HomeMy WebLinkAboutPermit Sidewalk 2005-12-5
225 FI FTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
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/;)",-5""-0'\
PERMIT
NUMBER:
COM J.()(J If 1Jf2 30'
APPLICATION DATE:
SITE INFORMATION:
LOCATlONOFWOIIK: '3, 2.~
APPUCANTC.rt1\!t(~ (".() P c; r.
ADDRESS 2:;24r:;- ("J')PxJ/2f7 (2:(:) -:tCltO
GA-Tf3;.W Ir'-'1
f
PHONE
(P '& 7;cr1f-4 r
TAX MAP: /70 32'2'Z-
TAX LOT: ,?C 0 D
CITY: ~\/.F-v
STATE:
nj2...
ZIP:
q ,4--0 \
SUBDIVISION:
OWNER: ?=~~~ t'%~\\~-S
,ADDRJ:SSq 6 n L.)' r I~_ +k CITY E.u~~
STATE:
PHONE:
f}-(L
ZIP Of 74-01
REQUESTED PERMITS:
ISI SIDEWALK: ....................,....................,..,..,............................,......,........,..,..........$ 80.00, ~ $
AMOUNT OF SIDEWALK IN EXCESS OF 90FT, @$0.08SF, _ =$
SInEW AL K REPAIR: ......., ............ ...........' ........................ ............ ............ .........,~ 0.0j!,.. =$
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CURB CUTIDRlVEW A Y: NUMBER OF DRIVEWAYS
X ................,$ 80.00.. = $
MULTIPLE PERMIT DISCOUNT EA: ..(MAX 2) .........................................,$ 30.00.. ~$_(-
(MULTI PERMIT DISCOUNT GOOD FOR ONE SITE AND ONE SITE INSPECTlON.illILY
APPLIES TO 2nd AND 3rd PERMITS ONLY. NOT SIDEWALK REPAIR)
TOTAL DUE WITH PERMIT $
o PROOF OF INSURANCE: $500,000 MINIMUM IF WORK IS DONE BY PROPERTYOWNER
)-
CONTRACfOR INFORM A TION:
~
CONTRACTOR r: t-( A ^^ ~ '\2.(", I' Y> JU "'" ('
ADDRESS 22-9<) CD B<.J (2. (-r /2..b :#;'00
CONTRACTOR REGISTRATION NO: 1/4 '2-5 B
PROJECT SUPERVISOR: -;<, Ic..t+ +-1 '::I2..tL~
PHONE to8 794-4-)'
. EXPIRATION DATE: 6 - ~o -0"7
PHONE:Z'2~ -(.,z~
INSPECfIONS:
AN INSPECTION REQUEST SHOULD BE MADE PRIOR TO POURING CONCRETE, AFTER THE PROPOSED WORK HAS BEEN FORMED AND MADE READY
TO POUR, CURD CUT AND S\DEW ALK INSPECfIONS CALL 726-3769 (RECORDER) STATE YOUR DESIGINA TED CITY JOB
NUMBERlPERMIT 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 DA Y, REQUESTS AFTER 7:00 A,M, WILL BE MADE THE NEXT WORKING DAY, INSPECTIONS ARE TO BE CALLED IN
AFTER EXCA V A TlONS ARE MADE AND FORM WORK IS IN PLACE BlJf PRIOR TO POURING CONCRETE,
YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
SIGNATURE:
AMOUNT RECEIVED:
R'ECEIPT NOQ2 /-J-OO ,t:;"
9 () c2f€
-r-~ -It-,. ~
- ,
DATE PAID:
RECEIVED BY:
/2- ~ - 0 )
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By signature. I state and agre;c, thai I have cartfully examined the completed applicalion and do hereby certify that all information herein is true
and correct and I further certily thai any and all work Denormed shall be done in accordance with the Ordinances of .
the City of Springfield, applicable Cily Standard specifications and Drawings, and the laws of lhe State of Oregon pertaining 10 the work described herein. I further certify that
only ~ontr~cfors and employees who are in compliance wilh ORS 701.055 wi I be used
on thIS project. .
The City may inspect the work site described in this permit al any time during a one year period following the receipt by the City of notice of com pIe lion of-the described
work and specify, al the CitY.'s sole discretion, any' additional restoratIOn work required to return the site to a standard acceptable to the City. The pemuttee will be notified in
writing of any work require(J and will have thirty days (30) from the date oflhe notice to complete the work. Work not completed at the en(J of the thirty days will be performed
b,y . ., ,
tile City and the costs WIll be billed to the permittee.
I further agree 10 ensure thai all reqUIred inspectIons are requested at Ihe proper time, thai project address IS readable from the
street, and the approved set of plans ~ Ihe sile at all tImes durmg construction
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ENCROACHMENT PERMIT APPLI.CATION' ,
.' .
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
APPLICATION DATE:
.~.
ENCROACHMENT PERMIT
NUMBER: .
. DATE ISSUED:
LOCATION OF WORK
APPLICANT Gt+~ ~c::;. C.OI-:)"';;. "";'i2.-.3<:..1' t:) 10.,) PHONE.
SITE ADDRESS: -3 r 2. '? G.,-A-r~ ~
CllY: ~ 'Pf""\) STATE: () T'2.- ZIP:
{pBt -&(4-4-r
TAX MAP: I (O '3 Z. '2-- 2.-
TAX LOT: ~~O 0
SUBDIVISION:
OWNER: ~~ ""r'n ~ ?r"26Pe:P-1"\ ~ L \'\::>
ADDRESS: qgO LUiL.LM.s'rti:. CllY: €:J(,.,~;:;' STATE: e;L
CONTRACTOR:;;,tt7nA~<; Cft~.ADDRESS: 22-~ CJJBJ/267 f2r) ~1t>O
CONTRACTOR REGISTRATION NO: ' 1/4 2 S-B EXPIRATION ~ATE: &7 - '30 - 0"
PROJECT SUPERVISOR: 1< I (' M ?F-~...A.--L- PHONE: "Z 28- U, 2~
pHONE:
ZIP: ?74--tJ I
PHONE: <0 '87-<f44-..i
REQUESTED PERMITS:
INSPEcnoNS REQLnAED: APPUCATlON FEE I DEPOSIT
ACCOUNT NO:
iii ENCROAC~MENT PERMIT NO ............................................~ '$130,00/
VAUOFOA5OOY(roIDAYSFAOMllATEOFISSUANCE ~ . . .
::~::n:":~:" f///l. '. in. ~
D CONSTRUCTION, STORAGE: STAGING I G U
DOTHER I., . ~ 7J
'. ' . I ~ (
o D;::::E;~:'I~'~~~~'~I~"""'~~r:"'."""""'/.'7'",:"5,,.E_.~
D BlANKET SURETY BOND D SURlITY BOND D CASH I CHECK $
o SANITARY SEWER CONNECTION: ..........,, 0 MAIN UNE(EASEMENT-AIW) DTOSTUB DOTHER
o STORM SEWER CONNECTION: D CATCH BASIN' BUBBLER D SlUB D MAINliNE
o PRnnF nF IN~IIt=lANCF ' $500,000 MINIMUM D ATTACHED D ADDITIONAl REOUIRED AMOUNT
TOTAL DUE WITH PERMIT $
DESCRIPTION OF PROJECT: ______
PERIOD OF USE OR TIME OF CONSTRUCTlON:------
/' /'
o PLANS (TWO SETS) ATTACHED
AREA: LENGTH: '/ .
lYrE OF WORK/cUT: .
OTHER: /
EXISTING SGRFACE MATERIAL:
BACKFlri MATERIAL TO BE UllLlZED:
SUR?CE REPLACEMENT MATERIALS TO BE UTILIZED:
lYf'E OF DUST CONTROL TO BE UTILIZED:
NtME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
"VARNING DEVICES TO BE UTILIZED: _
Advance signing and 'ItQlk zona protection 10 be In oompllance with the Manual on Unllotm Iraffle Caltrol Devices (MUTeD),
)ESCRIPTION: ,::-, y .f),e / v I2-tVlf Y J1.-S :"\ r1 ~ lY A./ /,u f) L../9,.1// ~. "
\7?&.-1t10U?;_ H4,fd)/CllfI'EV ft1.+IU<IUS. A1/P Sr<!"'1:."""'r
. ~rtO~L~I1-tc\ I'I--r-- Wlft...L.<o..v+'r'J -ay R.f'fl<PUf't"'-l Sr4ev-><fU.
0~ iV.e. ( 5 ' . 1
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-
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~. TIME:
............. TIME:
HEIGHT:""-
"'"
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"\. .'
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FROM 'DATE:
TO DATE:
WIDTH:
DEPTH:
BORE:
BACKFILL MATERIAL:
----
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------- '
--
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CllY CODE. CONTRACTOR TO COMPLY WITH MUTeD.
REVISIONS 2121KlI FORM -# 116
PLAN REVIEW COMMENTS I S
AL INSTRUCTIONS:
t' ..,... .~I' I
.
RESTORATION WORK SHALL BE IN CONFORMANCE WITH EXISTING CI1Y CODES AND IN COMPLIANCE WITH CURRENT STANDARD
SPECIFICATIONS, EXCEPT AS NOTED BELOW. '
'. . 0 019 Minumum4'dearancealanypoinl,SYNlg.away.
o . 001 BackfiU with %- minus rock. . 0 020 Concrete minimum 4" depth. 3.000psl.
