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Home My WebLink AboutPermit Encroachment 2019-07-25Application to Work in the Ri ght of Way willbe issued City Oncethe application has been approved, a225 Fifth Street Springfi eld, Oreg on 97 471 Engineering &Transportation Services Division Phone (541 ) 726-3753 Step 1-Location of Work Who is filling out the application? iilffi""^' 'u will need to identifu the Applicant, owner of the abutting property, and the contractor, if applicabre. John Doe is the owner ofthe abutting property. You would need to put name, address and contact information.Jane Doe is the Applicant. This is the person fiiling out the application ana filing for i fei.it. yo, *ortu put in the contact information. :Jl',Y.il:;:tff;l['n,.:ilf"r that is doins woik in the risht orwav and wouia t".-n ionria",ed an appricant. you *orra put in the 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 Itl 7 ir*,| Bl Applicant: Email Address: Owner: Address: City: Contractor: Contractors Registration (CCB) #; Project Supervisor: lnsurance Tax Lot pnon",NTk)'LS)M6 Phone: Phone: Ln o-l State: O[ ztp: C.L Expiration Date: ,no"",fl\- t1t:i7bT [- Proof of lnsurance, minimum 5500,000 coverage limit Utilities Does your utility company have o fronchise ogreement or license with the city? Please identify which type of agreement you currently have with the City. [- Franchise Agreement Name of other utilities if this is a joint pro.ject : lntent of project for other utility who will own any facilities placed in right of way: f- License 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 project. 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 cut, 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 bacKill material you will be using. -Any required separation from other facilities. f- Placing new facilities in the right of way [- Repairing/maintaining existing facilities r.rJc-4'L 1,1-q il^4-Jn:*,+" d ":[[cv€-'*J q-)Sa.r-r i L(. . L,..re._ r-rt- &-bu-L L-"L Project Description:| -"fi,.*,-l'o\o*.lk g--- t Reset Form can FromDate: 7->b- l1 Daily StartTime: 7- 7L- t1To Date: Daily End Time: 5TaP-lnswer these questions next ;AreyouworkingintherightofwayorconnectingtoCityfacility?lfyes'continue at Step 2a: Work Site Area - Are you storing material/objects ' 3: Submit a Work Plan in the right of way other than during hours of work? lf yes' continue at Step Step 2a [- Cut Length Existing Surface Material: Area Other: Depth width Height Surface replacement material to be utilized: Backfill material to be utilized: System Connections to City lnfrastructure Directions: Submit plans that identify in detail the scope of work to be performed in the city right of way/easement The work shall 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' f Stormwater Connection [- Catch Basin/Bubbler [- Stub [- Main Line Description: Safety and Environment You ate reqrrr Call Number" 81 1 or 1-800-332-2344 Air Quality Type of Dust Control to be utilized: 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, 54 1 I )a 541:9. 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. [- 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 of wayleasement is in full compliance with DEQ and EPA regulations. Nospillageofrawsewageshalloccurduringconstruction,includingspillageinanopentrenchorexcavation. Thecontractor shall take all reasonable precaution to avoid spills and shall immediately notify City of Springfield Maintenance ,c4 I 7 7 6 3 6I 5 or 5t:7)637b1;Afierhcrrrslniergerly,Re:pcrseiea:r5rrl9533428intheeventofaspill. Plan submittalfor 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 TemporaryTraffic Control Handbook. Plan Submittal requirements: Submit your Traffic Control Plan OCP) with the following information on 8.5"x1 1 " or 