HomeMy WebLinkAboutPermit Encroachment 1996-5-9
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225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING OIVISION
OFFICE TELEPHONE 15031 726-3753
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ENC,fc;ACHME~ PERMIP.tl",r fM..,>G.O 'fIN') -
NUMBER:
PERMIT NUMBER:
9~o~74
o/r/~
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
APPLICATION DATE:,5!qlq{p
DATE ISSUED:
LOCA TION OF WORK
APPLICANT -HktcA.;~ I~Jo~/-c<J.. ~'tors_ ~flc..
SITE ADDRESS: g ~ '1 mav. StYe__6j--
CITY: &?I'Hi4f,etat STATE: D f..
f I
SUBDIVISION:
OWNER: 1-ktc.k,n'S .I. ~ YY1G.rDY5.. PHONE:
ADDRESS: P.o. I7iN: 1N. CITY: EonllMlef..o{ STATE: DIl
CONTRACTOR: Strdb() Consfn<c.tD~ ,ADDRESf: ' '.' =. 1 1:':' Z'l~'f. MI'\.f.A- ~
CONTRACTOR REGISTRATION NO: 03.3 7 / E;PIRATION DATE: r. Iz.\ f<it..
PROJECT SUPERVISOR: R.Dbert ,~"n
REQUESTED PERMITS:
PHONE
ZIP:
Cj7LJ7'7
TAX MAP:
TAX LOT:
17-003. 35- y~
los:::>O
747 - 3~74-
ZIP: q I'] Lf 7 7
PHONE: 4 b 1-(i$'lf3
PHONE: q St.{-(,z'l{..
o ENCROACHMENT PERMIT NO: .,....,....,..........,........ n
INSPECTIONS REQUIRED:
APPlICA lION FEE I DEPOSIT
0 $20.001
0 $
0 $
0 $
0 $
0 $
0 $10,00+ $.15/FT,
ACCOUNT NO:
VAllO FOR SIXTY 1601 DAYS FROM DATE OF ISSUANCE
o CUT STREET 0 BORE 0 OTHER
o DUST CONTROL lTVPE OF CaNTRaLl
n
o CONSTRUCTION, STORAGE. STAGING
o OTHER
o ASPHAL T DEPOSiT...................... ........................
n
o
*
TYPF OF SECURITY DEPOSIT
o BLANKET SURETY BONO 0 SURIITY BONO 0 CASH / CHECK.
o CURB CUT PERMIT NO: .........,...,...... FT, 0-
INSPFr.TION. CURB I APPROACH AFTER FORMS ARE ERECTED BUT PRIOR TO POURING CONCRETE.
VAllD.FOR 180 DAYS FROM DATE OF ISSUANCE.
o SECON'O DRIVEWAY (SEE SEPARATE APPL/CA nON I
l\O SIDEWALK PERMIT NO: ........,.........., FT, /CO' ~
F VALID FOR 180 DAYS FROM DATE OF ISSUANCE.
,0 NEW MREMOVE / REPAIR 0 PAVE PLANT STRIP
o SETBACK 0 CURBSIDE 0 LENGTH
IN!':.PFrllnN' SIDEWALK J DRIVEWAY FOR All CONCRETE PAVING WITHIN THE STREET RIGHT OF WAY. TO BE
MADE AFTER ALL EXCAVATING IS COMPlETE. AND FORM WORI( AND SUB.BASE MATERIAL IS IN PLACE.
o SANITARY SEWER CONNECTION PERMIT: ................ n
VAllO FOR SIXTY (601 DAYS FROM DATE OF ISSUANCE,
o TO STUB 0 MAIN LINE (EASEMENT-R/WI 0 OTHER
M STORM SEWER CONNECTION PERMIT: .:,..............,..n
t"( VAllO FOR SIXTY 1601 DAYS FROM DATE OF ISSUANCE
Ji(rCA TCH BASIN / BUBBLER 0 STUB ~MAINLlNE
PROOF OF INSURANCE' $500.000 MINIMUM
o ATTACHED 0 REQUiRED AMOUNT
............................................................
~" .1
~+$.15/FT. /9,QO
0$5,001.
o $5.001
G,oo
DESCRIPTION OF PROJECT:
TOTAL DUE: $
TOTAL DUE WITH PERMIT $
24, i? D
PERIOD OF USE OR TIME OF CONSTRUCTION:
ijt"t>LANS ITWO SETS) ATTACHED
AREA: LENGTH: -10.^ ' .WIDTH:
TYPE OF WORK: CUT: 5.'>1.. ,^'" Ui
OTHER: 4"' 10
EXISTING SURFACE MATERIAL: 51'li:{ (' ';r!C,.w/J(
)
BACKFILL MATERIAL TO BE UTILIZED: r Vu\LtJ ro-d::.'
