HomeMy WebLinkAboutPermit Sidewalk 2000-5-30
, '-'" Ci1y of Springfield
DRIVEWAY/SIDEWALK ' PERMIT APPLICATION
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
BPRINO..,IiEL _
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PERMIT NUMBER:
DATE ISSUED:
t:)cJ - <3 o 87;?-, 01
APPLICATION DATE:
c.5'5"- "30-00
SITE INFORMATION:
LOCATIONOFWORK:--55t1 Po/f-4.II4- Sf,
APPLICANT Gpt"ald T Pf"wd'ho/MWle
Pol ft{ 1/4 Sf
STATE: 0 R.
SUBDIVISION: R ,'VPr Ira :Is
OWNER: r; -e,.ql ~ T i Cq('o /
ADDRESS: .5 S 7 Po I few q
PHONE
q~-1'383
ADDRESS: 55'7
CITY: .~ <At-"/'
TAX MAP: !7(!;}33'f.2. 3
ZIP: Cj) tf7?
TAX LOT:
O/7oC)
f1.. <tel'k Out_ ~
CITY: ..5r":~'1.{;'{>( d
PHONE:
STATE: 0 1<
9'/?'R -13 'i?.3
ZIP: c,)~)')
REQUESTED PERMITS:
B DRIVEWAY ICURB-CUT /SIDEWALK: .....................................................................$ 60.00
AMMOUNT OF SIDEWALK IN EXCESS OF 90FT. '-PI I X 5 I @$0.06 SF. $ /3 - ~ ., ~
o SIDEWALK REPAIR: ...................................................................................$ 10.00.
o ADDITIONAL DRIVEWAY:
............. ............. ........... ........ ........... ...........$ 30.00
o fROOF OF INSURANCE: $500,000 MINIMUM IF WORK IS DONE BYPROPERTYOWNER ~ ~z., (..1-
TOTAL DUE WITH PERMIT $ .w J. l.~
CONTRACTOR INFORMATION:
et(5 fOWl CoYlcY'efe
Co6ur-j Rd. /
CONTRACTOR REGISTRATION NO: /00 Lf",q
PROJECT SUPERVISOR: ~) l,^" k': '" 'f
}<;"'c:J'5
q (') J./_~
'E"'tUvo. e ,01< q)IfD~ PHONE: lil/- 9~8
J
EXPIRATION DATE:
, PHONE:.J.Y If - 'N '13
CONTRACTOR:
ADDRESS:
"
INSPECTIONS:
AN INSPECTION REOUEST 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 AM. WILL BE MADE THE
SAME DAY, REQUESTS AFTER 7:00 AM. 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 REOUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" '-800-332-2344
48 HOURS BEFORE DIGGING
SIGNATURE:
AMOUNT RECEIVED: ~?6 Y DATE PAID: ~~a.~
RECEIPT NO: ~ /4L/ / RECEIVED BY: / a ~:;,.. .
By signature, I state and agree, that I have carefully examined the completed application /~ebY certify that all information herein
is true and correct and I further certify that any and all work performed shall be done in ac~d~nce With the Ordinanc~s of
the City of Springfield, applicable City Standara specifications and Drawings, and the laws of the State of Oregon Rertalning to the work
delcr,ibed herein. I further certify that only contractors and employees who are in compliance with OAS 701.056 will be used
on lh S 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 re~uired to return the silt:
to a standard acceptable to the City. The permittee will be notified in writing of any work required and will have thirty days (30) from the
date Ilf the notice to complete the work. Work not completed at the end of lhe thirty days Will be performed by
the CllY and tho COltl will be billed 10 Ihe pormillOo,
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 approved set of plans will remain on the site at all times during construction.
Signature~/2J~
Date
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