,."..,........,..".,..,.,..,.....,.,..,..,....,..,..",.,..,..,.$ 30.00
o PROOF OF INSURANCE' $500,000 MINIMUM IF WORK IS DONE BY PROPERTVOWNER
TOTAL DUE WITH PERMIT $
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CONTRACTOR INFORMATION:
CONTRACTOfl: tAL II )J 1 'A
ADDRESS: '-(fl ,p.~r - ~/CP 1-1
CONTRACTOR REGISTRATION NO: I ~ (') lJ.Q '1
PROJECT SUPERVISOR:
1
PHONE:V.P-6'R'?r-
EXPIRATION DATE: p6J/OO
PHONE:
INSPECTIONS:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WORK HAS BEEN FORMED
AND MADE READY TO POUR.
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 CONCRETE.
YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" '.800.332.2344
48 HOURS BEFORE DIGGING
SIGNATURE:
,
AMOUNT RECEIVED: -:p~o,oo DATE PAID: /O/I~ /"'i?
RECEIPT NO: Cl?S" 8 Go 3 RECEIVED BY: Boer {;;:, ~
By signature, I state and agree, that I have carefully exa';'ined the completed application and do hereby certftv 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 Ordinanc~s of
the City of Springfield, applicable City Standara specifications and Drawings, and the laws of the State of Ore.Qon p'ertalning to the work
descr,ibed ~erein. I furth~r certify that only contractors and employees who are in compliance with ORS 701,055 will be used
on thiS 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 notic,
of completion of the described work and specify, at the City's sole descression, any additIonal restoration work reguirec to return the site
to a standard acceptabie to the City. The permittee will be notified in writing of any work required and will have thIrty days (30) from the
date 9f the notice to cO'l1plete lhe work, Work ~ot completed at the end oflhe thirty days WIll be performed by
the CIty and the costs will be bIlled to the permIttee, '
I furthor agree to ensure that all required inspections are requested at the proper time, that project address is readable from the
street, ana the approvell set of plans will remain on the site at all times during construction.
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Signature&/' /" /vfJ~' Dale /O/'f /99
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City of Sp~ingfield
225 Fifth St~eet
Sp~ingfield, OR 97477
(S03) 726-3753
T~~ns~ction numbe~ 035863
Octobe~ 13, 1999 11:00 AM
Received f~om: P.J.C. LLC
Cont~~ct/O~n : CONTRACTOR
Add~ess: 940 H~V 99 N.
City: EUGENE St: OR Zip: 97402
-BlJilding-
Job t: 991401
Desc~iption
Side~~lk
AllIt
Tot.~l:
Received:
Check t: 1200
Thank YOll, Bob T.
t~et
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Fee
60.00
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60.00 .?,-O . ilIA
1'.0.00 Check * l f&{I-"
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