HomeMy WebLinkAboutPermit Encroachment 1997-7-23
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, ~ CITY OF SPRIN~_ ,ELD . . k -.dRMIT APPLlCA liON
226 FIFTH STREET
SPRINGFIELD. OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
8P"INGP11D.D
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ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER: Cj11 J 1("
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
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APPLICATION DATE: '1 ~Z,.?-'11
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DATE ISSUED: 7 - 23 -9 7
,LOCATION OF WORK
APPLICANT ..:;:ptl VI () l-f.AM M .PHONE
SITE ADDRESS: 4?o.7' ~'N (~"()-tJl '/) ;<;11')/:"':)
CITY: .c, f? STATE: 6 II ZIP: flt:r17
SUBDIVISION:
OWNER: . U. 5. B 4Nr PHONE:
ADDRESS: 4'$7 Mil-IN CITY: c,p STATE: tJlL
CONTRACTOR: ..J!i.:> r'C)).,JS-r/~t: ADDRESS: Ro.&-l. 110'3
CONTRACTOR REGISTRATION NO: --1..1A.l2J EXPIRATION .DA TE: ..1 /) - ~ _ f?7
PROJECT SUPERVISOR: '1/.6.\lIO I+t\.M IV-. PHONE:
,
72-(" - 02# ~7Al -~ ~ .
TAX MAP: .../.....7 -en - '?O::; ,n'>.i .
TAX LOT: If Jfsr:)
ZIP: -rJ<r71
PHONE: :zz.c..-t..l9Y
REQUESTED PFRMITS:
77(. -Wf'f
o ENCROACHMENT PERMIT NO: ............................... n
VALID FOR SIXTY 1801 DAYS FROM OAT! OF ISSUANCE
Q CUT STREET Q BORE Q OTHER n
Q DUST CONTROL (TYPE OF CONTROU
Q CONSTRUCTION, STORAGE, STAGING fl 0 $
QOTHER .fl 0 $
Q ASPHALT DEPOSiT.........,.......,........................................................,..............................., 0 $
TYPE OF SECURITY DEPOSIT
Q BLANKET SURETY BOND Q SURIITY BOND Q CASH 1 CHECK 0 $
INSPECTIONS RfQUlRED: APPUCATlON FEe IDEPOSrT
ACCOUNT NO:
o $20.00 /
0$
o CURB CUT PERMIT NO: ................~... FT. 0
INlt~MtnN. CURB' APPROACH AFTER FORMS ARE ERECTED BUT I'RIOR TO POURINQ CONCRETE.
. VALID FOR 180 DAYS FROM DATE OF ISSUANCE.
...v/Q SECOND DRIVEWAY (SEE SEPARATE APPLICATlONI
~ SIDEWALK PERMIT NO: .................... FT,_,Q O~ 0
VALl) FOR 180 DAVS FROM DATE OF ISSUANC!.
Q NEW Q REMOVE 1 REPAIR Q PAVE PLANT STRIP
Q SETBACK Q CURBSIDE Q LENG1H .
1N'l:~"'TIn"'. 'l:lDEWAlK I DAfVEWAY FoA All CONCArn,PAVINO WITHIN THE STAm RJGKT OF WAY, TO BE
MADE AFTEA ALL EXCAVATlNO IS COMPlrn , AND FOAM,WOAK AND SUB-BASE MATEAIAllS IN PLACE.
D SANITARY SEWER CONNECTION PERMIT: ................ n
VAllO FOR SIXTY IISOI DAYS FROM DATI! OF ISSUANCE
Q TO STUB Q MAIN UNE IEASEMENT-R/W) 0 OTHER
o STORM SEWER CONNECTION PERMIT: ...........,........n
VALlO FDA SIXTY 1101 DAYS FROM DATI OF ISSUANCE
Q CATCH BASIN / BUBBLER Q STUB Q MAINLINE
PROOF OF INSURANCE' $500.000 MINIMUM
Q ATTACHED Q REQUIRED AMOUNT
o $10,OO+$,15/FT,
~O.+ $.15/FT,
/~ d) 0
O' 95.do.-1 .
o 95,001
TOTAL DUE;.-$
TOTAL DUE WITH PERMIT $
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DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:
o PLANS (TWO SETS) ATTACHED
AREA: LENGTH:
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 UTlpZED:
NAME OF OTHER UTILITIES IF THIS IS A' JOINT PROJECT:
WARNING OEVICES TO BE UTILIZED:
Advance signing and work zone protection to be In compliance with the Manuel on Uniform TraUlc Control Devlc.. (MUTCDI.
'i? .r; ?? .AC..L N.h !!S I W PiMtet. S ,.f/'tlM 7re... ~ Bf./ . .
FROM DATE:
TO DATE:
WIDTH:
DEPTH:
TIME:
TIME:
HEIGHT:
BORE:
BACKFILL MATERIAL:
A
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DESCRIPTION:
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE, CONTRACTOR TO COMPLY WITH MUTCD,
REVISIONS B/24/95 FORM' lIB
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PLAN REVIEW COMMENTS / SPECIINSTRUCTIONS: ..
RESTORATION WORK SHALL BE IN CONFO ANCE WITH EXISTING CITY CODES AND I_MPLlANCE WITH CURRENT
STANDARD SPECIFICATIONS. EXCEPT AS NOTED BELOW.
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J 019 Minumum 4' clearance at any point. swing-away.
J 020 Concrete minimum 4- depth. 3.000psi.
021 Trench to be -T- cut.
022 Needs State I County permit.
023 No above ground encloslngs In sidewalk or handicap ramps.
024 Diamond cut A.C./Concrate value boxes co grade.
025 Fresh on signs I Graded.
026 Comply with Arne.rlcana with Disabilities Act.
027 Concretl Ilab.. 72hrs. curing time. 4500psl.
028 Concrete slabs require Joint 8881 material.
029 Driveway requires dowels every' 8-.
030 Submit traffic control plan prior to. eX~8vation.
031 Notifv Tr8ffic'Olvisio~'befo!e excav8ti~n.' ,
032, . Cors_drlll mainJine~ insert tee. 2% min"grade.
1i:i3' Must comply with'the provisions of ORS 757,541 to 757.571.
343 6" Circular holeIH20.Vec.
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J 001 Seckflll with~" minus rock.
. 002 Compect evecy 1 S" loos. depth,
. 003 Requires compaction with 8 steel roilier.
. 004 A.C. to match the greater of existing depth or 4-,
005 All cutl sealed for flnellnspecdon.
006 Temporary patch may ~e u~ed at the end of the day.
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. 007 Signing and Zona protection to comply with MUTeD
. 008 C~t concrete only. on score lines or, cold Joints.
009 Sidewalks end driveways mln~.3.000psl.
010 Curbing min 3,500poi' No patchwork less then 3',
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. 011 Mest min. requirements on curb cuts. Spfd. code.
. 012 Rostor. plonted..r.es, Spfd, code 206,3,05
013. .Spec, t.Sore' Jeck' No A.C. cuts,
. 6,4' Mechenlcol compacting r8q~lred. .
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~ 015 No petchwork .1I0wed, I
016 Lateral' cuts to have control density fill. . '. ".
017 Cuts to be pOlymerized creck sealed for final inspection.
018 Mlnlnum 2- crushed rock %- minus.
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Comments:
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YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
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INSPEGJjeNS:
'"iJY"CURB CUT AND SIDEWALK INSPECTIONS CALL 726-3769 (RECORDER) STATE YOUR DESIGINATED CITY JOB
NUMBERIPERMIT 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:
RECEIPT NO:
/~.oo
7~" 8/ fa
DATE PAID:
RECEIVED BY:
o.l?"?111
. /2, .47
1/064- KII'
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By signature, I stete end agree, that I have carefully examined the completed application and do hereby certify that alllnfo,mation
herein Is true end correct. end I further certify that any and all work performed shell be done in accordance With the Ordinances of the
City of Springfield, eppllcable City Stendard specifications end Drewlngshand the laws of the State of Oregon perteining to the wo,k
desc,ibed herein, I further certify thet only contrectors and employees w 0 are in compliance with ORS 701,055 will be used on this
project,
The City mey Inspect the wo,k site desccibed in this p'ermit at eny time during a one yea, period following the receipt by the City of
notice of. completion of the deecribed work and specify, at the Clty's sole descression, eny additionel restoration work ,equired to
return the site to e stendard eccepteble to the City, The pe,mittee will be notified in writing of eny wo,k ,equi,ed and will have thirty
deys (301 from the deta'of the notice to complete the wo,k. Work not completed at the ena of the thirty days'will be perfo,med by the
, .' City end the costs will be billed to the permittee, .
I furthor eg,ee to ensure thet all requlre~ Inspectiors are requested a,t the proper lime, that project add,ess is readable f,om the street.
end the epproved set of plans I remain on the site et all times dUring construction, .
Signaturrf JJ-' - Date 7P~7
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 (COMPLETED) IN PERMIT DRAWER.
, INSPECTION:
:. INSPECTION:
WORK IN PROGRESS
AT TIME OF COMPLETION:
ELEVENTH MONTH:
DEPOSIT RETURNED:
.,' .
DATE:
DATE:
DATE:
DAT~:
DATE:
DATE:
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