1 1 "x 1 7" paper. Fill out and submit this form with your TCP. Page 2 of 3 --\ f Wastewater Connection [- To Stub l-- Main Line f- Other: A vicinity map: That includes the nonh 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 b€ 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 appropriate traffic control diagram(s) as shown in the current MUTCD and/or the ODOT Oregon Temporary Traffic Control Handbook that reflect the work zone may be included as a standard reference. ODOIS Traffic Control Handbook website: wlvuL oreson.qov/oDQT-lLlIryY[BAfF]eEQ4DWAVdocs/od?QITCH 06pdflga-t [- Traffic Control Plan attached in email to Land Development; LDS@springfield-or.gov - No Traffic Control PlanI Th"r" rr" no public traffic safety issues with this application. What kind of work plan do you need? You will need to submit a copy of the work plan, which includes: - Site location and vicinity map - ldentify extent of excavationsI include North arrow. I or bore locations. - Outline limits of disturbance/f ;f *;;i ;;. Show location of utilities within right of way. ldentify pipe f identify staging/material [- size and type' mainline connection location' and ' storage areas connection tYPe' Work Plans attached in an enrailto Land Developmerrl, send to LDSgspringfield or.gov. Refetence site location and name in subrect 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). lnformation Fee Encroachment/Placement Permit 5345.00 Fees that may apply -A 5Yo 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 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 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 warrantyinspectionwill beconductedelevenmonthsafterthefinal constructioninspection. Financial securitywill 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 I 1 month inspection as required in Municipal Code 3.222that 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 3.2 1 0 (2). When do you need an Encroachment permit? Municipal code 3.208 Work On or Under Surface-Encroachment Permit Reouired (htto://www.qcode.us/codes/springfieleD defines when you need an encroachment permit. When do you need a Placement permit? Municioal code 3.224 placement of Devices or Structures in the Public Wav ( httB/wu^ry-S@derqtqoletiplnSfiqlel/l defines when you need a Placement Permit. Step 5: Signature Signature Date: l- Owner l- Applicant f- Contractor l- Utility Project Manager you are required to call: The Lane Uriliries Coordinating Counril's 'One Call Nuntber" 1 800'332 2444 48 hours before before digging. Check one: Page 3 of 3 The TCP shall be a legible hand drawing, or a computer aided design with the following information: Traffic Control Plan form is located at www.springfield-or.qov/menuonlineforms 2011 Edition Diagram 320 covers total closure of one lane of a two-lane, two-way roadway. See the detail inset for the layout if using a single flagger to control both directions of traffic on low volume roads (less than 400 ADT) with good sight distance as discussed below. 1. Use truck-mounted flashing warning lights on work and protection vehicles. See Section 4.3 - Lights and Lighted Signs for exceptions 2. For added visibility, a truck-mounted arrow board or PCMS in caution mode may be used. 3. Flaggers at each approach are required if any of the following conditions exist: a. Night Operations. b. Work space is over 200 feet in length. c. Sight distance is less than 750 feet from each approach through the lane closure. d. Traffic volumes are greater than 400 ADT. 4. The length between the Flagger Ahead signs shall not exceed one mile. Use Diagram 340 - Lane Closure with Pilot Car if exceeding one mile. 5. Cones should be used to outline the work space when curves or other roadway alignments prevent clear direction for the motorists to pass the work space safely. 6. Cones along the work space are recommended when posted speeds are 45 mph or greater, when working under heavy traffic or when travel lanes are narrower than 11 feet. 7. Extended queue signing (see Diagram 5-4) should be used when traffic queues extend beyond the initial advance warning sign. 8. When flagging near an intersection, the "Flagger Ahead" (CW23-2) sign should be visible to traffic entering from any side road. Additional advance warning and Flagger Ahead symbol signs may be placed on the side road(s). 9. Sign set-up and flagger placement shown may be used for intermittent full road closures of 20 minutes or less. 10. The "ONE LANE ROAD AHEAD'(W20-4) sign is optionaland should be considered on high volume or high speed roads, or when extended queues are expected. Chapter 5 September 20'16 (E =N o oJ N Page 84 $tatlonafy Lane Ctosuf$ with Flagging Page 85 Lo (U o)oo o)o)o)6 lL o EF It aaa :(! .o CLo 2011 Edition -.E E9: 9o*t c€ 6o b^!E !IU 9<B9=(,)o-F B aa ru a a a a a a t a a a I o. CC, .r I t o fdI I E .l tI E3I E .o !uo6qo-Fo5-E0)\E;(UOEJ EEc6 altI6oo+ Fo t ga Ma Mo Ec .9 ctoMo l,o oG :a(ro = 20 50 25 75 30 1oo 100 100 100 12535 1S0'U) 350 350 350 45 1E0 21050 25055 60 285 55 325700700700 36570 :<(Eo = o o TE Chapter 5September 201 6 N) t- o)l -o N € 0) $tationary Lane Closure with Flagging 320 _lI CERTIFICATE OF LIABILITY INSURANCE CERTTFICATE o 1988.201s 8 oaTE (MM/OOryYYn CERTIFICATE ALTERNEGATTVELYAFFIRITATIVELY THIHOLDER.sNOUPONRIGHTSTHEANDYCONFERSINFORMATIONOFONL,TTERAMAAS,TECERTlFICA ISSUED1STHIS POLICtTHE ESBYAFFORDEDCOVERAGETHEOREXTENDORAMEND,NOTDOESFICATECERTI AUTHORIZEDtssuINGTHElNsuRER(S),BETWEENCONTRACTCONSTIruTENOTADOESOFINSURANCECERTIFICATETHISBELOW HOLDER.CERTIFICATEANDTHEORATIVEREPRESENT.PRODUCER, ormustanc6rtificatethe onAstatemcntanendollement.certainconditionsandth6of maypolicies requiretotermlthepolicy,SUBROGATIONtf WAIVED,rs sublect suchofholdercerttflcatelieutnthetonotdogsconferthis I PRODUCER United lnsurance Agencles, LLC PO Bor 2589 Eugene OR 97'f02 Alpha Plumbing & Rooter Service, LLC 3015 Kincald St Eugene OR 97405 INSURED REQUIREMENT. PERIODPOLICYFORTHETOINSUREDTHEABOVENAMEDHAVEBELOWISSUEDBEENPOLICIESTHEINSURANCEOFLISTEDISTHISCERTIFYTOTHATWHTHISlcHTOORDOCUMENTOTHERRESPECTWITHOFCONDITIONCONTRACTANYANYORTERMNOTWITHSTANDINGINDICATED.THEISHEREINALL TERMS.SUBJECT TOBYPOLTCIESTHEDESCRIBEDINSURANCETHEAFFORDEDBEMAYORISSUEDPERTAIN.MAYCERTIFICATE BYREDUCEO CLAIMSPAIDsHol/vhlLIMITS MA BEENHAVECONDITIONSANDSUCHOFPOLICIES.EXCLUSIONS 1 s 06/01/2018 t2019Y44CL607363 COTIrER.CIAL GENERAL LTABILITYE LIMIT PER: LOC APPL!EStrPRO. JECT CLAIMS-|I/IADE OCCURA I 3BOOILY INJURY BODILY INJURY (Por $x 98Y44CL607363 AUTOTOBILE UABILITY ANY AUIO OWNED AUTOS OI{LY HIRED AUTOS ONLY AUTOS ONLY SCHEOULED AUTOS NON.OWNEO A IxxIOCCURUTIBRELII LIAB EXCESS LI.AB t2018 06/01/20'lg44CL607363YA Y 05/022019N/A 683975 AND ETIPLOYERS UAEIL]TY COUPENSATK'N ln NH) dssibe B appear, moro tlRcmrrksbrrttachsdspac.r.quipd)Mdltional Schcdule,m.y101LOCATIONSVEHICLESOPERAIIONS(ACORDOFDESCR|PTION acanasbeenincludedhavePROPERTIESOWNEDTHEIRMANAGEDOROFANDLLCOWNERSHIPTHEENTTTY(S)RESIDENTIALAVENUES andconditionstointereststerm,policytheirmaysubiectasoncontracttheliabilttywrlttengenerillpolicybyrsquired red.lnsu formPer MP9767namedtheworUservicetobyperformedwlthrcspectsercluslons AvenueS Residential, LLC c/o Registry Monitoring lnsurance Seruices' lnc. 5388 Sterling Center Drive Westlake Village, CA 91361 I SHOULD ANY OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE AEREOF, NOTTCE WILL BE DEUVERED IN ACCOROANCE WITH THE POLICY PROVISIONS.t_ ACORD 25 (2016/03)The AGORD name and logo are registered marks of ACORD All rlghts neserved. 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