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Home My WebLink AboutPermit Building 2018-08-21225 Fifth Street Springt"field, Oregon 97477 Engineering & Transportation Services Division Phone (541)726-3753 Step 1-i_ocation ofVVork Who is filling out the application? n this section, you will need to identify the Applicant,. Owner of the abutting property, and the Contractor, if applicable. Example: John Doe is the owner of the abutting property. You would need to put name, address and contact information. )ane Doe is the Applicant. This is the person filling out the application and filing for a permit. You would put in the contact information. Utility Doe is the utility company that is doing work in the right of way and would be an considered an applicant. You would put in the contact person's information. Contractor Doe is the contractor who will be doing the work in the right of way. You will need to put this contact and license information. Site Address or Location Applicant: Email Address: ----------------------------------- Owner: I Address: ' City: ----------------------------------- Contractor: State: ZIP: Tax Map LutC J/ 42 "' c`;> Tax Lot Contractors Registration (CCB) #: Expiration Date: Project Supervisor: c,Ama) Rr J G—GfL Phone: el"� �C Insurance (— of of Insurance, minimum $500,000 coverage limit Utilities Does your utility company have a franchise agreement or license with the City? Please identify which type of agreement you currently have with the City. r Franchise Agreement r' License Name of other utilities if this is a joint project Intent of project for other utility who will own any facilities placed in right of way: Step 2: Description of Project What type of work do you need to do? In this section you will describe the location, intended use, and what measures you are implementing, such as traffic control measures, dust control measures, and types of backfill material to be used. -Provide the start and end dates, start time of day and end time of day, of your project. It is important that you give time of day that you are requesting for your project work. There are codes and inspections that are time sensitive. -Identify your method of intrusion into the surface of the right of way, such as cut, bore, or drilling. -Describe the surface area length, width, depth, and height of your project. -Identify what type of surface material is currently there, what you will do with this material, what is the replacement type of surface material you will use, and what type of backfill material you will be using. -Any required separation from other facilities. 1— Placing new facilities in the right of way Repairing/maintaining existing facilities Project Description: From Date: t / To Date: / � . DaiiyStartTime: � Daily End Time: .� pCi STOP: Answer these questions next Are you working in the right of way or connecting to City facility? If yes, continue at Step 2a: Work Site Area Are you storing material/objects in the right of way other than during hours of work? If yes, continue at Step � 3: Submit a Work Pian Step 2a: U�/OriC Site Area r Cut [Bore Other: e; Cl�'L� � �-za l � t.� Length �� Existing Surface Material: Depth S'� Width /� r'L�- Gy° ,2, � Gl,,c Surface replacement material to be utilized: Backfill material to be utilized: '�� ' System Connections to City Infrastructure L�I.F�'/ rJ� o :mac.. Cyt u. J.>✓� Height Directions: Submit plans that identify in detail the scope ofwork to be performed in the City right of way/easement. The work shall be performed by a licensed contractorthat is aware of wastewater spills/overflow reporting requirements and City design standards. Your permit shall have specific instructions from the City inspector on how to perform the work. Keep these instructions on site. �' Wastewater Connection [! To Stub Main Line [ Other: Description: Safety and Environment Air Qualitx Type of Dust Control to be utilized: [; Stormwater Connection [ Catch Basin/Bubbler Stub [ Main Line c a �� You are required to call: The Lane Utilities Coordinating Council's "One Call Number" ' 811 or 1-800-332-2344 48 hours before digging. Stormwater Pollution Prevention Directions: The City is required by Federal and State law to monitor the discharge of construction stormwater and site runoff. Applicants shall develop and submit a Stormwater Pollution Prevention Plan (SWPPP) that minimizes to the maximum extent practicable the discharge of sediment and other pollutants to the public stormwater system. Call LDAP with questions, 541 726-5489. Listed below are some ofthe most common issues on right of way construction projects. How