HomeMy WebLinkAboutPermit Encroachment 1997-9-8
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- ~/"CITY OF SPRING.. .ELD '. . I _RMIT APPLICATION', .:
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225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
8PRINQlltao
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ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER:
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INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
APPLICATION DATE:
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DATE ISSUED:
. . LOCATION OF WORK
APPLICANT (' AM~J'VJ /"<j :T:'~
SITE ADDRESS: Co 3 ? ({' n LV'
CITY: S",CU STATE: /Yf?
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SUBDIVISION:
OWNER:
ADDRESS:
CONTRACTOR:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERVISOR: 'T""" /?_.da.s./I
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CITY:
ADDRESS:
PHONE(B) 7~!- 6313 (kj) II~'S ~7,y~P;
TAX MAP: .
'TAX LOT: ~
.PHONE: ~
STATE:
2'137/ A""~_~J<l &;,-
EXPIRATION.DATE:
ZIP:
'771'7)
ZIP:
_ PHONE: ~Yr- 7Mfi
PHONE:
REQUESTED PERMITS: INSPECTIONS REQUIRED,
Q ENCROACHMENT PERMIT NO: ............................... n
VALID FOR SIXTY ISOl DAYS FROM DATe OF ISSUANCE
Q CUT STREET Q BORE Q OTHER n
Q OUST CONTROL ITYPE OF CONTROU
Q CONSTRUCTION. STORAGE, STAGING n
Q~~ n
Q ASPHALT DEPOSiT........................................ ........ .................................................... .......
APPUCAnON FE! I OEPOsrr
ACCOUNT NO:
o $20.00/
0$
TYPE OF SECURITY DEPOSIT
Q BlANKET SURETY BONO Q SURIITY BOND Q CASH I CHECK
o CURB CUT PERMIT NO: ................~... FT..._ __ 0
1N~"M1nN. CURB' APPROACH ArnR FORMS ARE ERECttD BUT rnlVNIU POURING CONCRETf.
. VALE) FOR 180 DAVS FROM DATE OF ISSUANCE.
Q SECOND DRIVEWAY ISEE SEPARATE APPUCATlONJ
o SIDEWALK PERMIT NO:.................... FT.
VALID FOR 180 CAYS FROM DAn OF ISSUANt!.
Q NEW 0 REMOVE I REPAIR 0 PAVE PLANT STRIP
o SETBACK 0 CURBSIDE 0 LENGTH
1N~"l"'TlnN' !:tDEWALK I OArlEWAY FOR ALL CONCRETE PAYING WITHIN THE STREET RIGHT OF WAY. TO BE
MADE AnEA All EXCAYATlNQ IS COMPLETE. AND FOAM WORIl: AND SUB.BASE MATfRIAllS IN PLACE.
(3t SANITARY SEWER CONNECTION PERMIT:..""""..".. n
VALl) FOA SIXTY 1801 DAYS FROM DATI! OF ISSUANCE
o TO STUB 0 MAIN UNE IEASEMENT.R/W) .a OTHER T. . M.M
o STORM SEWER CONNECTION PERMIT: .""...""."."..n
YAll) FOA SIXTY 1801 DAYS FROM DATE OF ISSUANC!
Q CATCH BASIN / BUBBLER Q STUB Q MAINLINE
PROOF 0" 'NC:IIRMlCE; $500,000 MINIMUM
Q ATTACHED Q REQUIRED AMOUNT
0$
0$
0$
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0$
o $10.00H.15/FT.
n
o $10.00:+-$.15/FT.
o $5.0'0 I .
o $5.00 I
TOTAL Due;'-$
TOTAL DUE WITH PERMIT $
?A~&-C-'
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DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION: FROM DATE: . TIME:
o PLANS /TWO SETS) ATTACHED TO DATE: TIME:
AREA: LENGTH: WIDTH: DEPTH': HEIGHT: .'
TYPE OF WORK: CUT: BORE: 'j
OTHER:
EXISTING SURFACE MATERIAL: . BACKFILL MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEMENT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UTlpZED:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
WARNING DEVICES TO BE UTILIZED: . ..
