HomeMy WebLinkAboutPermit Land Drainage Alteration 1998-4-6
- C:: "Lity of Springfield
This Side To Be Filled Out by Applicant
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.. This permit is required for eny site activity in the flood plain and everywhere site alteration consists of
. fifty (50) cubic yards of material or more and/or if a drainageway is affected, within City limits and ,
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COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
, .
Date of Application Permh,Expiration Date:
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Property Owner -.IJ,../I ~edf'l ,J l"l ~ s e..i....../ P~one:, 'II 1,-_ I.. q 2...~
Address: 57lL-'1 ,vV 1"/ c - >! t'3~-:-- C'tY4"-' "~tate:-SJ.AZIP_
Site Address: In q c:; -:s (.;.).11 (' I t!- I) ,Springfield, Oregon
D
UGB Tax Map No:
Journal number applicable Land Use Application
Tax Lot:
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FILL, Quantity_i:2J/J {{I, 0
Supplier
GRADING, Quantity
EXCAVATION, Quantity
Supplier:
Address
, Source Location
, Material
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<:l..n '(A f) b
Destination:
Project Supervisor
, Phone
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SITE PLAN Required Data:Quantity of material, Property lines and descriptions, Tax map and
lot number, Site address, Existing contour lines, Proposed contour lines, Existing drainage
ways, Proposed drainage ways, Significant trees and folialle, Ground cover, Soil types,
Buildings, Septic systems, Sewers, Areas subject to flooding, Utilities, Areas subject to land
slides, Proposed site improvements.
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CROSS SECTIONS,
SOILS & GEOLOGY PLAN,
DRAINAGE, POLLUTION AND EROSION CONTROL PLAN
REPLANTING PLAN
ADDITIONAL INFORMATION,
, 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:
I understand that I or my successors may have future plans for my property which may be anticipated or unanticipated at
this time. I understand that such future plans may require permits and developement approvals from the City of Springfield,
I understand that notwithstanding any approval of this Land and Drainage Alteration Permit (LDAP), that at the time of
application of future permits or approvals the City may review and reconsider all actions which I or my successors have
undenaken persuant to this LDAP. I understand that the City may as a condition of any future approval, require the
undoing, changing, or modification of any actions which I have undenaken as a result of the City's approval of this LDA,P.
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 funher cenify that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield, applicable City Standard specifications and Drawings, and the laws of the
State of Oregon penaining to the work described herein. I funher certify that only contractors and employees who are in
compliance with OAS 701.055 will be used on this project. .
The City may inspect the work site described in this permit at any time during a one year period following the receipt by
the City of notice of completion of the described work and specify, at the City's sole desecration, any additional restoration
work required to return the site to a standard acceptable to the City. The perr:nittee will be notified in writing of any work
required and will have thiny (30) days from the date of the notice to complete~he work, Work not completed at the end of
the thirty days will be perf rmed by e ity and the costs will be billed to th(p,~jttee. ,
I further agree to ensu that all red inspections are requested at the pro~me, that project address is readable from
the street, an~'l proved plans will remain on the site at all times during con!!truc~ion.
Signature ~ /' Date )pA.L _ L- 98
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1/6/1998
o DRAINAGE, 0 Stonn, 0 Ditch, 0 Culvert, 0 Natural
o ~LANDS, Description iJ1I
o FLOOD PLAIN, Zone: c., , FEMA Community Panel No.:~(S'Sq7 ClXLLf If
o FLOODWAY, FEMA Community Panel 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 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 200,000
Estimated Volume:
1<t!:> 175.
Plan Check Fee:
Received By:
-:>.....-
Grading Permit fee: ~
Received by: =KIA)
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Plannina (J~
Engineering
Building: ~~~_ :;_'- ," ~
M' ?
alntenan e:
Permit Number~_72
BaQ.u.in~rl ~in~1 Inc:::np("tinns...:
Planning:
Engineering:
Building:
Maintenance:
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$20,00
$30.00
$40.00
$40.00 For the first 10,000 cubic yards. plus
$20.00 for each additional 10,000 cubic yards or fraction thereof.
$220.00 For the first 100,001 cubic yards, plus
$20,00 for each additional 10,000 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.
$30,00
$30.00 For the first 100 cubic yards, plus
$14,00 for each additional 100 cubic yards or fraction thereoL
$156.00 For the first 1,000 cubic yards, plus
$12.00 for each additional 1,000 cubic yards or fraction thereof.
$264.00 For the first 10,000 cubic yards, plus
$54.00 for each additional 10,000 cubic yards or fraction thereof.
$750.00 For the first 100,001 cubic yards, plus
$30.00 for each additional 10,000 cubic yards or fraction thereof.
Receipt No:
Date:
Date:
Receipt No:
Date:
Date:
df~ I,., -9 {
Date:~
Date:
Date: ?-q.~
Date
Issued by:
Date:
Date
Date
Date
Date:
Land and Drainage activity as outlined in this permit has been completed in accordance with
the provisions of this permit.
L~nd and Dralnaae ac.tivitv as outlined in this permit has not been completed in accordance
With the provlslllhS 01 thIS permit.
.,
Land and Drainage activity was performed prior to application for this permit.
Accepted by:
Date: