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HomeMy WebLinkAboutPermit Application 1995-9-6 . ~ Oregon ..---- DEPARTMENT OF TRANSPORTATION September 6, 1995 DistrictS FILE CODE: C & E Rentals ATTN: Scott 1570 South A ST. Springfield, OR 97477 Enclosed is an Application to Perform Specified Activity within State Highway Right of Way. THE APPLICATION IS NOT A PERMIT, . Please sign the application in the box marked APPLICANT and fill in the date space. Any of the items checked below will also be required. (X) insurance ( ) Perfonnance bond in the Amount specified on form. (form attached) (X) Administrative fee in the amount of$ 50.00 . Make check payable to the Oregon Department of Transportation. (X) Signature oflocal government official Ifinsurance is required you will need to provide the Oregon Department of transportation with an insurance certificate nammg the denartment as additional insured. The Sincerely ~)/ V~ //K~/ A5'-c. p Michael J. Barker Permit Specialist mjb c: e. . . " .' " " 734-2257 (4-92) 3620 Gateway Springfield, OR 97477 (503) 726.2552 FAX (503) 726,2509 Q""'..... ~ -./1 .'j ~.",~"",o HIGHWAY DIVISION HIGHWAY NAME McKenzie .APPLlCATION AND PERMIT TO _ CONSTRUCT APPROACH ROAD PERMIT NUMBER MILEPOINT I ENGINEERS STATION 15 I COUNTY Lnne 2.64 SIDE OF HIGHWAY o NORTH 0 EAST o SOUTH 0 WEST HIGHWAY REFERENCE MAP AND ATTACH 80+20 APPROACH TO SERVE HIGHWAY NUMBER BETWEEN OR NEAR LANDMARKS Rental Business o DRAWING NUMBERS 15th St AND 17th St 5B-36-8 BOND REQUIRED AMOUNT OF BOND APPLICANT NAME AND ADDRESS ~ REFERENCE o YESXX NO OAR 734-50-025(6) $ I INSURANCE REOUIRED REFERENCE .DYES 0 NO OAR 734-5Q.025(3) I AMOUNT $50.00 1 ~STRICT MAINTENANCE SUPERVISOR OF REPRESENTA liVE I ~EGION ENGINEER OR REPRESENTATIVE UTILITY PERMIT SUPERVISOR o I C&E Rentals 1570 South A Street Springfield,OR 97477 'I Xl ADMINISTRATIVE FEE o TEMPORARY DEPOSIT CHECK NUMBER DATE COMPLETE APPLICATION RECEIVED L DATE APPROVAL DATE TELEPHONE NUMBER; x APPLICANT I APPLICATION DATE SPECIFIED COMPLETION DATE: REFERENCE: OAR 734-so.050(4) Q-JC1-Q'; x The eppllcant declarel that he/she Is the owner or lessee 01 the real propertr. adlolnlng the above described highway and has the lawful authority to apply lor this permit. When this application Is approved by the Department 01 Transportation, the applicant s subject 10 the terms and provisIons contained hereln and attached hereto: and the terms 01 Ore~on Administrative Rule, Chaplar 734, Division 50, which Is by this relerenca made II part of this permIt. Copies 01 the Rule may be obtllined from Ihe District Malnlenance Supervisor's olllce. Issuing 01 permits under these regulations Is not a Ilndlng of compliance with the statewide planning goals or the acknowledged comprehensive plan lor the area. Permits are Issued subject to the approval 01 city, county or other governmentalagencles having either Joint supervision over the section 01 highway 0( authority to re!:lulate land use by means 01 zoning and/or building reguletlons. II shen be the applicant's responsibility to obtain any such approval including, where applicable, local government determination 01 compliance wilh the statewide planning goals. (OAR 734.5().{l55) SPECIAL PROVISIONS 1 - If the proposed application requires traffic control devices and/or special road construction, the applicant shall provide a copy of this application to the ~ocal government. The original application must be signed by the local government official. ~AL(N~2ATU~~ I TITLE . r:2--< ~ ID9_/6~f 2.L Within 48 hours b~~~~ ork and after completing the p mlt work, the applicant or hIs c~ntr8ctor shall notify the District Representative at telephone number - Approach to be reconstructed to ADA standards and City of Springfield standards. This permit canccels and supercedes permit D 14824. TYPE 4 APPROACH ROAD - CURBED HIGHWAY NOTE: All material and workmanship shall be in accordance with the cur. rent State of Oregon Standard Specification for Highway ConstructIon. R/W L1n_,-, I I I I I , Drwy. r Iw- 30' W,- 36' APPROACH TYPE A x- 4' CURB TYPE I ~;- .} , r.s.~! lN~tj" _ I ANGLE OF SKEW 90 A NOTES: W - WIOTH OF ORIVEWAY K - DISTANCE FROM FACE OF CURB TO BACK OF PRESENT OR FUTURE WALK OR 10 FEET. WHICHEVER IS LESS W, - SEETABLEAON REVERSE X - SEETABLEAON REVERSE 734-3307E (&-88) SEE BACK OF APPLICATION produeed by STATE PRINTING