HomeMy WebLinkAboutPermit Encroachment 1998-8-13
'i'H STREET
. IELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3763
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ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER: q~ 1046'
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE .
APPLICATION DATE:
c;; - r=<.-9 R"
DATE ISSUED: 8-17-q{(
,LOCATION OF WORK , ll. Y\D ..... ~V7h f\~
. APPLICANT V~N ~B"NS~N. - :r;:!Z,.t~O( PHONE ~~/ ~~A'1sy/ --..:..... "
SITE ADDRESS: ":50IlRNFlL /\/0. qb7 q~A~~IS1..w:c~llt.lnJ&'1~X P;' J7-O'... -.34-2'"
CITY: :3PRIA1~A'7/) STATE: ,..R. ZIP: T LOT: 12r,1") I
SUBDIVISION: ...blB&r.E7"l( ", J
OWNER: VeR/IJ RPN<::,<)Af ' .PHO~"2,I/ b'ir!!.- '1, JIo"1' ~
ADDRESS: 9.t,to ~b}'" CJ'9 IV, CITY:-EO~~~ STATE: r->R., ZIP: 9741.t).2
CONTRACTOR: u JAl.J)PN ("'tNI/."',r ADDRESS: PI') J~'lY /{d/) 77 .&7..Jr~... Nf'. PHONE: ..br\",~~"
CONTRACTOR REGISTRATION NO: /.. ~~7 EXPIRATION.DATE: '"7-":<'/- ~6
PROJECT SUPERVISOR: RI)[3e-RT ',IDJ nIS]..I PHONE: .kf)""7~C:-~.2
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REQUESTFD PERMITS: ......CTIONI...ClUUWl'
~NCRO~CHMENT PERMIT NO: ............................:.. n
VAlD FOR SIXTY CSO) DAYS FROM DATI 0' ISSUANCI
o CUT STREET 0 80RE 0 OTHER n
o ~UST CONTROL ITYPE OF CONTROU
o CONSTRUCTION, STORAGE. STAGING n 0 $
o OTHER n 0 $
o ASPHALT DEPOSiT............................................................................................................ 0 $
ArrUCAT10H RlI 0EP0an'
ACCOUHl' HOI
, !
Q $'80.0~
0$
TVP~ ,,~ ,~"I" 'RITY DEPOSIT
o BLANKET SURETY BONO Q SURIITY BOND Q CASH I CHECK
IdYCURB CUT PERMIT NO: ................;~.. FT. "32. Q
INOIlM'1nN. CURl I APPROACH AFTER FORMS ARI wcno 8U1' PfUOR TO POURlNO CONCRfTL
. ' VAlIlfOR '10 IlAva mow IlATlO'IS$UAHCL
o SECOND DRIVEWAY ISEE SEPARATllAPPlJCATlONl
Cl SIDEWALK PERMIT NO: .................... FT.
VAll) 'OR 110 DAVS FROM DATI 0' ISSUANCE.
o NEW Q REMOVE' REPAIR 0 PAVE PLANT STRIP
D'SETBACK 0 CURBSIDE 0 LENGTH
INIII:J>FrTlnt.l. ':;IOI!W,tJ.K I DRIVEWAV FOR ALL CONCRnl PAVING WITHIN 1M!! STRUT RIGHT 0' WAY, TO BE
MADE AFTER AU EXCAVATlNQ 18 COMI'UTI. AND FORM WORK AND aUB-IASE MATERIAl II IN PLACE.
/1!1ISANITARY SEWER CONNECTION PERMIT:................n
VALl) fOR SIXTY 110) DAVI FROM OAT! Oil JSSUANCI!
o TO STUB I;!l MAIN UNE lEASEMENT.R/W) 0 OTHER
\
.1il1 STORM SEWER CONNECTION PERMIT: .................... n
VALl) fOR IJXTV leOJ OAva MOM DATI OfIllauANCI
o CATCH BASIN I BUBBLER I;lI STUB 0 MAINUNE
PROOF o~ "J"'Il'~ $600.000 MINIMUM
. 0 ATTACHED Ql REQUIRED AMOUNT
Q$
Q $10.00+$.~6~.
i4-,80'
n
Q $10,00:+ $.1 61FT:
. a $5.do, .
a $6.00'
DESCRIPTION OF PROJECT:
~E~ OF USE OR TIME OF CONSTRUCTION:
~ PLANS (TWO SETS) ATTACHED '
AREA: LENGTH: .wIDTH:
....-.
TOTAL DUE: .
TOTAL DUE WITH PERMIT $
14:. ~D
L4-. ro
FROM DATE:
TO DATE:
~
I Ci~
, DEPTH.
TIME:
TIME:
HEIGHT:
TYPE OF WORK: CUT: BORE:
OTHER:
EXISTING SURFACE MATERIAL: , BACKFILL MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEMeNT 'MA TERIALS 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: ... ..
Advance Ilgning and work 10nl PfotlctJ1? to be In compUanc. WlU1 '(1\' Manual on Uniform Tr.cno Con~ D.vIe.. (MUTeDI.
DESCRIPTION: '-'f)QtA) d1ilH'lJ..l/J 1-1- . ,-Urh waf.!:.. +- cH1Z1!:J:J ,iJAt<J.pJ/iF;! dlr.
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WORK SHALL COMPLY WITH CHAPTER X ARTICLE II OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD .
REVISIONS 1124ta6 FORM , 110 '
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PLAN REVIEW COMMENTS/SPECIAL INSTRUCTIONS: , ~. '
'RESTORA110N WORK SHALL BE IN CO....ANCE WITH EXlSl1NQ CITY CODES AN.MPUANCE WITH CURRE ..
STANDARD SPECIFICATIONS. EXCEPT'AW'OTeD BELOW. '.
3 001 Btcktm WIth ll' mlnUl rock.
.. 002 Complet IVlry 18.1.... dlpth,
.. 003 Rlqulrel oompletl.n with I It..1 r.III."
.. 004 A.C.I. mltch thI grelt.,., 1.llllng dlpth or 4'.
,. 005 AD 01111 1IIIId I.r llrillll1lploilon.
. ooB. Tlmponry pltch'mlY bl ulld II thllnd., tho dlY.
. 007 Signing Ind Z.n~ pr.tletlon I. c.mply with MUTCD
. 008 Cut ooncrete only on Icor. tin.. or, cold lolntl.
. 009 Sldlwllko Ind drIVlWIYI mln. 3,OOOPIL
. 010 Curbing mln3,Boopol 'N. pllohwollt IIII thin 3'.
. 01 I MOil min. requl..mln:1 on curb 01111, Spld. codl.
. 012 Rill." pllnlld.lrell, Spld. codl 20B.3.05
. 013 SpIC.tO. S..., Jlck" No A.C. CU!I;'
~ 014 Mlchonlcal comPleting required. .
,015 . ,No patchw.'" in.wld. '
01 B l.Il.,11 01111 to hlvl c.ntrOl d011l1tY IIn.
017 Cutlt. be poiYmarlZld crack loalod I.r IInalln'pactl.n.
, 018 Mlnlnum 2- CNlhed rock ~. mlnul. .
- 019 Mlnumum 4' cl..r.nce at any point, .wlng..way.
.
. 020 C.ncrltl minimum 4' dapth, 3,oaopal.
021 Trench to bt "T- cut. .
.
. 022, Noad. Statl , County p.rmlt.
. 023 No .boy, ground Inclollngl In ,Idewalk or h.ndleap ramp..
. 024 Diamond cut A.C./Concretl value boxeI to grlde.
. 026 Frnh 011 olgno , aredod.
. 02B Comply with Am.,lcan. with DlnblllUn Act.
. 027 C.ncrltl IIabl, 72hll. curlng tlma, 4600p,l.
. 028 C.ncreta .labl IIqulrelolnl ..al mltarlal.
. 029 OrlVIWIY nqulrtl dowII, Ivery 18-.
. ,030 Submit tr,ffle control plan prior to exc.~ation.
. 031 N.tlly Trimc Dlvlllo"lia'oio o.ca'vailpn. .
. 032, Core drill mlln IInl, Innrttee, 2% min. grad.. .
. ' 933 "Mull comply ';;Ith tho provlalono 0' ORS 757.641 to 757.571.
- 343 a' Clrculor hola/H2o.Vlc. '. '.'r ' "
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Commanta:
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YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
4S HOURS BEFORE DIGGING
1 '
INSPECTIONS:
'0
CURB CUT AND SIDEWALK INSPECTIONS CALL 726-3769 (RECORDER) STATE YOUR DESIGINATED 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 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 WOfjK IS IN PLACE BUT PRIOR TO POURING CONCRETE.
o SANITARY SEWER; STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726-3781.
SIGNATURE:
AMOUNT RECEIVED:
RECEIPTN<9:
\fj~
1J.. \ \ ()\
io
DATE PAID:
RECEIVED BY:
~-I'7-q(
v\A~I~
By slg1atura, I stata and agraa;! that I hava carafully axamlnad Iha complatad application and do haraby cartlfy that all Information
hara n a 1IUa and corrac;t, and furthar cartlfy that any and all work parformad shall ba dona In accordanca With tha Ordinancas of tha
, City of Sprlngflald, appllcabla Ity Standard apaclflcatlons and Drawlngshand tha lawa of tha Stala of Ora.9on partalning to tha work
desjCrlbad hareln. I further cartlfy that only contractors and employeas waara In compliance with ORS 701.055 will ba used on this
, pro act. ,
Tha City may Insl1act tha work alta dascrlbad In this l1armit at :any tlma during a one yaar pari ad following tha receipt by tha City of
notlca of.complatlon of tha daacrlbad work and apal;[Iv, at tho City's sole descrasslon, any additional rasloration workre~uired 10
. raturn tha ,Ita to a standard accaptabla to the City. THe permlttaa will be notll'ad In writing of any work required and will have thirty
" days (30) from tha defe ofb Ithed"Otlce to complete the work. Work not completed atlhe en~ of Ihe thirty days'will be parlormed by Iha
City and tha costa wll ba IlIIa 10 tha parmlttaa.
, I furthor agrae to ansure that all raqulred Inspactlons ara raqutlstad at tha propar tlma, thaI proJact addrass Is readabla from the straet,
and tha approvad sat of plans will remain on tha sita at all tlmas during construction.
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Slgnatura
Data
VALIDATION:
o TRAFFIC REVIEWED BY:
o ENGINEERING REVIEWED BY:
o MAINTENANCE:
o PERMIT ISSUED BY;
DATE:
DATE:
DATE:
DATE:
, FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRA WER.
\'
DATE:
DATE:
DATE:
DAT~:
DATE:
DATE:
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INSPECTION:
:. INSPECTION:
WORK IN PROGRESS
AT TIME OF COMPLETION:
ELEVENrH MONTH:
DEPOSIT RETURNED:
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