HomeMy WebLinkAboutPermit Encroachment 1997-5-23
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726.3753
BPRINO,.IELO
k~
"l7o'lZ(O szo HArt.t.ow ~A'D
fj(i,';O p6Z"'.T pol'>. rJtrw sEI-Jt;:ft. c~"..t:.C.17o.. 1>1
ENCROACHMENT PERMIT ~,.,..~E..r
NUMBER:
PERMIT NUMBER: q~ ~~
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
,.
APPLI~ATION DATE:
DATE ISSUED: ~...2 "3"2?
,LOCATION OF WORK ~2...t:> ~~ LDiv' ~.
APPLICANT r:;r~~JCb ~';>)t9.y , .#~q '. . PHONE
SITE ADDRESS: ~ 2t:> ~I'J? 73'n
CITY: ~~ STATE:" ~~. - ZIP: ~CY77 TAX LOT:
;?~ - "
SUBDIVISION: .
OWNER: ~ ~ PHONE:
ADDRESS: ~~$.~tF/b CITY: ;*r:7U'!!>V~~STATE: /1..>~ ZIP: ~~
CONTRACTOR: .----=~ ,...lj~~ ADDRESS: ~~~ /..u. PHONE:
CONTRACTOR REGISTRATION ~O: 9:-'1":> 7./ :;vft~~'o'-iI?E: .~7?'?-;:::J .
PROJECT SUPERVISOR: PHONE:
TAX MAP:
/>'-Dr.:?':;> - ~
L!>2~.s-
REQUESTED PERMITS:
INspeCTIONS REQUIRED: APPLICATION FEE' DEPOSIT
ACCOUNT NO:
o ENCROACHMENT PERMIT NO: ............................... n
VAllO FOR SIXTY ISOI DAYS FROM DATE OF ISSUANCE
o CUT STREET 0 BORE 0 OTHER
o DUST CONTROL (TYPE OF CONTROLI
o CONSTRUCTION, STORAGE. STAGING
o OTHER
o ASPHAL T DEPOSiT.........,...................................,....
n
0 S20.00 /
0 S
0 $
0 $
0 $
0 $
0 $10.00+$.15/FT.
n
n
TYPE OF SECURITY m:pn~II
o BLANKET SURETY BOND 0 SURIITY BOND 0 CASH / CHECK
o CURB CUT PERMIT NO: .................... FT. 0
INSPFCTH"lN' CURB I APPROACH AFTER FORMS ARE ERECTED BUT PRIOR TO POURING CONCRETE.
VALlO FOR lBO DAYS FROM DATE OF ISSUANCE.
o SECON'O DRIVEWAY (SEE SEPARATE APPLICATION)
o SIDEWALK PERMIT NO:.................... FT.
VAllO FOR leD DAYS FROM DATE OF ISSUANCE.
o NEW 0 REMOVE / REPAIR 0 PAVE PLANT STRIP
o SETBACK 0 CURBSIDE 0 LENGTH.
J"1c::E'E....TLn~I._(qDEWAlK I DRIVEWAY FOR ALL CONCRETE PAVING WITHIN THE STREET RIGHT OF WAY, TO BE
MADE AFTER ALL EXCAVATING IS COMPLETE. AND FOAM WORK AND sue. BASE MATERIAL IS IN PLACE.
o
o $10,00 + $.15/FT.
J?I
o
SANITARY SEW.ER CONNECTION PERMIT:................n
VALID FOR SIXTY (601 DAYS FROM DATE OF ISSUANCE
o TO STUB 0 MAIN LINE (EASEMENT.R/WI 0 OTHER
STORM SEWER CONNECTION PERMIT: ....................n
VALID FOR SIXTY r601 DAYS FADM DATE OF ISSUANCE
o CATCH BASIN I BUBBLER 0 STUB 0 MAINLINE
eaonc nc '''~''R~ $500,000 MINIMUM
o ATTACHED 0 REQUIRED AMOUNT
j4J
$5.00/.
.&7. --
o $5.00/
TOTAL DUE: $
TOTAL DUE WITH PERMIT $
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:
o PLANS (TWO SETS) ATTACHED
AREA: LENGTH:, .WIDTH:
TYPE OF WORK: . CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
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:
FROM DATE:
TO DATE:
BORE:
DEPTH:
~,
TIME:
TIME:
HEIGHT:
BACKFILL MATERIAL:
I
~I~
DESCRIPTION:
Advance signing and work zone protection to be in compliance with the Manual on Uniform:Traffic Control Devices (MUTeD).
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE, CONTRACTOR TO COMPLY WITH MUTCD ,
REVISIONS 8/24/95
FORM" 116
,"
PLAN REVIEW COMMENTS 1 SP_L INSTRUCTIONS: ..
