The URL can be used to link to this page

Home My WebLink AboutPermit Encroachment 2019-07-10Print Form Application to Work in the Right of Way em.il or print .nd bring to Public Works City Hall. You wlll need to cometo Public Works, Clty Hallto process permlt. City of Springfield Oncethe has been approved, o permit will be issued will need to complete application, save as, then attach to ication can be emailed to '.gov,225 Fifth Street Springfi eld, Oregon 97 477 Engineering & Transportation Services Division Phone (541) 726-3753 Step 1-Location of Work Who is filling out the application? ln this section, you will need to identify the Applicant, Owner of the abutting property, and the Contractor, if applicable. Exa nr pl e: John Doe is the owner of the abutting property. You would need to put name, address and contact information. Jane 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: Address: City: Contractor: lnsurance rzlz s. r"q+u P\ c tws uc Tax Map Tax Lot zq@ \ Phone: Phone: Expiration Date: 3 * I -( 4czo Phone: -fq/-?tq-tt1 3 ?3 State:ZIP: Contractors Registration (CCB) Project Supervisor, J Og #: Xproof of tnsurance, minimum 5500,000 coverage limit .",4 I Utilities Does your utility company have o franchise ogreement or license with the City? Please identifu which type of agreement you currently have with the City. l- Franchise Agreement f License Name of other utilities if this is a joint project : lntent 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? ln 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 pro.ject. lt 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. -ldentify your method of intrusion into the surface of the right of way, such as cu! bore, or drilling. -Describe the surface area length, width, depth, and height of your project. -ldentify 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. lfelacing new facilities in the right of way [- Repairing/maintaining existing facilities Project Description: 51", r t4 f\tA', 0., wA+<r .-1-p S<-rt( Con*<t; dtP +o ("T + fPU-" ) Period of use or time of construction: 7am to 6 pm only, unless it's an emergency. From Date:t-t-Iq. roDate: 1-t-I1 DailyStartTime: f( o"-,,,a. DailyEndTime: SJOP: Auuet q-qestions nex! y Are you working in the right of way or connecting to City facility? lf yes, continue at Step 2a: Work Site Area Are you storing material/objects in the right of way other than during hours of work? lf yes, continue at Step /t c) 3: Submit a Work Plant- Step 2a: Work Site Area ( Cr, .l-- Bore other: Lens\h (D' Depth v width Ztl" Height Existing Surface Material:4+)"A.lt Surface replacement material to be utilized:lr" System Connections to City lnfrastructure Directions: Submitplansthatidentifyindetail thescopeofworktobeperformedintheCityrightofway/easement. Theworkshall be performed by a licensed contractor that 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. T Wastewater Connection T Stormwater Connection l- To Stub [- Catch Basin/Bubbler pJrlain Line [- Stub f Other: l- Main Line Description: r r, ZaTrua'/.t'l'i.lJ C Safety and Environment Air Quality Type of Dust Control to be utilized: vol are re-quired to cail, rhe t-ane utilities Coordin-atlng council\ rone call l{umbe/ 811 or1-800-332-2344 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 '/ )6 5'i89. Listed below are some of the 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. f- Dewatering I/ Soil erosion [- Hazardous material storage/spill prevention k sa*cut rlrrry runoff ff site runoff/sedimentation/r- Wastewater Spill/Overflow Prevention Directions: City policy requires that all work performed in the City right of way/easement is in full comPliance with DEQ and EPA 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 511 / ) (> 36 | 5 or 541 176 31(jl: After lrorrrs l nret<,eircv Rcs;:olse learrr 5'1'l 951 1428 inthe eventofaspill. Plan submittal for Wastewater main line work l- 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 Subminal requirements: Submit your Traffic Control Plan (ICP) with the following information on 8.5"x1 I " or 1 1 "xl 7" paper. Fill out and submit this form with your TCP. Page 2 of 3 Backfill material to be utilized: TheTCPshatlbealegiblehanddrawing,oracomputelaideddesignwiththefollowinginformation: i,#',1'llrTli*e north arrow, ro"9 "".-"1ll.ily::l,il';:Iil:i:Ts Points' curb lines' the work zone' and anv special reatures such as buildings, access Points' sig Where will the TCP be active?Thiscanbealinedrawingoftheworkzone(s)and/oramapthatclearlyindicateswheretraffi<contro|Location: Attachments of the aPProPriate traffic control diagram(s) as shown in the current MUTCD and/or the ODOT Oregon Temporary Traffic Jevices will be Placed, including spacing and cone taPers. Control Handbook that reflect the work zone maY be included as a standard reference'ODOIs Traffic Control Handbook website: u4Lu4 Control Plan attached in email to Land Development;LDS6sprinsfield-or.sov 6nf fl eI S No Traffic Control PlanTThere are no traffic issues with this m a n ldentify extent of excavations or bore locations. What kind of work Plan do You need? Y*, *il| n""d to submit a copy of the work plan' which includes: $ite location and vicinitY maP T/ \'ihclude North arrow. - outline limits of disturbance/ Show location of utilities within right of way. ldentify pipe I of work area. J- iize and type, mainline connection location, and f identifystaging/material connectiontype. *",ur,"":t",1::;J::t"-.,emairtoLandDeveropment; sencr roLDsg,springtierdor.gov. Referencesirerocationandnameinsubiecrline' *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 or oregonl i.tign or non tacilities shall at a minimum meet the current federal Technical Requirements as described in the United states Accesi Board's 2011 Proposed Accessibility Guidelines for Pedestrian Facilities in the Public Right-of-way Notice of Proposed Rulemaking (NPRM)' lnformation Fee Encroachment/Placement Permit 5345.00 Fees that maY aPPIY -A 5olo Technology Fee will be applied to the total cost of the permit for processing the application' -A 51061.00 Asphalt deposit is required when the asphalt will be disturbed' -Additional financial security may be required. Deposits and Financial SecuritY projects involving work within puUtic right of way in the City of Springfield are subject to deposits or other approved forms offinancial securitythatmayincludep"rforr.n..bonds,set-asideletters,orirrevocablelettersof credit' Thetypeof financial securityisdeterminedbytheproject'ssize,scope,andpotential impacttopublicinfrastructure. Examplesoftypical 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 warranry period allows the City to monitor the structural integrity of repairs and determine their long-term viability. Financial security provides the City with 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 after the final 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 1 I 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 Reouired (http://www.qcode.us/codes/springfield/) 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 ( http://ww.qcode.us/codesl5pringfieldl defines when you need a placement permit. Step 5: Signature Signature Date: l- Applicant ff Contractor T Utility Project ManagerA_ red to call: The Lane Utif/ties Coordinating Council's "One Call Number" 1-800-332-2344, 48 hours before before digging. Check one: You requr Page 3 of 3 1-tc-1q