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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