RESTORATION WORK SHALL BE IN CO.MANCE WITH EXISTING CITY CODES AN_<:bMPLlANCE WITH CURRENT
STANDARD SPECIFICATIONS, EXCEPT AS NOTED BELOW.
001 Backfill with y," minus rock.
002 Compact every IBM loose depth.
003 Requires compaction with a steel rolller,
004 A.C. to match the greater of existing depth or 4M,
005 All cuts sealed, for final inspection.
006 Temporary patch may be used' at the end of the day.
007 Signing and Zone p;(}tection to comply with MUTeD
008 Cut concrete only ~tfcore 'jne~ or cold joints.
009 Sidewalks and dtive'wFtys min. 3.00Qpsi.
_ 010 Curbing min 3,50Qpsi I No patchwork less than 3',
011 Meet min. requirements on curb cuts, Spld. code.
012 Restore planted areas. $pld. code 206.3.05
013 Spec. to Bore J Jack J No A.C. cuts.
. 014 MechanIcal compacting required.
015 No patchwork allo":"ed.
016 lateral cuts to have'control density fill.
.
017 Cuts to be polymerized crack sealed lor final inspection.
018 Mininum 2" crushed rock %" minus.
'I
,
.
019
020
021
022
023
024
025
026
027
926
029
. 030
031
. 032
033
343
Minumum 4' clearance at any point. swing.away.
Concrete minimum 4" depth, 3,QOOpsi.
Trench to be "T" cut.
Needs State / County permit.
No above ground enclosings in sidewalk or handicap ramps.
Diamond cut A.C./Concrete value boxes to grade,
Fresh Oil signs / Graded,
Comply with Americans with Disabilities Act.
Concrete slabs, 72hrs. curing time, 4500psi.
Concrete slabs require joint seal material.
. Drh:eway requiros dowels every' 8",
Submit traffic control plan prior to excavJlIion,
Notify Traffic Oivision before excavati~n.
Core drill main line, insert tea, 20i,{min: grade,
Must comply with the provisions of ORS 757.541 to 757.57l.
6" Circular hote/H20.Vac. .. '
c
Comments:
"
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 CALL 726-3769 (RECORDER) STATE YOUR DESIGINATED CITY JOB
NUMBER/PERMIT 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.
o SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726-3761.
SIGNATURE:
AMOUNT RECEIVED:
...,..._ _'ff?
DATE PAID:
RECEIVED BY:
~""-<3~'"::>
~fII~- -
.
RECEIPT NO:
?~~6
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information
herein is true and correct, and I further certify that any and all work performed shall be done in accordance WIth the Ordinances of the
City of Springfield, applicable City Standard specifications and Drawlngshand the laws of the State of Ore_gon pertaining to the work
described herein. I further certify that only contractors and 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 Hermit at any time during a one year periOd following the re'ceipt by the City of
notice of completion of the described work and specify, at the City's sole descression, 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
days (301 from the date of the notice to complete the work. Work not completed at the ena 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 are requested at the proper time, that project address is readable from the street,
and the approved set of plans will remain on the site at all times during construction.
Signature 4/-Z5- ~~r:-_______ Date _;:/~;/97
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 /COMPLETEDIIN PERMIT ORA WER.
INSPECTION:
INSPECTiON:
. WORK IN PROGRESS
AT TIME OF COMPLETION:
ELEVENTH MONTH:
DEPOSIT RETURNED:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
. crry OF
, . JOB NO. '17o<fl."
. '. ATTACHMENT B . .
S~INGFIELD SYSTEMS DEVE~PMENT CHARGE
WORKSHEET
,
NAME OR COMPANY:
c::...rr:t-wtU)
~17J~ . M('teicA
LOCATION:
SZo
;.H+rz.LCIA../
;ZeAl) .
'..
, '
DEVELOPMENT,TYPE: ~'",fG.;o c:m'1 r~r::FCClG..N(1 5TUl'io,;,l
-'
. BUILDING SIZE: '
I ()T SIZE 6'4. 'f C"3
C:;Q. F~.
1.' C:;TORM ORATNAGf
'l-IlZw
f'1W~,.n ",a>tfZ. 11<'- j"',;T1-/ eM'T 'I'Al<-r or- FltJPUT::J
!l~ ~ 'de = GYoe ,.f '.7 8S""0 sf
~ is K I~_:; 'Z'fI'C ~;)
IMPERVIOUS SQ. FT.
8 5~O 5~
X $0.216 PER SQ. FT.' $
I lO'i8 q~ /.
2. SANTTARY srWFR-CTTY
NO. OF PFU'S 1\8(" X $44.'75 PER PFU
. (See Reverse Side) . I' Co"€: ~'t.G ,
>1Z.B;",;~lT'> )( O,.:.jq '~"/w'.Jlr
3. .' TRANSPORTATTON cl:€Prr EJ<,srr"c, 1S">'<'Oi"IG t~1''''C.'J ~
'. . /Coost;.
