HomeMy WebLinkAboutPermit Land Drainage Alteration 1999-6-28
~\
~ t." , iCily of Springfield'
This Side To Be Filled Out.by Applicant '
"~..:" ~ This permit is required for any sita activity in the:flo.od plein and eVe;Y~hara 'Blt~ elteretlon consists of
~. fifty (50) cubic yards of material. or mor~:and/C?rlf a drajnageway is affected, within City limits and
, .... , ' .. .' .' \,
OOc.u"YlIJ-/ No. lQ9C(-()/;-:-OlfobbaTui
~/~-#=: QC;o157
I-
-
~
~
u.J
Cl..
Z
o
-
J--,
~
u.J
I-
--J'.
<(
u.J
c.J
<(
Z
-
~
o
o
z
<(
o
z
:s
Date of A~~lication t - 2 \) ~ '7 c; Permit Expiration Qate:.
Property Owner II IV.. 1\1\' ~ Phone:
Address: -, 7.. 6 '\- I'd-o-LL y. City
Site Address: N. of Ma..,... ~'1\) Bu+ ~~.. N' ~ 1~+-' s.w~d- .'
,17~()~.3~~ojl .
UGB Tax Map No: I-=l 2-.:5 .~ '= --"1":"
Journal number applicable Land Use Application
,4 ,- s-~ I 4-
State:_Zip_
'. Springfield, Oregon
(I(<D
Ta;'Lot: ~E.-~o
o
o
~'
, Source Location
, Material
FILL, Quantity
Supplier
GRADING, Quantity 2..0 Y.I'\I"'-O oS
EXCAVATION, Quantity '2-0 ~~SDe~tination: C))...:J
Supplier: Profect Supervisor
Address , Phone
o
o
oS (IF
)(
. . .
SITE PLAN Required Data:Quantity of matarial; Property lines and descriptions, Tax map and
lot number, Site address, Existing contour Iinas, Proposed contour lines, Existing drainage
ways, Prollosed drainage ways, Significant trees and foliage,. Ground cover, Soil typas,
Buildings, Septic systems, Sewers, Arees subject to floodong, Utilities, Areas subject to land
slides, Proposed 'site improvements, .. . ' .. .
o
o
~
o
o
CROSS SECTIONS,
SOILS & GEOLOGY PLAN, .
DRAINAGE, POLLUTION AND EROSION CONTROL PLAN
REPLANTING PLAN
ADDITlqNA.L' INFORMA TION,'
. "5 (L-, F4tN<L~
II '-I JoO'vIJ C~lM-L{O).Jl--. PHONE ? c. <;. - In.r
SttJ-J I'tt:-U (L':J~ '
1f-cL",y5:r-,. CITY..s p,cp
. .COMPANY NAME: It-l
PROJECT SUPERVISOR:
ADDRESS: '7 '-- '7 -,
COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
STATE rtr1L.
, PHONE
, .
" "
CITY
STATE
CONT~A'CTOR NAME: tv/LL/iwnJ ~
PROJECT SUPERVISOR: .:5"~Vi:-
Registration Number: / f I K'<16
ADDRESS: '7 'L Cj7 ~ y
STATE: ~ ,ZIP:
MOBILE PHONE:
\
'~~7-"" ~"T2"if~
PHONE '. '7 "L (; - I s-r.r-
, Expiration Data: 2. - ~OOO
,CITY: ~.f'~..b
FAX 7 <G 13/1
OFFICE PHONE
., EMERGENCY PHONE:
I understand that I. or my successors m~y have future plans fot 'my,' property ~hich may be anticipated or unanticipated at
this time, I understand that such future plans may require permlts and developement approvals from the City of Springfield,
I understand.that notwithstanding any approval of this Land and Ofalnaga Alteration Permit (LOAP), that at the tima of
application of future permits or approvals the CitY may review'snd,reconsider all a_ctions which I or my successors have
undertaken parsuant to, this LDAP. I understand that the- City may'.ds a condition pf any;:future aprroval, require the
undoing, changing, or modification of any actions whlC,h I,_tlave undertaken as e result of the City s approvai of this LDAP.
By signature, I state and agree. that I have carefully examined the'completed application' and do hereby cenify that all
information herein is true and correct, and I further certify. that anv and all work performed shall be done in accordance
with the Ordinances of the City of Springfield, applicable City Standard specificationa:end Drawings. and the laws of the
State of Oregon pertaining to the work described herein. I further certify that only contractors and employees who are in
compliance with OAS 701.055 will bo use~ on this project. ,.
The City may inspect the work site described in this permit at' any time during a orae year period following the receipt by
the City of notice of completion of the described work and specifY,'lIt the City's 661e desecration, any additional restoration
work required to return the site to a standard acceptable .to the CitY, The permittee will be notified in writing of any work
required and will have thirty (30) days from the date of the. notice to 'complete the work', Work not completed at the end of
the thirty days will be performed lJy the City and the cost's will be billed to the permittee.
I further agree to ensure that all rC4uirod inspectiOns are requ~ited .t the prop~r ~lme, that project address is readable from
the stree~. a approved s7t 0 PlaA~ilI re in on the .Slt8,.lIt 1111 times during construction. '
'L.- /' .. s-".:v"-w,,-,-,,.,..) . ../ ,a
Signatur i -_h ~_ /_\1 ~ __. Date ,C -- 2.... g ---r q
- .
,
, w
{,::28.fi9 ~t. ~
... . eM i J~ -
r-
-
~
~
UJ
0-
Z
o
-
~
UJ
r-
-J
<(
UJ
c.J
<(
Z
-
~
o
o
z
<
~
z
::s
11.6/1998
o DRAINAGE, 1:1 Storin, ~ o'itch, 1:1 Culvert; 1:1 Natural
[jJ/ WETLANDS, Description""/ JAJ I ill1l!WrM t V1 [VlVevt-fzl ~ - 5el" C!.oflLt
a FLOOD PLAIN, Zone: (I.' , FEMA Community Panel No.:3+5512 O(J()4..!3
o FLOODWAY, FEMA Communi.tyPanel No.: ,Date:
PLAN CHECK 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 ioo,ooo
~.
$30.00
$40.00
. $'4o~od For the first 10,000 cubic yards, plus
. $20.00 for e8ch additional 10.000 cubic yards or fraction thereof,
$220.00 For the first 100,001 cubic yards. plus
$20.00 for each ndditionall 0,000 cubic yards or fraction thereof.
$340 For the-first 200,001 cubic yards, plus
'$6;00 for each additional 10,000 cubic yards or fraction thereof.
200,001 CUBIC YARDS OR MORE.'
GRADING PERMIT FEES:
UP TO 100 CUBIC YARDS
101 TO 1.000 CUBIC YARDS
$30.00
$30.00 For the lil:;l 100 cubic yards, plus
$14.00 for 8ach additional 100 cubic yardS or fraction thereof.
$156.00 For ttie first 1,000 cubic yards, plus
$12.00 for each additional 1,000 cubic yards or fraction thereof.
10,000 TO 100,000 CUBIC YARDS $264.00 For the f;rst 10,000 cub;c yards, plus
. . $54,00 for each additional 10,000 cubic yards or fraction thereof.
. o. ... $750.00 For the first 100,001 cubic yards, plus
~ . $30.00 for each additional 10,000 cubic yards or fraction thereof.
1--/,) uti s :~"~
4D?O
(J~_
Grading Permit fee: 1) ~ ,00
Cs
1,001 TO 1 o,ooq CUBIC YARDS
100,001 TO 200,000
Estimated Volume:
Plan Check .Fee:
Receipt No:
Datelazg,Cft
Received By:
Date:
Receipt No: .3'1-995
Date:
7/16/0.
Received by:
Oate:
APPL(qt}.JU~/#~AlIJ A~ ~~ SfA-78
fiND . c~ . .. '.FOUJ.,...::; ,..,7;) IS: .
!fYIP'VL:-.' i'J.:'iff'-....,-r-c..p::, . /AJ13-7 {.;~lA1JJJ url::- jVt/ It-rtUFllDN
H~ 1;6(~ ~rT
~
o
o
Y.1l?A/L-
#:; fr ~
Date: 7/S /9 Cf
oate:~
Date:
Date
Planninll'
Engineering
Building:
Maintenance: .
Permit Number
Date:
Issued by:
8.e..QJ,irprl ~in..aU.p..s.rp,..'tinnc:" .
Plannin$:
Date
Engineering:
Date
Building:
Date
Maintanance:
Date:
o
o
o
Land and Orainage activity.as outlined in this permit has been completed in accordance with
the I'rovisionsof this .permit. . .
Laf\d. and Dralna!le ae-tii.<itv as' outlined in this permit has not been completed in accordance
With. the provIsions 01 thiS permit. ..
Land:.and Drainage activity w.as performed prior to application for this permit.
Accepted by: .
Date: