HomeMy WebLinkAboutPermit Encroachment 1998-9-10
226 FIFTH STREET
SPRINGFIELD. OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (603) 726-3763
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ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER: 9'[( 0/ /4' /
APPLIOATION DATE:
INSPECTION LINE SEE INSPECTlONS ON BACK SIDE .
9J-{)/9'~
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DATE ISSUED:
0/-/045'
. . LOCATION OF WORK
APPLICANT
SITE ADDRESS:
CITY: -$ f1.
SUBDIVISION:
OWNER:
ADDRESS:
CONTRACTOR:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERVISOR:
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C-4/t.A-u; IiO. 6--r
{) /L. ZIP:
PHONE
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TAX MAP: /7-<:'/<,-2.(,,-c..1
'TAX LOT: ~C{()<<-I
STATE:
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CITY:
ADDRESS:
.PHONE:
,STATE:
ZIP: ~l .
,PHONE: ~
PHONE:
EXPIRATION,DATE:
REQUESTED PERMITS'
o ENCROACHMENT PERMIT NO: ............................... n
VALl) FOR SIXTY 1801 DAYS 'ROM DATI 0' tSlUAHCI
o CUT STREET 0 BORE 0 OTHER n
o DUST CONTROL ITYPE OF CONTROU
INSNCT10NS N!OUJREOI AfttlUCA110N FlI, DUOItT
ACCOUNT NOI
Q .'80.00
Q.
o CONSTRUCTION. STORAGE. STAGING ,n
Oo~~ n
o ASPHALT DEPOSiT.....................................................................................................,......
TVDO IlF SEClIRITY 1l0DQSII
o BlANKET SURETY BOND 0 SURIITY BONO 0 CASH 1 CHECK
o CURB CUT PERMIT NO: ................;... FT._. Q
INOFM'1nN. CURl I APPROACH AFTER FOAMS ARI WCTlD BUT PRIOh 'fO POURlNQ CONCRfT!.
, VAll) fOR 110 DAVI fROM DATI D' ISSUAHCI.
~ ~ SECOND DRIVEWAY (SEE SEPARATI!APPUCAnONl
~ SIDEWALK PERMIT NO: .................... FT. /0 /" Q
VALl) ~A 180 DAYS 'ROM DATI 0' ISSUANCE.
o NEW 0 REMOVE I REPAIR a PAVE PLANT STRIP
O'SETBACK a CURBSIDE 0 LENGTH
IN~PF,..Tln.... f:.1C(WAl.K, DRIVEWAY FOR AU. CONCRm 'AVlNQ WITHIN TH! STRUT RIGHT 0' WAY, TO Bi
MADE MTER ALL lXCAVATV'lIO IS COMlUTI. AND fORM WORK AND aulolAS! MATERlAL IS IN PUCE.
o SANITARY SewER CONNECTION PERMIT:................n
VALl) FOR SIXTY leOI DAVS FROM DATI Of ISSUANCE
a TO STUB 0 MAIN UNE (EASEMENT-R/W) a OTHER
o STORM SEWER CONNECTION PERMIT: ....................n
VALe fOR SIXTY leo) DAva fROM DATI OIIIS1UAHCI
a CATCH BASIN I BU88W\ a STUB a MAINUNE
PROOF OF IN!:lJRANCF' 8600,000 MINIMUM
. 0 ATTACHED 0 REQUIRED AMOUNT
0$
0$
O.
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Q .10.00H.161FT.
Q .10.00:+ ..161FT.
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a $5.do I .
a $5.00 I
DESCRIPTION OF PROJECT:
...-.
TOTAL DUE: .
TOTAL DUE WITH PERMIT $
~ / ' C'()
/1. ;O~
PERIOD OF USE OR TIME OF CONSTRUCTION:
o PLANS (TWO SETS) ATTACHED
AREA: LENGTH:
TYPE OF WORK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZEO:
SURFACE REPLACEM'ENT 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:
AdVlnc. .lgning and work lone protection to be In compU.m:. ~u, the Manu'l on Uniform Tr.Ulo Control D.vleN (MUTeD).
'1"")IZ.( I/~w/l-'" I.. /I ntiA/I,Jr,;. .
FROM DATE:
TO DATE:
9-/o-'1V
TIME:
TIME:
HEIGHT:
.wIDTH:
DEPTH:
BORE:
BACKFill MATERIAL:
I
DESCRIPTION:
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WORK SHAll. COMPLY WITH CHAPTER X ARTICLE Ii OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD .
R&VIlION8 1/34/11 fORM 1111 '
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PLAN REVIew COMMI!NTS/'SPE;I' L INSTRUCTlONSI' " ., -
RESTORATION WORK SHALL BE IN CO ANCE WITH EXISTING CITY CODES AN.MPUANCE WITH CURRENT "
STANDARD SPECIFICATIONS, EXCEPT A OTED BELOW,
3 001 Ilocktm Wlth~. mlnUl rock. : 018 Mlnumum 4' cl....nc. .t.ny point, .wlng..w.y,
" 002 Comp.Cl.y.ry IS. 100.. d.pth. . 020 Coner.t. minimum 4' d.pth, 3,OOOPII.
.. 003 Rlqulr.1 ccmplotlon with. 11..1 rom.r. 021 Tronch to b. "T. cut.
. 004 ....0, 10 ..0l0ll1llo ,ro.I.' .'.IdOlln, d.,th cr 4., 022. Noo'" 11.1.' CounlV ,.""",
.. 005 AD cut. ...ted for flri.IIMpeotton. ? 023 No .bov. ground Inclollngl In Ildowalk or handicap ramp..
. OOS. T.mporory ,"ch m.y b. uI.d .t tho .nd 0' th. dlY. 0 024 Olomond eut ....C,/Concr.t. yolu. bCx" to grad..
. 007 Signing and Ionll prot.etlon to comply with MUTCO . 026 Fr.lh 011 Ilgnll Orod.d.
. OOB Cut concr.t. only on leor. IIn.. or. eold Joint.. . 02B Comply With Am.rlc.n. with OloablllU.. Act.
008 SId.w.lk. .nd drtV.w.y. mln. 3.000p.~ 027 Concr.t. .I.b., 72hr.. cu~ng tlm., 4600PII,
. 010 CUrbing ml'3,800plll No pllchwotlt 1...lh.n 3'. [j 028 Concr.t. .I.b. requl..lolnt ...1 m.t.~.I.
:I 011 Mi.t mln, ..qulram.nll on CIlrb eut', Spld, cod.. 0 028 O~y.w.y ..quire. dowll. .y.ry IS..
. 012 R.llor. pl.nt.d....... Spld. eocl. 208,3.06 . 030 Submit tr.fflo contrcl plln p~or to IXClvatlon.
. 013 Spoc, to 80..1 Jack I No ....C. eut.. _ 031 Notlly T..fflo Olvlllon bo'oro .xcavatlpn.
_ 014 Mochonlcal eompaetlng roculrod. 032 Coro drm m.ln IIno.ln.on too. 2% min. grado.
. 018 No patchwork allow.d. ~ 033 MUll ccmply with tho proYlllonl of ORS 757.641 to 757.671.
. 018 Llto..lcuta to hay. control d.nllty fill. 343 8" Clreulor holoIH20.vac.
. 017 Cutl to bo pOlymo~Zld crack ..alod lor f1nalln,plctlon. .
_ ' 018 Mlnlnum 2- crushed rock.. mlnul.
Comment.:
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YOU ARE REQUIREO TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
INSPE,C.TIONS:
'IZ:(CURB cUr AND SIDEWALK INSPEcnONS CALL 728-3769 (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 WOFjK IS IN PLACE BUT PRIOR TO POURING CONCRETE,
a SANITARY SEWER. STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726-3761.
SIGNATURE:
AMOUNT RECEIVED:
RECEIPT 'Ne:
/ I c;-eJ
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DATE PAID:
RECEIVED BY:
'1 JtJ If!
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By slgnsture, I stete end egree~ that I heve carefully exemlned the completed eppllcetion and do hereby certl'y that all Information
herein Is we and correct, and further certify that any and all work performed shall be done In eccordence WIth the Ordinances 01 the
. City of Springfield, epplicable Ity Standard specillcations snd Drawlngshand tha laws Qf the S\ate of Ore,gon pertsining to the work
described herein, I further certify thet only contractors end employees w 0 are in compliance WIth ORS 701 ,055 will be us ad on this
. project. . I
The Clt" mey Inspect the work .Ite describad In this Ilermlt at :any time during a one year period following the receipt by the City 01
notice c f.completlon of the described work end speltlly, at the City'. sole descresslon, eny additlonel restoration work'required to
. return t Ie ,Ite to e .tandard acceptable to the City. THe permittee will be notified In writing of any work required end will haye thirty
. days (3 lltrom the dflfe Of the nollce to cOlJlplete the work. Work not completed at the en~ of the thirty day., will be perlormed by the
. City anu the ccstl w ba billed to tha permittee. .
I furthor agree to ensure that all f1equlrad Inspections are requdsted at the proper time, that project eddress Is reedeble from the street,
and ,the eppro'(jd set of plans w II re~atn on the site at all times during construction. .
Signature k..d<< (I~ jj-~~/ Date 9-/0- '11r
VALIDATION:
0 TRAFFIC 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 DRA WER.
. INSPECTION:
:. INSPEcnON:
WORK IN PROGRESS
AT TIME OF COMPLETION:
ELEVENTH MONTH:
DEPOSIT RETURNED:
DATE:
DATE:
DATE:
DAT~:
DATE:
DATE:
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PUBLIC WORKS DEPARTMENT
ADMINISTRATION
ENGINEERING DIVISION
MAINTENANCE
SP.FIELD
225 FIFTH STREET
SPRINGFIELD, OR 97477
P.PPlICATION FOR A !>ECONO ORIVEW~U..l OVERWIOTH ORIVEW~
fS,.(
DATE: CJ - / - 9 't
APPLICANT (PROPERTY OWNER): S;f'otr c.. _ ~ +ro r d
ADDRESS OF PROPERTY FOR DRIVEWAY PERMIT: )t(()t.j I..co-a.lee 'S~. S~~ teL
APPLlCANrs TELEPHONE NUMBER: 7'iG, 6 $'il"l. (~~ 1 7:</.,. ~Ol'f(/.%)"/<.)
Please sketch the proposed dJive';'ay. Include the following app6cable Items: housa or building, proposed
driveway. exlsUng driveway. and street names. Include dimensions and measurements to property 6nes. road
Intersections and bordering driveways. (See attachment for an example.)
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AU. APPLICATIONS OUTSIDE THE CITY LIMITS OF SPRINGFIELD THAT ARE WITHIN THE URBAN
GROWTH BOUNDARY REQUIRE A LANE COUNTY PERMIT.
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Note: The City of Springfield will not grant a second driveway permit on an Arterial, or Collector Straet.
ADMINISTRATION/ENGINEERING (503) 726.3753 FAX (503) 726.3689
MAINTENANCE (503) 726.3761 FAX (503) 726.3621
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1. Property type: Single Family Residence / Duplex ~ Other
2. The proposed driveway will take access from which street_ .LQxo..L~~ 'S-+.. ,
3. The distance from the edge of the driveway to the nearest corner (measured to the eurb return) is
feet.
4. The second driveway will give access to: garage_ carport_ side yard_ Other
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5. The distance from the property line to the garage, carport, fence, wall, or other. (where the vehicle Is
to be parked) is 'I feet.
6. Will the proposed parldng / storage area create a vision obstruction to adjacent property driveways or
to any vehicular movement on a pubfic street? (See vision clearance attachment) iV 0
Applicant hereby agrees to inslaD the requested driveway to City of Springfield standards. The applicant further
agrees to have 6" of eonctete in the sidewalk area (adjacent to the driveway), and to pave the area behind the
back edge of the sidewalk, or driveway apron, with a min&num depth of 3" asphaltic concrels or 6" of portland
cement conerels. The area behind the sidewalk shaD be paved a min&num of 18 feel
The applicant agrees that if he/she does not pave the area behind the sidewalk within 30 days of cutting the
curb opening, the City of Springfield has the authority to elose the driveway access by removal of the eurb eul
AD ineurred costs shan be assumed by the applicant and if unpaid, said cost shan beeome a lien of the property.
)
When this appfication Is approved by the City, the applicant must obtain a curbcuVdriveway permit from the
Public Works Department, Engineering Division. "
~~J_rbcut I D.",,-~wav PP-rn]!.W
a. On an Improved street (existing curb): $10,00 plus $.15 per fineal foot of curb cut.
b, On an unimproved street (no curb): $12.00
c. On currently unimproved streets that are under eonstruction: $12.00
PROPERTY OWNER'S SiGNATURF'
~cr_I./~~
.DATE:
9~/-P>8'
APPROVED BY:
(TRAFFIC DIVlSION
,DATE'
BUILDING PERMIT NO.:
,DATE:
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TRAg.l
ATTACHMENT: Vision Clearance, Example #1
Ej'AMPLE ~l .
flPPLlCA TION fO,R A SECOt-l~ORIVEWAY I OVE'!\'\II()TH ORIVI:WA Y
DATE:
APPLICANT (PROPERTY OWNER):
ADDRESS OF PROPERTY FOR DRIVEWAY PERMIT:
APPLICANT'S TELEPHONE NUMBER:
Please sketch the proposed driveway. Include the foilowing applicab'le items: house or building, proposed
driveway, existing driveway, and street names. Include dimensions and measurements to property lines, road
intersections and bordering driveways.. (See attachment for an example.)
STREET NAME
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All APPUCATIONS OUTSIDE THE CITY UMITS OF SPRINGFIELD THAT ARE WITHIN THE URBAN
GROWTH BOUNDARY REQUIRE A LANE COUNTY PERMIT.
II
I Note: The City of Springfield will not grant a second driveway permit on an Arterial or Collector Street.
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THIS DIMENSION: I 25' FOR CORNER LOTS
15'FOR LOTS AT ALLEY INTERSECTIONS
10' FOR DRIVEWAYS
IH ALL DISTRICTS
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~2-15
09/10/98 14:21
'8'15416862224
WILSON HEIRGOOD
III 002
r~CiiRD n.~~. .-, f~--- "i bATE~Din1"'~
F~ --,-,-,.,:~=':'_...._. '.....~.' "....:.. 09/10/98 il
11ilS IS EVIDENCE lHAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS All 11iE
RIGHTS AND PRMLEGES AFFORDED UNDER 11iE POUCY.
PROlRlcEfl 1~_J5411 342-4441
WILSON-HEIRGOOD ASSOCIATES
(541)342-4441 - FAX 686-2224
POBOX 1421
EUGENE
"""" 019448
~ER I> ",AHUFSOl-2
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COIIP_
OR 97440-1421
11lU8COllE<
VALLBY INSURANCE
2450 14TH Av~.v~
POBOX 1119
ALBANY
CO
SOUTHEAST
OR 97321
LDAJlIC.IMSUl.
SCOTI' C HUFFORD
VICKI B HUFFORD
2404 LARALEB STREET
SPRINGFIELD OR
97477
I POUCT --
43H0420974
EU'lRA11DII DAft. I
CONTINUED UNTL.
10(30/97 10(30/98 nTERMINATBlIFC;><E<XED
'IH9 REPLACES PRIOR " 00,", '." DATED:
....-.~,;;;....". DATE
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LOC ,','.' .,,,,~..:RPI1DN
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~;j;b.dH~~~~i$l~~*OW~ek"": : !.!.lAwI '~1.~~~......"t,~~;,~;~~m~.*,~f:... ~'.....,.....' "'~~rm
HOMEOWNERS $108000
PERSONAL LIABILITY
MEDICAL PAtu.",,'~S
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~8 AMDUIn' OF MSlIR-1ICE OEDUcmBLE
$500,000
5,000
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11iE POLICY IS SUBJECT TO ll-tE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD 11iE
POUCY BE TERMINATED, TIiE COMPANY WILL GIVE ~E ADDmONAL INTEREST IDENTIFIED BELOW DAYS
WRITTEN NOTICE, AND WIll. SEND NOTIFICATION OF ANY CHANGES TO ~E POLICY TllAT WOULD AFFECT TllAT
INTEREST, IN ACCORDANCE WJnj 11iE POUCY PROVISIONS OR AS REQUIRED BY V.W.
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ICAIIIE AND ADCREU MORTGAGEE ....oomONAL INSURED
L068 PAYEE
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