HomeMy WebLinkAboutPermit Sidewalk 1995-3-6
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~fpIDENTIAL - QOMMERCIAL
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. SIDEWALK I CURBCUT
-~; APPLICATION I PER1IT
11~
SPRINGFIELD
2250 NORTH FIFTH STREET
SPRINGFIELD, OREGON <31411
ENGINEERING DIVISION
OiTICE NO. 171:>-31503
INSPECTION LINE: 121:>-311:><3
JOB ADDREe5: 72ft:; ,Aj....J,o~,..;;
ASSESSORS MAP NO.* / 7 0 ~~:; 1/
SUSDIVISION:
CA5I-1
If::, S-/1
~7??;Y
LDJ.J.~
TAX LOT NO~ *&7
RECEIPT NO:
CHECK
STATE:
H D eJ. L.C> )-..t
PD Bo~
61(_
C2.o 1-l. S1:J..lC:tt 0 1-1
~
ZIP: 17~'Z-
CITY: '{tJK~
Pt-l~~..;. 743 '"2..lo'L
*
CH::CKED FOR DELINaENCI::S _
OLlNER:
ADDRESS:
~ DESCRIPTION: ~'
~
S!DauALK:
CUSS SID::
5::T8ACK
CURB-CUT: RESIDENTIAL CO:--n-ERICAL
S=COND DRIvEWAY (S=:: TRAfi=IC )
REQUIRES APFLICATlo.--l FOR A SECOND DR!V::WAY('T-4.1a)
OR A COUNTY APPLICATION FOR FACILITY PE~IT (C <38-203)
IF IN THE U.G13.
DATE OF APPLlCATlo-.l
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, SIGN::D:
~1fI
DATE:
WORK TO BE FE~D 6Y:
CONTRACTOR * l-\CJC{Z..("ZOJ..,./ CJ:; ~ S,'(~"({ OJ...!
ADDRESS eO. &;" €::,(P -r(/IlN~
~UN:R
CONTRACTOR
REGISTRATION No.*96 fl/
::XPiRES: 5""-S'. i~ ,
P;"';ON::: 93/-~) ') t:'f
~fL
~t:vURE FOR INSPECTION REQUEST:
CALL 121:>-311:><3 (RE:CORDER ) STATE YOUR CITY D::SIC::NATED J05 NUi15=R. J05 ADDRE:SS,TYP:: OF
INSPECTION REQUESTED Al,JD UJt-lEN YOU WILL 5:: READY FOR INSPECTION, CONTRACTORS OR Ou.N::RS NAM:: AND
P!-iON= NUM5ER REQU::STS RECEIVED 5::FORE 1:00 At1 WILL 5:: MADE TH:: SAME DAY, REQU::STS AFTER 1:00
AM WILL BE MADE TH:: NEXT WOR<.INC:: DAY
"* SEE I3boK
EXISTING: 5UILDINC:: PE~IT NO. ( IF APPLICABLE) #- 9q 1//'1
YOUR CITY D::SIC::NATED JOB NO, Isf
REQUIRED INSPECTIONS
I I ~::WALK I DRIvEWAY ,
Vf ~~ ALL CONCRE:TE PAVINC:: WITHIN
THE STRE:ET RIC::l..lT' OF WAY, TO 5E
MADE AFTER ALL EXCAVATING
IS COMPLETE AND FORM WORK
Al,JD SU5-5ASE MATERIAL IS
IN PLACE
CURB I A;-;-~OACH APRON
kiER FO~S ARE ERECTE
BUT PRIOR TO POURING
CONCRETE.
FEES:
SIDEWALKS
CURB-CUT
TOTAL F'E~IT FEE:
~ /01, 6 D
COMMERICAL DRIVEWAYS St-lALL
HAvE 50' TO 8' FLAIRS
3'.. 0" ST Al,JDARD
WALK X'
/ ~
J X'
'I 'I
.10.00 + .0.l5/LF. ( X ) (p(d:) ,
or WALK
.10,00 + ~.l5/LF. ( X )
I t-lAVECARt:t=ULL Y EXA"1INED T~E COMPLETED APPLICATiON FOR PE~IT, AND DO HEREBY CERTIFY Tf-l,L,T ALL
I~r-O~ATION HEREON IS TRJE AND CORRECT, A'lD I FURT;..J::R CERTIFY Tf-lAT ANY A'lD ALL WOF'K PE!'Q=O~ED
St-lALL BE DONE IN ACCORDANCE WITH THE ORDIN,L,NCES OF THE CITY OF SPRINGFIELD, AND THE LAWS OF THE
STATE OF OREGON PERTAINING TO THE WORK DESCR/5ED HEREIN, AND Tt-lAT NO OCCUPANCY WILL 5E M,L,DE
0;= I~NY 5TRJCTURE WITHOJT PERMISSION OF THE 5UILDING DIVISiON. ! FURTHER CERTIFY 7HAT ONLY CONTRACTORS
AND EMPLOYEES WHO ARE IN COMPLIANCE WITf-l ORS 101.0:;'50 WILL BE USED ON THIS PROJECT,
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