;/
so
$ 53,073-
-=
("Z:72 '...ps
- (-) 3(,,1" 'rips
NO, OF UNITS X TRIP RATE X COST PER TRIP
.
'1, Be T~".2::
1"651'
to~ 6lo
ZS,'(, '-':/,$
,X Z.5 .1(" tvi~X $451. 26
$ II Cot"i 'i~ ....... .
X
X $451. 26
$
x
X $451. 26
$
4. SANTTARY SFWFR-MWMC
"
. NO. OF PFU' S. 118" x$20. 69 PER PFU+$10 MWMCI ADM FEE
(Use PFU'Total From Item 2 Above) .
. ./
$ 2-~, S'fS 3.:!-
, MWMC CREDIT IF APPLICABLE (SEE REVERSE>
. .
19
$ (98"-
TOTAl -MWMC sor
,S' ./
$ "Z"'2, ""z. -
"
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
07
$ B'l, ZCf1 -
-
5. ' AOMTNTSTRATTVF FFFC;
BASE CHARGE (SUBTOTAL ABOVE) X .05
. J <l!>.
$ ..." 4(.,0.-
~ J,{,-ALLJS7f:e....
,. . .
Troy McAlllster.
SDC Coordi nator .
Date:
"'/Z'i /'17
I I
TOTAl SOC
, ,/
$ Q3,r""" 5.!;-
, FIXTURE UNIT CALCULATION TABLE: Numb~r of New FiX" es X UnitEquivalent = Fixtu,e IJnit~.
(NOTE: Fo, ,emodels, calculate o"'e .~ additional fixtu,es) " ' '
. .' '.' . . NUMBER OF . UNIT FIXTURE.
FIXTU~E TYPE, 'NEWFIXTURES' EQUIVALENT UNITS
, I
. . ,
Bathtub........:.............,..,...........,....,.......,.."...",...."... .
'Drinking Fount'ain........................ :...'..... .:.... .... .....:....
Floor D'ain...................................................:............ "
Intercepto,s Fo,. Grease/OiI/Solids/Etc.... ..........,..
Inte,cepto,s Fo, Sand/Auto Wash/Etc..:...............
laundry Tub/Clotheswashe'......."",...........,.."....,..
Clotheswasher - 3 Or MOrEl.............................:.......
Mobile Home Park Trap (1 Per Trailer)...:..............
Recepto, For Refrigerator/Wate, Station/Etc.........
Receptor For Comme,cial Sink/Dishwasher/Etc.. .
Shower, Single Stall..................................................
. Shower, Gang............,.......,......."...:....."".",.,."",...
Sink: Bar, Commercial, Residential Kitchen.:......................
Urinal, StaIl/Wall... ......................,.................... .........
Wash Basin/lavatory, Single.................................. .
Toilet, Public Installation.........,..........:.:...:............:
Toilet, Private.........."..... ..........:.. ....... .....:..........,..,.
Miscellaneous: .
c
2
1
2
3
6
2.
6
6
1
3
. 2 .
1/Head.
2
2
1
6
'4
t!
4-
I
I
'Z
~
iVi
25b
,"- i
'Z<c1,..
1';0
I'?C
I~O
5"7.C
TOTAL FIXTURE UNITS
,/
i\&(.,
CREDIT CALCULATION TABLE:
calculate credits separates.
II ' ;:'~-;-- .
I Annexed
'- 1979 0' befo,e
1980
1981
1982
1983
.1984
1985
1986
Based on assessed value, If improvements occurred after annexation date in table,
1
Rate per $1,000 .
Assessed Value
Year
. Annexed
Rate per $1.,000
Assessed Value
.,
1987
1988 .
1989
1990
1991
1992.
1993
1994
1995
. ~ 3 7;/ .
Credit fo, Pa,cel 0' land Only If Applicable /1',~cc x $ ~ S'()~ 0</0
(Rate X Assessed Value)
Imp,ovement (if afte, annexation date) X $
(Rate X Assessed Value)
$3.72.
3,64
3.58
'3.45 '
3,30
3,15.
2.96
2,68
$2.34
1,95
1.53
1.11
0,73
0.56
0.44
0.27
0.13
~ 186(, lj,. .
=
=
CREDIT TOTAL
,
= $
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
. (For Estimating Pu'poses Only) ,
.1
,
Resi.dential....../...'..........:......0.4
Comme'ical............,..,:...,..... 0.9
Indust'ial...........:................ 05
Govemmental.'.........,........... 0.5
\
'IMPERVIOUS AREA - TOTAL LOT SIZE X RUNOFF COEFFICIENT.