HomeMy WebLinkAboutPermit Land Drainage Alteration 1997-11-17
:. .:, '.' La~'~.. And D~ai~age~'A_~eration "Permit'[
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P.&:a~~
City of Springfiel~
22S Firth Street, SpringOeld, Oregon 97477. Developme.{t services
Date of Application 11/;7/5 '?
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Property Owner LC:5 $ ~ {;~
Address: '"7on<;tL, "7? .k/.
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Expiration Date:
Phone: 4fCz.r -.1.5" j- f~ fP Co
Clty~ State:.llt&.Zlp~.1 ~j
Site Address: '72 2..r m~,.A ?v ST.
D UGB Tex Mep No: !'f>A 2- ~.2.. .fJ .-
. Jo. No. of previous land use aDDlic"tlol1
,....- -..........."
. Springfield, Oregon
Tex Lot: ~/,n _ !_
~ Fill, Quantity J 2...-.,~, Source Location r Jl..J) .
-:f"~PPller r 'K 1') / '. ,Materlal_4T r r...... ~ .I ... rI 1: ""'~ .
~.-GRADING, Quantity '/-d (J 'V d~ '
tr>oL~ I
Qg EXCAVATION: Quantity (>0 \, ~ Destination: ;-.~ f)
~uPPller: Iff j) I, Project SupervIsor
Address .' Phone
ta'
SITE PLAN Required Dete:Quantlty of material, Property lines and descrIptions, Tax map and
lot number, Site address, Existing contour lines, Proposed contour lines, Existing drainage
ways, Prollosed drainage ways, Significant trees end foliage, Ground cover, son types,
Buildings, Septic systems, Sewers, Areas subject to floodfng, Utilities, Areas subject to land
slides, Proposed site Improvements. . ,
D CROSS SECTIONS,
D SOILS & GEOLOGY PLAN,
D DRAINAGE, POLLUTION AND EROSION CONTROL PLAN
D REPLANTING PLAN
. q ADDITIONAL INFORMATION,
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COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
. PHONE
CITY
STATE
...
j:
, PHONE
CITY
STATE
CONTRACTOR NAME:
PROJECT SUPERVISOR:
R~glstratlon Number:
ADDRESS:
STATE: . ZIP:
MOBILE PHONE:
PHONE
, ExpIration Date:
.' CITY:
OFFICE PHONE FAX
, EMERGENCY PHONE:
By Ilgnlturo, I Itato and agroo, thlll ha.o carofully ox ami nod tho comploled oppllcatlon and do horoby conlfy thaI all
Information haroln Is Iruo and corrocl. snd I furthor conlfy thol sny snd oil work porformod shsll bo dono In accordonco with
Iho Ordlnsncos of tho City of Sprlngflold, appllcablo City Stsndsrd spoclflcatlons snd Drawings, and tho laws of tho Ststo of
Oregon pertaining to the work described herein. I funher cenlfy that only contractors and employees who are In compnanco
with ORS 701.055 will be used on Ihll proJocl.
Tho City moy Inspocttho work litO doscribod In this pormll 01 sny time during e ono yosr periOd following the racelpt by the
City of notlco of complotlon 0' tho doscrlbed work and spoclfy; ot Iho Clly'1 1010 dosocratlon, sny addltlonol rostorotlon work
roqulrod to rotum Iho lito to a Itandsrd sccoplablo 10 Iho City. Tho pormlttoo will be notlflod In writing of sny work roqulrod
snd will hs.o thlny 1301 days lrom lho dalo of tho notlco 10 complola tho work. Work nol complotod at Iho ond of tho thirty
dsys will bo porformod by tho CllY snd Iho cosll will bo billod to tha pormlttoo.
.
I lurthor agroo 10 onluro thaI sll roqulrod Inspoctlons aro roquostod altha propor tlmo, thsl proJoct sddro.. Is rosdeblo from
tho Itrool, ~,"IOt 0.' P?~II r~ .Ito at slltlm.. during construction.
Slgn.tur~ /.7 ~g)' Data .//,=../ '7 -1 f .
