HomeMy WebLinkAboutPermit Sidewalk 1992-3-17
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (5031 726-3753
~RD~
ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER: f c:r 0 J (, V.
INSPECTION LINE SEE INSPECnONS ON BACK SIDE .
APPLICATION DATE: '3/17/ff
"
DATE ISSUED:
3/11/1 l'
\ LOCATION OF WORK
~P+-O ~,~
SITE ADDRESS: SO $5 Q:lU.,.:...;~~ l.A.-LA
CITY: ~1;-..v~ STATE:' 0TL I ZIP:
SUBDIVISION:
OWNER: . n,...... JL ~t=- . ,PHONE:
ADDRESS: ~D5-z.., BL'd'_BPA! CITY: ~iV't;-.fvC...l ('J \ STATE: .Ol1L. I
CONTRACTOR: tzo'~ ~:;.- 'D~ ADDRESS: QS7 (Z(.rL v frv-.c
CONTRACTOR REGISTRATION NO: 7/1 b,- EXPIRATION.DATE: Hfc,~
PROJECT SUPERVISORl
APPLICANT
.PHONE
b?i4.- {711
TAX MAP:
TAX LOT:
ZIP: ct 7.:iIJ
PHONE: c'~C(:(f II
PHONE:
REQUESTED PERMITS:
INSPECTIONS IU!QUIR!OI APPUCATlON FE! , DEPOSIT
ACCOUNT NO:
o ENCROACHMENT PERMIT NO: ............................... n
VALlO FOR SIXTY ISOI DAVS fROM DATI OF ISSUANCE
a CUT STREET a BORE a OTHER n
a DUST CONTROL (TYPE OF CONTROU
,
o $-80.0~
0$
a CONSTRUCTION. STORAGE, STAGING
a OTHER
n
n
0$
0$
0$
a ASPHALT DEPOSiT................................................................................'.....,........,......~.....
TYPE OF SECURITY OEPOS/"(
a BLANKET SURETY BOND a SURIITV BOND a CASH / CHECK
o CURB CUT PERMIT NO: .................... FT. 0
IN!:PFeTlON' CURB I APPROACH AFTER FORMS ARE ERECTED BUT I'Iil0R TO POURING CONCRETE.
VAllO FOR 1BO DAVS FROM DATI OF ISSUANCE.
Q SECON'O DRIVEWAY (SEE SEPARATE APPUCAnON) /'"
~ SIDEWALK PERMIT NO: .................... FT. 3 n
~ VALID FOR 180 DAVS FROM DATI! OP ISSUANCE.
Q NEW a REMOVE / REPAIR Q PAVE PLANT STRIP
a'SETBACK a CURBSIDE Q LENGTH
IN!':PF~TlnN. !':loeWALK' ORIVEWAV FOR AIi CONCRm 'AVING WITHIN THE STREET RIGtfT OF WAY. TO BE
MADE AFTER ALL EXCAVATING IS COMPLETE ..ANO FORM WORK AND SUB-BASE MATERiAl IS IN PLACE.
D SANITARY SEWER CONNECTION.PERMIT: ................ n
VALlO FOR SIXTY 1801 DAVS FROM DATE OF ISSUANC!
a TO STUB a MAIN LINE (EASEMENT-R/Wl a OTHER
o STORM SEWER CONNECTION PERMIT: .................... n
VALlO I'OR SIXTY'ISOI DAVS FROM DATI OP ISSUANCE
Q CATCH BASIN / BUBBLER a STUB Q MAINUNE
PROOF OF INStJRAM~J:., $500,000 MINIMUM
. a ATTACHED Q REQUIRED AMOUNT
0$
o $10.00+ ..151FT.
o $10.00:+-$.15/FT.
j(). 75-
o $5.00/.
o $5.00/
TOTAL DUE:.~.
TOTAL DUE WITH PERMIT.
. DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:
o PLANS (TWO SETS) ATTACHED
AREA: LENGTH: I .
\ '
TYPE OF WORK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEMeNT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UTI~IZED:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
WARNING DEVICES TO BE UTILIZED:
Advance signing and work zone protection to ba In compliance with the Manua' on Uniform TraUlc Cont/ol Devices (MUTCD).
FROM DATE:
. TO DATE:
WIDTH:
DEE'TH:
~.. <
. TIME:
TIME:
,
)1EIGHT:.- .
BORE:
. BACKFILL MATERIAL:
DESCRIPTION:
Ii
WORK SHALL COMPLY WITH CHAPTER X ARnCLE 6 OF THE CITY CODE. CONTRACTOR TO eOMPL Y WITH MUTCD .
REVISIONS 8/24/95 FORM 1118 I
.PLAN REVIEW COMMENTS I SPECIAL INSTRUClIONS: . '. ..
RESTORATION WORK SHALL BE IN CO, IMANCE WITH EXISTING CITY CODES AN&.. .... dbMPLlANCE WITH CURRENT
STANDARD SPECIFICATIONS, EXCEPT '- ~OTED BELOW. '
~ 001 Backfill with l. mlnua rock.
. 002 Complct every 18" 100.. d.pth,
. 003 Requlr.. complotlon with. .t,,1 roilier.
004 A.C. to mltch the grllter of .xl.tlng depth or 4",
006 AU cut. ...Ied for. flnlllnapeotlon,
008 . Temperlry pitch mlY b. u..d et the end of the diY,
007 Signing Ind Zoni proteetlon to comply with MUTCD
008 Cut concrete ohly on 'acore IIn.. or. cold Jolntl.
009 SIdewalk. and driveway. mln. 3,OOOp.L
010 Curbing mtn 3,1500pll' No pltchwork I... thin 3'.
011 Meet min. requlrementa on curb Cutl. Spfd. code.
012 Reatore pllnted.are.., Spfd. code 208.3.05
013 Spec. to Bore' Jlck , No A.C. cutl.
~ 014 Mechanlcll completing required.
016 No pltchwork .1I0w.d.
018 Laterl' cut. to hlv, control d.nllty fill.
017 Cutl to be polymerized crick "lied for f1nlllnspectlon.
, 018 Mlnlnum 2" crushed rock %- minus.
Comments:
019
020
021
022
023
024
025
026
027
028
029
030
031
.032
033
343
Mlnumum 4' cl..rlnce It Iny point. Iwing.8wlY.
Concr.t. minimum 4" depth, 3.000psl.
Tr.nch to b. ..,.- out.
Needs Stlt. / County permit.
No Ibov. ground .nclollngl In Ildewalk or handlclp ramps.
Dllmond cut A.C./Concrete vllue boxes to grlde.
Fr'lh 011 Ilgnl / Grld.d.
Comply with Amerlclnl with Disabilities Act.
Concr.te Ilabl, 72hrl. curing time, 4500psl.
Concrete Itlb. ,equlrelolnt .811 materlll.
Driveway ,.qulr.. dowell .very 18".
Submit trlWc control plln prior to exclvatlon.
Notify Trlfflc Dlvlllon before exclvltlpn.
Core drllfmlln line. In..rt tee. 2% min. grede.
MUlt comply with the provisions of OFtS 757.541 to 757.571.
6" Clrcullr hoII1H20.vlc.
t.
YOU ARE REQUIRED TO CALL
THE lANE UTiliTIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
INSPECTIONS:
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 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 WO~K IS IN PLACE BUT PRIOR TO POURING CONCRETE.
'0
o SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726-3761.
SIGNATURE:
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 dpne In accordance WIth the Ordinances of the
City of Springfield, applicable City Standard specifications and Drawlngshand the laws of the State of Ore.Qon pertaining to the work
described herein. I further certify that only contractors and employees w 0 are In compliance with ORS 701.055 will be used on this
project.
The City may Insp.ect the work site described In this p'ermlt at :any time during a one year period following the receipt by the City of
notice of. completion of the descrlbedlwork and ,pel~tfy. at th, City's sole descresslon, any additional restoration work'required to
. return the site to a standard acceptab e to the City. Tlie permittee will be notified in writing of any wprk required and will have thirty
. days (30) from the d~tQ of the notice to complete the work. Work not completed at the ena of the thirty days will be performed by the
. City and the costs will be billed to the permittee.' .
. I furthor agree to ensure that all required Inspe ons are requ&ted at the proper time, that project address Is readable from the street.
and the roved s t of plans will remain 0 e ite at all times during construction.
,,' .
t?
AMOUNT RECEIVED:
RECEIPT NO:
10.1f
t7 3) 1ft
-----.
Signature .
'10
3/17/,f1 I
/' f WM/
DATE PAID:
RECEIVED BY:
Date
~/17/9 ~
VALIDAT 0
0 REVIEWED BY: DATE:
0 ENGINEERING REVIEWED BY: DATE:
0 MAINTENANCE: DATE:
0 PERMIT ISSUED BY; DATE:
'.
· FOR SIDEWALK AND CURB CUT PERMITS PLACE A COpy (COMPLETED) IN PERMIT ORA WER.
. INSPECTION:
'. INSPECTION:
WORK IN PROGRESS
AT TIME OF COMPLETION:
ELEVENTH MONTH:
_. 'DEPOSIT RETURNED:
DATE:
DATE:
DATE:
DAT~:
DATE:
DATE:
.'