will you address these items on your SWPPP? Please be aware that each project is unique and may present challenges not addressed in this set of examples. [ Dewatering [!, Soil Erosion [` Hazardous material storage/spill prevention [ Sawcut slurry runoff [! Site runoff/sedimentation Wastewater Spill/Overflow Prevention Directions: City policy requires that all work performed in the City right ofway/easement is in full compliance with DEQ and EP,4 regulations. No spillage of raw sewage shall occur during construction, including spillage in an open trench or excavation. The contractor shall take all reasonable precaution to avoid spills and shall immediately notify City of Springfield Maintenance 541 726-3615 or 541 726-3761; After hours Emergency Response Team 541 953-3428 in the event of a spill. Plan submittal for Wastewater main line work Bypass pumping Temporary plugging of sanitary main Traffic Control Plan Criteria for City of Springfield Traffic Control Plan Submittals Directions: You will need to submit a Traffic Control Plan, which will need to be in compliance with the Manual on Uniform Traffic Control Devices (MUTCD) and Oregon Temporary Traffic Control Handbook. Plan Submittal requirements: Submit your Traffic Control Plan (TCP) with the following information on 8.5"x11" or 11 "x17" paper. Fill out and submit this form with your TCP. The TCP shall be a legible hand drawing, or a computer aided design with the following information: Traffic Control Plan form is located at wwws�rinofield-or.00v/menuonlineforms A vicinity map: That includes the north arrow, road names, intersection/driveway access points, curb lines, the work zone, and any special features such as buildings, access points, sight obstructions, that could affect the TCP. Location: Where will the TCP be active? This can be a line drawing of the work zone{s)and/or a map that clearly indicates where traffic control devices will be placed, including spacing and cone tapers. Attachments of the apprcpriate traffic control diagrams) as shown in the current MUTCD and/or the ODOT Oregon Temporary Traffic Control Handbookthat reflect the work zone maybe included as a standard reference. ODOTs Traffic Control Handbook website: www. Oregon gov/ODOT/HWY/TRAFFIC-ROADWAY/docs/pdf/OTTCH 06.pdf?ga=t Trar'fic Control Plan attached in email to Land Development; LDS@springfield-or.gov No Traffic Control Plan 'There are no public traffic safety issues with this application. Step 3 -Su rrlit a Wor Pan What kind of work pian do you need? You will need to submit a copy ofthe work pian, which includes: �ite location and vicinity map Identify extent of excavations —' include North arrow. � or bore locations. Outline limits of disturbance/ of work area. 5 w location of utilities within right of way. Identify pipe size and type, mainline connection location, and �entify staging/materia! connection type. �"= storage areas . Work Plans attached in an email to Land Development; send to LDS@springfield-or.gov. Reference site location and name in subject line. *Construction of ADA ramps or other ADA facilities require submittal of detailed topographic survey and design sheets stamped by a Professional Engineer licensed in the State of Oregon. Design of ADA facilities shall at a minimum meet the current federal Technical Requirements as described in the United States Access Board's 2011 Proposed Accessibility Guidelines for Pedestrian Facilities in the Public Right -of -Way Notice of Proposed Rulemaking (NPRM). Fee Encroachment/Placement Permit $335.00 Fees that may apply -A 5%Technology Fee will be applied to the total cost of the permit for processing the application. -A $1030.00 Asphalt deposit is required when the asphalt will be disturbed. -Additional financial security may be required. Deposits and Financial Security Projects involving work within public right of way in the City of Springfield are subject to deposits or other approved forms of financial security that may include performance bonds, set-aside letters, or irrevocable letters of credit. The type of financial security is determined by the project's size, scope, and potential impact to public infrastructure. Examples of typical impacts that will require financial security include asphalt trench cuts and sewer repairs that involve cuts to a main line. Warranties Financial security is held by the City during a warranty period that typically lasts one year and begins when the project passes final construction inspection. The. warranty period allows the City to monitor the structural integrity of repairs and determine their long-term viability. Financial security provides the City �,n/ith the means to repair infrastructure should failures that remain uncorrected by the applicant or applicant's representative occur during the warranty period. A final warranty inspection will be conducted eleven months afterthefinal construction inspection. Financial security will be released when the warranty period has passed final inspection. Restoration of City facilities It will be determined by the Public Works Director at the time of the 11 month inspection as required in Municipal Code 3.222 that the work area in the public right -of --way is in as good a condition or better than it was before the issuance of the encroachment permit.. Municipal Code 3.210 (2). When do you need an Encroachment permit? Municipal code 3 208 Work On or Under Surface—Encroachment Permit Required thttp://www.gcode.us/codes/snrinofieid� defines when you need an encroachment permit. When do you need a Placement permit? Municipal code 3 224 Placement of Devices or Structures in the Public Way 1 http://www.gcode.us/codes/springfield/) defines when you need a placement permit. Step 5: Signature �� -- ��-y°a � � _._. _ Signature w � Date: �`�b-t� Check one: [� Ow r [Applicant [Contractor [Utility Project Manager You are required to call: The Lane Utilities Coordinating Council's "One Call Number" 1-800-332-2344, 48 hours before before digging. Page 2 of 3 _ Page 5' Easement lz> 7' PUE Utility pole to be moved before work on driveway starts, DRIVEWAY MUST BE REBUILT. T APPROX LOCATION OF (1) REQUIRED STREET TREE. UNIT OCCUPANCY LOAD THE CONTENTS HERE ON HAVE BEEN REVIEWED, WITH ALTERATIONS NOTED ON THE PLANS OR BYATTACHMENT. CHANGES OR ALTERATIONS MADE TO THE APPROVED DRAWINGS OR PROJECT AFTER THE DATE BELOW SHALL BE APPROVED BY THE BUILDING OFFICIAL. CITY OF' SPRINGFIELD, OREGON NOTICE: This permit shall expire if the work authorized under this permit is not commenced or is abandoned for any 180 day period. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through 952 001 0090. You may obtain copies of the rules by calling the center. (Note: The administrative telephone number for the Oregon Utility Notification Center is (800)332-2344. Construct driveway per City Standard 3-19 or 3-20. Maximum width 24 feet. No above -ground facilities (fire hydrants, power poles, catch basins, valves, j -boxes. shall be permitted within the apron o, ramp area. New street trees shall be a'. !ea.n t 2 inches in caliper. Street trees shall be selected from the City Street T; oe List and installed as specified in the Cit✓"s E,igineering Design Standards and Procuduies Manual ` Connect Storm Sewer to weephoia(s) in curb per City Standard 3-6. Pipe constructed within Right -of -Way must be perpendicular to Riaht-of-Way. Connect Sanitary Sewer to new service c;uni,ection. Field verify location. MINIMUM SETBACKS— INTERIOR LOTS All measurements are from Property lines -Fro nt Yard to House 10 feet -Front Yard to Garage 18 feet -Side Yard to House or Garage 5 feet -Rear Yard to House or Garage 10 feet P.U.E. MAY CHANGE SETBACKS i 1 T APPROX LOCATION OF (1) REQUIRED STREET TREE. UNIT OCCUPANCY LOAD THE CONTENTS HERE ON HAVE BEEN REVIEWED, WITH ALTERATIONS NOTED ON THE PLANS OR BYATTACHMENT. CHANGES OR ALTERATIONS MADE TO THE APPROVED DRAWINGS OR PROJECT AFTER THE DATE BELOW SHALL BE APPROVED BY THE BUILDING OFFICIAL. CITY OF' SPRINGFIELD, OREGON NOTICE: This permit shall expire if the work authorized under this permit is not commenced or is abandoned for any 180 day period. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through 952 001 0090. You may obtain copies of the rules by calling the center. (Note: The administrative telephone number for the Oregon Utility Notification Center is (800)332-2344. Construct driveway per City Standard 3-19 or 3-20. Maximum width 24 feet. No above -ground facilities (fire hydrants, power poles, catch basins, valves, j -boxes. shall be permitted within the apron o, ramp area. New street trees shall be a'. !ea.n t 2 inches in caliper. Street trees shall be selected from the City Street T; oe List and installed as specified in the Cit✓"s E,igineering Design Standards and Procuduies Manual ` Connect Storm Sewer to weephoia(s) in curb per City Standard 3-6. Pipe constructed within Right -of -Way must be perpendicular to Riaht-of-Way. Connect Sanitary Sewer to new service c;uni,ection. Field verify location. MINIMUM SETBACKS— INTERIOR LOTS All measurements are from Property lines -Fro nt Yard to House 10 feet -Front Yard to Garage 18 feet -Side Yard to House or Garage 5 feet -Rear Yard to House or Garage 10 feet P.U.E. MAY CHANGE SETBACKS