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WEEKLY CONSTRUCTION PERMIT PROJECT
STATUS REPORT
This report is to be completed on a weekly basis and submitted to the City of Springfield, Public Works Department by the Engineer of
Record for the Public Improvement Permit Project referenced below. This report is provided for informational purposes only. Any
signatures by representatives of the City of Springfield are only an acknowledgement of the receipt of this form and do not in any way
signify the City’s agreement with or acceptance of the information provided.
REPORT NUMBER:
PERIOD BEGINNING:
PERIOD ENDING:
PROJECT NUMBER:
PROJECT NAME:
LOCATION:
DEVELOPER
CONSULTING ENGINEER
CONTRACTOR
N A M E :
COMPANY:
ADDRESS:
CITY:
PHONE:
JOB STATUS:
OVERALL PERCENT COMPLETE:
%
C L E A R I N G :
----
%
EXCAVATION:
----
%
DRAINAGE:
----
%
F IL L:
----
%
SAN IT AR Y :
----
%
B AS E Embankment
ROCK:
----
%
CURB/GUTTER:
----
%
PAV IN G :
-----
%
SIDEWALKS:
----
%
S TR E ET LI GH T S:
----
%
TRAFFIC
CONTROL:
----
%
C L E A N -
UP:
----
%
REMARKS (WORK: DONE LAST PERIOD, TO BE DONE NEXT WEEK, OTHER):
TENTATIVE CONSTRUCTION COMPLETION DATE:
ANTICIPATED CITY ACCEPTANCE DATE:
(ALLOW MINIMUM OF 3 WEEKS AFTER CONSTRUCTION COMPLETION DATE)
PREPARED BY:
DATE:
FOR CITY USE ONLY
EARLIEST PROJECTED PLAT FILING DATE:
EARLIEST PROJECTED BUILDING PERMIT ISSUANCE DATE:
CITY ENGINEER:
CONSTRUCTION INSPECTION:
CIVIL ENGINEER:
TRAFFIC INSPECTOR:
COPIES MAILED TO (AS INDICATED):
BUILDING O FF IC IAL
MAINTENANCE MANAGER
CONSULTING ENGINEER
DEVELOPER
CONTRACTOR
WATER DEPARTMENT
SUB ELECTRIC
DEPARTMENT OF ENVIRONMENTAL QUALITY
NORTHWEST NATURAL
SUB WATER
WILLAMALANE
SCHOOL DISTRICT
V:\FO R M S\ENGFORMS\WEEKLY CONSTRUCTION PERMIT.doc – February 2011