Advance Ilgnlng and work lone ,protection to be In compliance with lna Manual o~ Uniform TraUlc Control Cevlces (MUTeO).
DESCRIPTION:
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD.
REVISIONS B/24/95 FORM , 116
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PLAN REVIEW COMMENTS I SPECIINSTRUCTIONS: . j
. ~ESTOAATION WORK SHAll BE IN CONF ANCE WITH EXISTING CITY CODES AND I.MPlIANCE WITH CURRENT
, STANDARD SPECIFICATIONS, EXCEPT AS TED BELOW.
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Mlnumum 4' clearance at any point. swing-away.
Concrete.mlnlmum 4" depth, 3,OOOpsi.
Trench to be "T" cut.
Needa Stato I County parmit.
No above ground encloslngs in sidewalk or handicap ramps.
Diamond cut A.C./Concrete value boxes to grade.
Fresh Oil signs I Graded.
Comply with Americans with Disabilities Act,
Concrete slaba, 72hrs. curing time. 4500p51.
Concrete slabs require lolnt seal material.
Driveway requires dowels every 18".
Submit traffic control plan prior to excavation.
Notify Traffic Division before excavatifn.
Core drill ma.i~ I!n~. in~ert te~, 2% min. grade.
Must complv'wlth tho p.ovlslonso! OAS 757.541 to 757.571.
6" Circular holeIH20-Vac.
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:'~ 001 Backfill with %" minus rock.
002 Compact every 18" loose depth.
003 Requires compaction with a steel rolller.
- 004 A.C. to match the greater ot existing depth or 4".
.. 005 AU cuta lee led for flnallnspection.
- 006 Temporary patch may be used at the end of the day.
- 007 Signing end Zone protectlon to comply with MUTCD
. 006 Cut concrete only on score lines or. cold joints.
. 009 Sidewalks and driveweya mIn. 3.ooopsl.
. 010 Curbing mln 3,500psll No potchwork loss thon 3'.
. 011 Meet min. requirements on curb cuts. Spfd. code.
. 012 Restore planted,ereas, Spfd. coda 206.3.05
- 013 Spoc. to 60ro I Jack I No A.C. cuts. ,
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:l 014 Mechanical compacting required.
015 No patchwork allowed.
. 016 lateral cuts to have control density fill.
. 017 Cuts to be polymarized creck s8aled for flnal inspection.
- 018 Mlnlnum 2" crushed rock %" minus.
Comments:
. 019
. 020
021
022
023
024
j 025
.J 026
027
028
029
030
031
032
~ 033
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YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
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INSPECTIONS:
'Q
CURB CUT AND SIDEWALK INSPECTIONS CALL 726-3769 (RECORDER) STATE YOUR DESIGINATED CITY JOB
NUMBERIPERMIT 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.
Q SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726.3761,
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SIGNATURE:
AMOUNT RECEIVED:
RECEIPT 'NO:
~5,60
Z. 7,~ z <;"
DATE PAID:
RECEIVED BY:
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By signature, I stete and egreel that I heve carefully examined the completed application and do hereby certify that all information
h~rein is true end correct, end further certify that any and all work performed shall be done in eccordance w,th the Ordinances of the
City of Springfield, appliceble City Standard specificatIons end Drawrngshand the laws of the State of OreJjon pertaining to the work
described herein. I further certify that only contractors end employees w 0 are in compliance with ORS 701 .055 will be used on this
project.
The City may inspect the work site described In this p'ermit at eny time during a one year peiiod following the receipt by the City of
notice of. completion of the described work end speCIfy, at the City's sole descression, any additional restoration work required to
. return the site to a standard eccepteble to the City. The permittee will be notified In writing of any work required and will have thirty
. deys (301 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 furthor agree to ensure that all required Inspections ere requested at the proper time, that project address is readable from the street,
and the epproved set of plans will re~eln on the site et all tImes during construction. .
: Slgnature)(
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Date
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VALIDATION:
o TRAFFIC REVIEWED BY:
o ENGINEERING REVIEWED BY:
, 0 MAINTENANCE:
o PERMIT ISSUED BY:
DATE:
DATE:
DATE:
DATE:
: FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.
INSPECTION:
: INSPECTION:
~ WORK IN PROGRESS
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AT TIME OF COMPLETION:
ELEVENTH MONTH:
DEPOSIT RETURNED:
DATE:
DATE:
DATE:
DAT~:
DATE:
DATE:
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ADDENDUM
City of Springfield
To: PermiteelUtility InstallerlUtility Company
From:
Mike Koivula, City Survey Dep't-
April 9, 1997.
City Specifications, Survey Monumentation, State Law
Date:
. Subject:
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. PA<;JE 1 OF2
All permittees under our "Encroachment Permit" program should' b~ 'partiCul~ly aware of their .
i'esponsibilitiesas noted under the section "PLAN REVIEW'COMMENTSlSPECIAL . .
INSTRUCTIONS" on the reverSe side of the permit form which refers to the current city
sp~cifications document." . .
Besides the full' giunut 'or"construction ~dards the .document also lias specific provisions relating
to the protection and preservation of survey. monuments. '(1) Iii addition, there are Oregon State .'
'laws thai deal with the same subject(2)." .
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For. a general overview of survey monuments, please see the following page. . '.. '.
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For general information tegiu-ding city specifications imd the perin it proCess; please call o~r office
. at' (5~ 1) 726-3753. For specifi~ assistance with survey monumentation please call me directly at:
. . (541) 726-3679.. .
(I).City of Springfield Standard Specifications, 1993
Monuments"
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section 1 q5-1 0 "Protection of Survey .
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.(2) OREGON RE\iISED STATUTE 20~USO "REMOVAL AND DESTRUCTION OF.
. .MONUMENTS.."
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ADDENDUM.
City of Springfield
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TYPICAL MONUMENT CONFIGURA nONS CAN INCLUDE:
'1) Property corners
Th~se usually are a piec.e of steel reinforcing rod (rebar) of 1/4 to 1 inch diameter or lengths of
iron pipe with diameters of 1/2 to 4 incheS. They inay or may not have tags or caps of brass, . .
aluminum or plastic with identilYing letters,' numbers or combinations of the two. They are
typically found at recognized property occupation limits, fence co~er areas, hedge rows and
between utility services like water meters. Along road right-of ways; they can be found 1/2 to eight
feet behind the back of sidewalk, and may be found at typical "occupation" lines as delineated
. above and also at areas where r'oads make angular changes, curve or change in width..
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2) Roadway ce~terline markers' '. . ". . . .
. In asphalt or concrete streetS, 'these are typically nails of various types, sometimes with
identilYing tags or washers. They can also be ''rebars'' or iron pipes as delineated above. They can
be found typically at the intersections of roads, on the center of both roads, and on the .center of'
. one and the right-of-way of the other. They may also be found at angles and curves of road ,
. alignment or at,changes.inroadway width. In uniinproved dirt or gravel roads, they are typically
"rebars" ?r pipes set below the driving surface.. .
. 3) Road ReferericeMo'niiinen~ aDd Benchm~ks .
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These are typically s!riall nails. set in concrete curbs in the.vicinity of road centerlin~' markets.
They al~o can be brass caps of 1/2 to"2 inches in diameter. Benchmarks (vertical Control .
monuments) canillso be squares chiseled in to the curb .concrete. A system offederally installed
precise benc:hmarks comprises iron rods set into aluminum "valve~type~' cases at South A st in .the
vicinity of 14th 5t.and along Main St in the vicinities,of24th st, 33rd st (at house 'no. illS -N .
33rd),s4Istst,S9thst~ and64thst. ..
. 4) Government Control-Monuments
. Tt1ese typically compri~e brass caps set in concrete m~nuinents , railroad spikes set in p~ving .
, and various types'ofritOlluineittsset in "valve-type" cases. Their loCation varies with the type of:
monument and does not follow any typical location pattern: Often there are warning signs in the
vicinity or sUNey stakes and colorful ribbon to alert you to thes~ monuments. .
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