SURFACE REPLACEMeNT MATERIALS TO BE UTILIZED: r'nv.. r hi T;. ~ S ~~
TYPE OF DUST CONTROL TO BE UTILIZED: tJlt1,,,- C"if"'" .\C..~ '
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT: - - JJ A .
WARNING DEVICES TO BE UTILIZED: S ~~., ~ ~rNvu~_( .
Advance sj~jng and work zone protection to be in compliance with the Manual on Uniform Traffic COntrol Devices (MUTCD).
DESCRIPTION:
FROM DATE:
TO DATE:
5' I'> '1(,.
S' /'l%/
" DEPtH:
4'
. TIME: "1 ~
TIME: ~-~
HEIGHT:
.
WORK SHAll, COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD,
REVISIONS B/24/95
-fORM'116
f/e6.JG CC1:J-0 4J~ UJrv/r;ft - tJl/ wrJ-l fJtdJ - ~ ~
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.PoLAN REVIEW COMMENTS I SIIAL INSTRUCTIONS: -
RESTORATION WORK SHALL BE IN C ORMANCE WITH EXISTING CITY COOES A'IN aJMPLlANCE WITH CURRENT
STANOARD SPECIFICATIONS, EXCEPT AS NOTED BELDW,
c
001
002
003
004
005
006
007
008
009
? 010
J 011
012
013
014
015
016
017
..... 018
.
Comments:
',;.
Backfill with %" minus rock.
Compact every 18" loose depth.
Acquires compaction with 8 steel rolller.
A.C. to match the greater of existing depth or 4",
All cuts sealed for final inspection.
Temporary patch may be used at the end of the day.
Signing and Zone protection to comply with MUTeD
Cut concrete only on score lines or cold joints.
Sidewalks and driveways min. 3.00Qpsl.
Curbing min 3.500psi I No patchwork less than 3'.
Meet min. requirements on curb cuts, Spfd. code.
Restore planted arces, Spfd. code 206.3.05
Spec. to Bore I Jack J No A.C. cuts.
Mechanical compacting required.
No patchwork allowed.
Lateral cuts to have control density 1iI1.
Cuts to be polymerized crack sealed for final inspection.
Mininum 2M crushed rock %" minus.
019
020
021
022
023
024
025
026
027
028
029
030
031
032
033
343
Minumum 4' .clearance at any point. swing.away.
Concrete minimum 4" depth. 3,OOOpsi.
Trench to be "T" cut.
Needs State I County pcrmlt. t
No above ground enc10sings in sIdewalk or handicap ramps.
Diamond cut A.C.lConcrete value boxcs 10 grade.
Fresh Oil signs I Graded.
Comply with Americans with Disabilities Act.
Concrete slabs, 72hrs. curing time, 4500psi.
Concrete slabs require joint seal material.
Driveway requires dowels every 18M.
Submil traffic control plan prior to Qxcavation.
Notily Traffic Division before cxcavatipn.
Core drill main line, insert tee, 2% min, grade,
Must comply with the provisions 01 ORS 757.54110 757.571.
6" Circular holeIH20.Vac.
..
.
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,
-
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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
INSPECTIONS:
!B""'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. REOUESTS 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.
~ITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT-AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726-3761. "
SIGNATURE:
~LI 00 DATEPAID:S/rff!t:J.
i21' U G ~4?:4 RECEIVED BY: gO/J J::::,p7
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 Orawtngshand the laws of the State of Ore1)on pertaining to the work
descnbed herein. I further certify that only contractors and employees w 0 are in compliance with OAS 701.055 will be used on this
project.
The City may inspect the work site described in this P.ermit 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 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 (30) 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.
AMOUNT RECEIVED:
RECEIPT NO:
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 app~ed set of plans will remain on the site at all times during construction. .
Signa~e' /~ d) '~
511'/1~
Date
VALIDATION: .I
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 DRA WER.
INSPECTION:' DATE:
INSPECTION: DATE:
WORK IN PROGRESS
AT TIME OF COMPLETION:
ELEVENTH MONTH:
DEPOSIT RETURNED:
DATE:
DATE:
DATE:
DATE: