HomeMy WebLinkAboutPermit Sidewalk 2001-7-20
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
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PERMIT NUMBER:
DATE ISSUED:
APPLICATION DATE:
Julv 20, 2001
SITE INFORMATION:
LOCATION OF WORK:
APPLICANT Branch Enq .jGeQrge T. Travess
ADDRESS: Corner. of ,l9th_ and G Street
PHONE (541.) 746.-0637/(5-41 )747-9940
TAX MAP:.L7 -n~-~ n- 1 2
CITY: S:::>r inaf i eld STATE: Oreaon
SUBDIVISION: Travess Partition
OWNER: GeorGe T. Travess
97477
TAX LOT: 12200
ZIP:
PHONE: (541) 747-9940
STATE: Oreaon ZIP: 97477
,ADDRESS:1495 Cheek Street
CITY: SprinGfield
REQUESTED PERMITS:
W SIDEWALK:. ...... ..................... ........ ..... ....... .... ....... .......... ........ .... $ 65.00,........ = $
AMOUNT OF SIDEWALK IN EXCESS OF 90FT. 400 s. f. @$0.06 SF. = $
o SIDEWALK REPAIR:.........................................:....................... .....$ 1 0.00 ~......... = $
65.00
24.00
!XI CURB CUT/DRIVEWAY: NUMBER OF DRIVEWAYS 2
x.............$ 65.00.,....,....
$ 130.00
!XI MULTIPLE PERMIT DISCOUNT EA: ....(MAX 2) ........... ....................$ 30.00.. ........= $ j- 60. 00 )_
(MULTI PERMIT DISCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECTION...Q.NlY ,
APPLIES TO 2nd AND 3rd PERMITS ONLY. NOT SIDEWALK REPAIRl
TOTAL DUE WITH PERMIT $
o PROOF OF INSURANCE: $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
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CONTRACTOR IN~ORMATION:
CONTRACTOR: -Travess Construction, LLC
ADDRESS:
CONTRACTOR REGISTRATION NO: 138060
PROJECT SUPERVISOR: Mike Travess
PHONE: 51 7 - 749 n
EXPIRATION DATE:Nov. 1, 2001
PHONE: 51 7 - 7490
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 726-3769lRECORDER) 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
II ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
SIGNATURE:
AMOUNT RECEIVED:
RECEIPT NO:
DATE PAID:
RECEIVED BY:
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify 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 Ordinances of
the City of Springfield, applicable City Standard specifications and Drawings, and the laws of the State of Oregon pertaining to the work described
herein. I further certify that only contractors and employees who are in compliance with GRS 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 notice of
completion of the described work and sp'ecify, at the City's sole discretion, any additional restoration work reQuired to return the site 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 of the notice to
complete the work. Work not completed at the end of the thirty days will be performed by ,
the City and the costs will be billed to the permittee. " "
I further agree to ensure that all required inspections are requested at the proper time, that project address is readable from the
,street, and the~PProved t of plans will remain on the site at,,:imes during constructIOn.
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Signature. ~~/ ~ ~---:r?A'/~ Date /'""" (
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