", 0.002.. ~mpaclevery18.loosedeplh. 0 021 Trend11obe-rcut.
o 003' . Requfres compacUon with a stee{ roilier. 0 022 Needs Slale I County permil.
DO 004 A..C. to match the greater of ~~I~g depth Of 4", 0 023 No above ground enclosings In sidewalk or handcap ramps. .
005 A1~ ~s sealed for finallnspecllon. 0 024 Di~mond OJ! A.C./Concrete value boxes to grado.
o ooB , Tempo<ery patch mey be used ellhe end of the day, 0 025 Fresh 011 sign. I Graded,
o ' 007 ,SlgTing and Zone prolectlon 10 exmplywilh MUTCD 0 O2B Comply \\ilh Amerlcans\\ith Dlsabllilie. Act,
o . 008 OJt ronaele only 00 soors lines or cold joints. 0 027 Cornela slabs. 72hrs. wring lime. 4500psJ.
o 009 '. -~Sldewalks and dr~ys min. 3,OOOpsl. 0 028 Concrete slabs require joint seal material.
o 010 Curbing ITin 3,5OOpsI1 No palchwork less than 3', 0 029 Or' equf dow I lB'
. M!W8y r res e s fNery .
o 011 Meet min. requlremenls 00 Qnb rots. Spfd. code. 0 030 Submillraffic cOntrol plan prier to excavation.
o 012' Reslere planted areas, Spfd. code 206.3.05 0 031 NolifyTrafflc Oivisiro beforeexcavalion.
0',013 Spec. 10 Bore I Jeck I NoA.C. cuts, 0 032 ~-, din I I' In II 2w' de
. V\.He J man me, ser ee. ,.mm.ga .
o 014 Mechanical ccrnpactlng Jequtred.
o 015 No pelchworkellowed, 0 033 Must comply\\ilh the provision. of ORS 757,54110
, 757,571.
o 016 Lateral cuts 10 haveconlrol density fin., 0 343 6" Circular holeJH2D-Vac.
o 017 Cuts to be potymerlzedaack sealed for Ilnal inspecUon. . 0 .
o 018. ,Mfnlnum 2" crushed rock %- minus.
, YOU ARE REQUIRED TO CALL '
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
.
INSPECTIONS:
o CURB CUT AND SIDEWAlK INSPECTIONS GALL 726-3769 (RECORDER) STATE YOUR DESIGINATED CI1Y JOB NUMBER/PERMIT
NUMBER, JOB ADDRESS. 1YPE OF INSPECTION REQUESTED, AND WHEN YOU WILL BE READY FOR INSPECTION, CONTRACTOR':
OWNER'S NAME AND PHONE NUMBER. REQUESTS RECEIVED BEFORE 7:00 A.M, WILL BE MADE THE SAME DAY, REQUESTS AFT
7:00 A,M, WILL BE MADE THE NEXT WORKING DAY, INSPECTIONS ARE TO BE CALLED IN AFTER EXCAVATIONS ARE MADE AND FC
WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE,
o SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CI1Y MAINTENANCE AT 726-3761,
.
SIGNATURE:
AMOUNT RECEIVED:
RECEIPT NO:
DATE PAiD: '
RECEIVED BY:
By signaturell slate and agree! that I have carefully examined the completed application and do hereby certify that all inforlJ1atlon herein Is trul
cQrrect, and further certifY tha any and all work performed shall be done In accordance with the Ordinances 01 the Cily of Springfield, appllcc
City Standard specifications and Dray.'ings, a~d the I~ws of the Stale of Oregon pertaini~g to !he work described herein, I furfher certify that on
contractors and employees who are In compliance WIth ORS 701,055 Wlllbe used on thiS proJecl. '
The Cirv may inspect the work site described in this permil at any time during a one year period following the receipt by the Cily at notice of
comple1ion of the described work and specify, at the'City's sole aescression, any additional restoration work required to return the sile 10 a
stanaard acceptable to the CilV, The permittee will be notified in writing of any work required and will have thirty aays (30) from the date of the
notlc~ to complete the work. Work not completed at Ihe ,end 01 the thirty days will be performed by the City ana the costs will be billed to the
permittee,
I furthor agree to ensure that all required inspections are requested at the proper time, that project address is 'readable from the street, and th
approved set of plans will remain on the sile at all times dunng construction" ' ,
Signature Dale
..
VAUDATION:
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 DRAWER.
"
INSPECTION: DATE:
e
INSPECTION: DATE:
WORK tN PROGRESS DATE:
AT TIME OF COMPLETION: DATE:
ELEVENTH MONTH:
DEPOSIT RETURNED:
DATE:
DATE: