HomeMy WebLinkAboutPermit Sidewalk 1995-6-20
111"..0 . ~.
,- ...
J
225 NORT~ FIFT~ STREET
SPRINGFIELD. OREGON ':l1411
ENGINEERING DIVISION
OfTICE NO. 12",-~15~
INSPECTION LINE, 12",-~1",':l
t<::t:::JILJt:N IIAL -
..
L..-Unl~1 t: t-<::L..-I AL
SIDEWALK I CURBCUT .. .
APPLICATION I PE~IT ,
SPRINCFIELD
JOB ADDRE58; ~ v.v. Q'IN~V<-'
-~",,::-..;:- }~J""Y.I_~/.:t
ASSESSORS MAP NO.'*' 17-":? - 27 - "II
11_,,?, -'2.7 -q7_
sr:>::u.L4LK: CU:;S Sf!:>: _
C!JR3~CUT: !=<ESI08'71A.L _
S::COND DRIVEWAY I SEE TR.'.iTIC )
R!:ClUIR:S APFLlCATlo.-J FOR A 5:COND DRIVEWA':'I'T.4.1.)
OR A COUNTY ,l.PPLICATION FOR FACILITY PE!'70IT IC '38-20~)
IF IN TI-IE: U!:>5.
::>ATE OF APf>LICATlo.-J .h -20 -'IS
SUSDIVISION,
O.lNER, H.A.6t'...A.
APDR!:SS, 30 () ,,.,)
STATE, () i2-
lJ..IORo( DE5CRIPTION,
-.r
- 6E.E... ki-rAc..J.Jt;;n
T"-X LOT NO: '* ~'///
REC::IPT NO, I ?t?/t)
CASH
"
Cl-i::C<
..----
(Bell::.l-/~ HA H'e.. '1
FA-Ie\1 \\=_vJ CITY'6pel!...IWE.L.D
ZIP, 0/ 7'-177 P;.lON:: NO.
of. ..-/'
C;.iE:CKE:D FOR DE:LINOJ:NCi::S
S:::iBACK _
CO..iI:.RICAL
.SIGN::J,
\&~~
- 0- 7jJ,.q\'
DAi'::
WORK TO BE FE.........."'" u:::D BY: OCN:R
CONTRACTOR*' 6'1 A.'1orJ c..o 1--I6-re.uc:r, ()/.J R!:GISTRATION
="R:55 2.q ~4 -I", A\~fZ--r e..rl, t::.J J/-.I='.J...i~ . ""Q.
I~ONTRACTOR
'*
NO. :;17~/1
::,<PiRES, ,3.;2. /-'1'"
P'-'O"=, </(,,/ _e.<:;cn.
r1'<V.....cOURE FOR IN5FECTION REQUEST:
CALL 12"'-~1",':l IR::CORDER ) STATE YOUR CITY D::SIG!-lAT::D J09 Nu:-19=R. JOS APDR:SS.TYP:: OF
INSPECTION REClUESTED A'ID ta-lEN YOU WILL S= R:A"Y FOR INSP::CTlo.-J, CONTRACTORS OR O""2RS N.t.."::: ,1..'1"
Pf.lo.<E NUM9ER REQU::STS R::CEIYE::> S:FORE 1,00 ":''1 WILL SE: MAPE THE: SAME DAY. REOJ::STS "-FTER 1,00
A'1 WILL BE MAPE THE: N:XT l!.ORKING DAY
*c..t:'C'r::r.~
..........~
REQUIRED INSPECTIONS
FEES:
51DEWALK5
EXISTING BUILi:JING F::R:'1IT NO. ( IF ,6.F"PUCA9LE )
YOU~ CITl D:::5IGNATED J09 NO. IS!
CIs-a 999
~SIDEWALK I DRIVEWAY
FOR ALL CONCRETE PAVING WIT~IN
THE STR:ET RIG~T or WAY. TO SE
M.4.DE .l..FTER ALL EXCAYATlNU
15 CO:--iPLETE AND FO~ lU::)~
A~D sL!9-9A5E MATERIAL [5
IN PLACE
D
., CURS I APPROACH AFRO
AFTER FO~5 ARE ERECT:
BUT PRIOR TO FO~RING
CONCRETE.
CURB-CUT
WAL< x'
~10.00 . ~0.15/LF. ( X )
0;= WALK
J.{O of- Cf7 r'U5.:- 14.S'!}
24,5S
S
TOTAL FERMIT FEE: _
~10.00 . ~.I5/LF. ( X )
/
t
x'
""
J.
COMMERICAL DRIVEWAYS SHALL
HAVE 5' TO 8' FLAIRS
~'- O. STA.'1DARD
"
I HAVE CARERJLL l' EXA'1I"ED THE COMPLETED APPLICATiON FOR PE~IT. "''10 DO HER:BY CERTIFY THAT ALL
IN""r-O~ATrON J-lEREON IS TRUE A~D CORRECT, A"lD I FURT;";ER CERTIFY TJ-lAT A"lY ~"JD ALL lUOR<. FE~OR:'1ED
SHALL BE DONE IN ACCORDANCE WITH TH: ORDIN"-'1CES OF THE CITY or SPRINGFIELD. AND THE LAeJ5 OF THE
5TATE OF OREGON PERTAINING TO n-IE W:::>RI< DESCRI9=D f-!EREIN. "::'''lD THAT NO OCCUPANCY WILL BE M..:.aE
OF t..--...:.,.- 5TRJCTU~ 1111TMOUT PER:"1IS5ION 0:= THE !3U1LD!NC:J DIVISION. I FURTHER CERTIFY 7J..l..1T ONL ";' COSTR.ACTC~5
.<.ND EMPLOYEES ta-l0 ARE IN COMPLIA'ICE WITH ORS 101055 WILL BE USED ON THIS PROJECT.
~ ~ - . lo - 2-0-=7';;:
SIGNED
DATE