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~AINAGE,
lZ}St'orm, Cl Ditch, Cl Culvert, ~urel
o WETLANDS, Description
~ FLOOD PLAIN, Zone: IV /IJ '- ,FEMA Community Panel No.:
[2(' FLOODWAY, FEMA com~unity Panel No;: ;;/ flY
/J) fiJ
, Date:
PLAN CHEC.K FEES:
UP TO 100 CUBIC YARDS
101 TO 1,000 CUBIC YARDS
1,001 TO 10,000 CUBIC YARDS
10,000 TO 100,000 CUBIC YARDS
100,001 TO 200,000
200,001 CUBIC YARDS OR MORE
$20.00
. $30.00
$40.00
$40.00 For tho first 10,000 cubic yards, plus
$20.00 for osch oddlUonall0,OOO cubic yards or fraction tharoo',
$220.00 For tho f~st 100,001 cubic yards. plus
$20.00 lor oach additional 10,000 cubic yards or Iractlon tharoof.
$340 For tho first 200,001 cubic yards, plus
$6.00 for oach additional 10,000 cubic yards or Iractlon thoraof.
GRADING PERMIT FEES:
UP TO 100 CUBIC YARDS
101 TO 1,000 CUBIC YARDS
1.001 TO 10,000 CUBIC YARDS
10,000 TO 100,000 CUBIC YARDS
100,001 TO 2<\0,000
$30.00
$30.00 For the Iirstl00 cubic yards, plus
$14.00 lor oech additional 100 cubic yards or Iraction thoroo'.
$156.00 For tho flret 1.000 cubic yords, plus
112.00 for aach oddltlonal 1,000 cubic yards or Iractlon thoroo'.
$264.00 For tho first 10,000 cubic yards, plus
$54.00 for oach additional 10,000 cubic yords or fraction theraof.
$750.00 For the first 100,001 cubic yards, plus
$30.00 for oach additional 10,000 cubic yards or Iraction thareof.
Estimated Volume:
Plan Check Fee:
0-
Date:
Receipt:
Received By:
Date:
Grading Permit fee:
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Receipt
Dete:
Received by:
Date:
~anninp
~nginaerlng
[9-'"' Building:
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. DatE!: ) ~/ / $ / '7"1-
Date: . /Z/; (I jq y
Date: _/ 2/1 ~7
. Date
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Maintenance:
Permit Number 7'1/ ~ 3 ~
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Issuod by:
Date:
!2/2.3A 7
FinAl In"pAetlnn!ll.
Planning:
Date
Engineering:
. Oata
Building:
Date
Maintenance:
. . Date:
"
," . ':.' .: La~~. And Drail1age~'A.(eration" Permit:.
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City of Springfiel~
22S Firth Street, Springfield, Oregon 97477. Development services
Date ~~ ApPlication. I (II r ?
Property Owner LC5 ~ ~ {r3;
Address: "7,n.... 77 ~ -"'.1.</.
Expiration Date:
Phone: ~z.r - j s r- J''- fP C
CltyB?g~ Stete:Jlt4Zlp~.::iJ...1
Site Address: 72 ZS- ~c.A ~ ST.
o UGB Tax Map No:/t9:,/9 2.;r) 2.. 2.../ ....
Jo. No. of previous land use ~!.lplication,
.' Springfield, Oregon
Tax Lot: .-:. h1"1) , ")
ca FILL, QuantltyJ2.....,~. Source Location r I?, 1).
--"Y'~PPller r-1? 1') / '. .' Materlal~
aa..,......GRADING. Quantity /-a? rg \; d~
tr>c......:..6J- /
· Qg EXCAVATION. Quantity ~Cl \, rI)
<J1I.~~uPPller: If) j) I
Address
o........~/"-rI ,f'~_
Destination:
I~D
.' Project Supervisor
" Phone
ta
SITE PLAN Required Dete:Quantity of material. Property lines and descriptions. Tax map and
lot numbar, Site address. Existing contour lines. Prol>osed contour lines. Existing drainage
ways. Proposed drainage ways. Significant trees anll fOliage. Ground cover, Soli Wpes.
Buildings. Septic systems, Sewers. Areas subject to fioodfng. Utilities. Areas subject to land
slides, Proposed site improvements. .
o CROSS SECTIONS.
o SOILS Be GEOLOGY PLAN.
o DRAINAGE. POLLUTION AND EROSION CONTROL PLAN
o REPLANTING PLAN
. 0 ADDITIONAL INFORMATION.
COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
. PHONE
. CITY
STATE
.' PHONE
. CITY
STATE
CONTRACTOR NAME:
PROJECT SUPERVISOR:
Registration Number:
ADDRESS:
STATE: . ZIP:
MOBILE PHONE:
PHONE
. Expiration Date:
.' CITY:
OFFICE PHONE FAX
, EMERGENCY PHONE:
By Ilgneture. I etete end egree, thet I he.e cerefully ..emlned the completed eppllcetlon end do hereby certify thet ell
Information hereIn ,. true end correct, and I further certlry that any and all work performed shell be done In accordance with
the Ordlnencee 0' the City 0' Springfield. eppllceble City Stenderd speclflcetione end Orewlngl, end the lewe of the Stete of
Oregon pertaIning to the work described herein. I further certify that only contractorllnd employe88 who ere In compliance
with ORS 701.055 will be uled on thll proJect.
Trie City mey Inspect the work lite dllcribed In this permit .t eny time during e one yelr period following lhe receipt by tho
City of notice of completion of the dllcrlbed work Ind Ipeclfy; etthe Clty'1 lole delecretlon, eny eddltlonel reetoretlon work
required to retum the .Ite to I IlIndlrd eccepteble to the City. The permittee will be notified In writing of eny work required
end will he.e thirty 130) deYI Irom the dote of the notice to complete the work. Work not completed It the end of the thirty
deYI will be performed by the City Ind the colte will be billed to the permittee.
.
I further egr.. to enlure thet ell required Inepectlone ere requllted etthe proper time, thet project eddress II reedeble from
tholtree" e~~"et 0.' P,?~III r~ lite etelltlmll during conatructlon. _
Slgnetur~ ? .7 /f:0.~~""""" Oete II-I? 1f.
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, '. :'. Lan,,_ . And . D~~lnag~ "A_ .eratlori ; Peroni-.:
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~AINAGE,
lZYStorm, 0 Ditch, 0 Culvert, ~ural
o WETLANDS, Description
g---- FLOOD PLAIN, Zone: IV /tr , FEMA Community Panel No.:
~. FLOODWAY, FEMA com~unlty Panal No;: ;1// f).--
Il/ Iii
, Data:
..'
PLAN CHEC.K FEES:
UPTO 100 CUBIC YAROS
101 TO 1,000 CUBIC YAROS
1,001 TO 10,000 CUBIC YAROS
10.000 TO 100,000 CUBIC YARDS
100.001 TO 200.000
200.001 CUBIC YARDS OR MORE
GRADING PERMIT FEES:
UP TO 100 CUBIC YARDS
101 TO 1;000 CUBIC YARDS
1,001 TO 10,000 CUBIC YARDS
10.000 TO 100,000 CUBIC YARDS
100,001 TO 2QO.000
$20.00
. $30.00
$40.00
$40.00 For tho first 10.000 cubic yards, plus
$20.00 lor oach addlllonall0,OOO cublo yarda or Iraction thareol.
$220.00 For tho lIrst 100,001 cubic yards, plus
$20.00 for each additional 10,000 cubic yards or lracllon thorool.
$340 For the lIrst 200.001 cubic yards, plus
$6.00 lor oech addlllonal 10.000 cubic yarda or lrectlon therool.
$30.00
$30.00 For tho first 100 cubl. yards. plus
$14.00 lor ea.h additional 100 cubl. yards or fraction thoroof.
.156.00 For tho lIrst 1.000 cubl. yards, plus
$12.00 lor oach eddltlonal 1,000 cubl. yarda or fraction thoreof.
$264.00 For tho lIrat 10,000 cubic yerds, plus
$54.00 lor oach additional 10,000 cubic yards or lractlon thereol.
$750.00 For tho lIrstl00.00l cubic yerds, plus
$30.00 for oach eddlllonallO,OOO cubic yards .r fracllon there.f.
Estimated Volume:
Plan Check Fee:
.~.
Date:
Receipt:
Received By:
Date:
Grading Permit fee:
rS ~P'),~
Date:
Receipt
Received by:
Date:
'6H..I~ ~A1~~ IU.MS.iM~
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Melntenance:
Date: ) ~/ 12/<7'9-
Date: /Z/; {lIe; Y
Date: / 2./J ~ 7
Date
~Iannlnp
'~nglneerlng
I:!:r' Building:
Permit Number 7'11" 3~
flnaUnctn~,..tl"'tnS..:
Planning:
~{J;C'~~
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Date: 0/.207
Issued by:
Engineering:
Date
'.
,
Date
Date
Date:
Building:
Malntenanca:
,