HomeMy WebLinkAboutPermit Encroachment 2019-05-24CITY OF SPRINGFIELD OREGON
DEVELOPMENT AND PUBLIC WORKS
Office Copy
ENCROACHMENT PERMIT
OREGON
APP|ICANT: Preclsion Construction
LOCATION: o6e S. zt$ st
PERMIT; 811-19-000118-Pw
DATE:0512412079
A I I liN'IION: Orot;tlrr law Ie (luirgs yotr lo ltrlkrw nrlt:s arloJlted l.ry llto
Qregon Utilily Notil-rcatlon Ccnlrtr. 'l hos;cl rulssi ttre sgt lottlt ln OAR
9ti2'001-0010 through trliz.001 0090, You miry 0lrlairt copios of lhrr
ruluo by r:alling lhr., (:onlor, (Nol(l l'lto admlnislrntlvc tok)phlrrr.t
numberr for tha O,og(rn t,Jlilily Notificittion Conler ls (000)33?.2344.
CONDITIOT{8 OF APPROVAL
Contact Cralg Fltrgereld at (541)954-6477 a mlnlmurn of 24 hours prtor to core drllllng and to schedule lnsPectlon of plpe
connectlons.
Refer to Clty of Sprlngfleld Munlclpal Code 3,208 for Informatton on Encroachment Permlt requlrements.
Work wlthln publlc rlght,of-way shall only be performed only by contracto?s and employees certlfled purcuant lo ORS
701.026. All materlals and workmanshlp shall, at a mlnlmum, meet Clly of Spilngfleld, Department of Publlc Workg
nstandard Constructlon Specificatlons, L994" as amended ln 199t (or current edition). The CltV has the rlght to require
additlonal work not shown/deecribed here ln but necessary for the restolailon of the Clty's ROW lnfrastrusture.
A splll kit is to remain on-slte for the duratlon of all constructlon actlvltles. The splll llt shall, at a mlnlmum, contaln
absorbent, splll booms, and splll pads, The splll klt ls to be placed ln an area tvhere lt ls easily vlslble and accesslble ln case
of a splll em6rgency.
Rppllcant shall malntaln overslght of all contractors and sub-contrectors performln6 work authorized by this permlt and
shall be responslble for ensuilng all work ls performed ln accordence wlth Clty of Sprlngfleld Standerd Speclllcatlons and
the speclflc condltions of approval contalned ln thls permlt.
Ci$ of Springflcld . 225 Fifth Stsoct . Springfhld, OR97477 . 541.?26.3753 . 541.735.1021 Frr
ranilw.sptl n gfl eld-or. gov
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By rlgnoturc, I rtoto I hovo corefully oxomlncd thc opprovod pormh ond do hcrcby ogrrG lo comply wlth
tfic rcqulromcnf of thc pornrlt ond I ccrrlfy ony ond oll work pcrformcd sholl bc donc In occordoncc wlth
tho Ordlnonces of ,he Cly of Sprlngfiold, oppllcoble Clty Stondord Spcclflcorlon ond Drowlngs, ond the
lows of thc Sloto of Orcgon pcrtolnlng lo tho work dascrlbed hcrcln, I furthcr ordlfy only controclore ond
cmploycot who orc ln complloncc wlth ORS 701,055 wlll bc uscd for thfu prolcct.
I ogrcc for myrclf, my conlroclorr, ond cmployocr, lhol ,hc opprovol of tho rlghl of woy pcrmlt ln no
monnGr prcsumcs or lmpllcl rhc opprovol or tcrmr of opprovol of ony othor fulurc pcrmll roqulrcd by thc
Clty for the sltc ond lndomntfles ond holds horrnlcrs thc Clty regordlng ony fulurc opprovol o, o future the
plon, ponltlon, eubdlvlrlon, or ony olhpr rcqulrcd pcrmlt fior moy couto sny work completcd ln
complloncc wlrt fic rlghr of woy pormlt to bc ohcrcd lo conform to tir flnol pcrmll opprovol.
I undorrtond ond ogrco the Clty moy lnspccf thc work ritr dorcrlbcd ln thls pcrmil ot on7 tlmc durlng o
666.yGor pcrlod followlng thc rccclpl by thc Clty of norlca of complcilon of fhc dcrcrlbcd work cnd
spcclfy, ot fio Clty'r solc dl:crctlon, ony oddltlonol raglorollon wqrk requlrod 10 relurn lhc sllc to o
stondord occrproble to rhc Clly. I wlll bo notlflcd ln wrltlng of ony work roqolrcd ond wlll hovc 30 doyr
from fhc dorr ol lho notlco to complctr tho work. Work not complc?cd ot thc cnd of thc 30 doyr wlll bc
pcrformcd by he Clty ond thc cosls wlll bo blllcd to mc.
I luahrr ogrc. lc .ntur. ell roqulrrd lnrprcllonr ci. i.qu..l.d ol lhc PtoP.? tlmr ond thr opprovld
pcrmlt ond rl ol planr wlll romcln cn lhc rltr ol cll llmcr dudng ccnrhucdon cnd unlll rcmovcd by
thc Clly.
I sholl do{ond, lndemnlfy ond hold hormlors rfio CIty from ond ogolnsl oll lloblllty or lorr ond ogolnst oll
clolms or actlons boscd upon or orblng out of domogc or lnfury to persont or property cou:cd by or
lutrqlncd ln connccllon wlrh pcrformoncc lf thk Controcl by thc pcrmltlca crccpt, purtuonl to ORS 30.140,
for losol, clolmr, or octlonr rcsultlng from thc rolc negllgcncc of lho Clty.
I sholl q*umc oll rcrpcnllbllhirr for thc work, ond bcor oll loarcr cnd domogcs dlrcctly or lndlrcctly
rcsultlng to fie pcrmlltoo, tho Clty, or to olhcrs on occounl of lttc chorsclcr or pcdormoncc of lhc work,
unforcsccn dlfflcuhlcs, occldcntr, or ony oilrcr couscs whsEocvcr. I sholl ossume dcfcnsc of, lndemnlfy
ond tovc hormlom thc Clty, ltr officlolr, ogcnfi, ond cmployror from oll clolms, lloblllty, los, domogc, ond
lnlury of cvcry klnd, nolurc ond dorcrlpllon, dlrcctly or lndlrcctly rcrultlng frcm octlvlllcc ln lho
porformoncc of rhe Coalroct, lhc owncrshlp, molntenonG! gr u6c of mo?or vchlclcr ln conncc'ilon lhcrewlth,
or lho cclr, cnkrlonl, oporotlons, or ccndusl cf lhr pcrml?lee or ony Subccatrocior undcr ttc Contrqo or
ony rv6y orhlng our of thc Controo, Irrorpcolvc of whcthcr on ocl, omlrtlon or eonducl of thc Clty
conncced wllh thc Conhoct h o condltlon or coilrlbutory couso of tho clolm, lloblllty lorl, domogc or lnlury
ond lrcspoctlvc of wholhcr ocl, omlsrlon, or conducl of rhr prrmlncc or Subcortraclor h mcraly o
condltlorr rorhcr thon o courc of o clolm, lloblllty, lorr domogc or lnlury. I tholl not be lloblc for, nor be
requlrcd to dcfcnd or lndcmnlfy, the Clty ralollve to clolmr for domogc or domogee rcsulllng solcly from
ocl! or omlsslonr of thc Clly, ltr offlelol;, ogonts, or cmployccr. Ihc pcrmlttac's obscncc of or lnodcquocy
of thc lloblllty lnluronco rcqulrcd by tltc Clty of Sprlngflcld rholl not ncgo?c pcrnlt?cc'r obllgorlonr ln thh
ogrccmcnf.
PERMITTEEI
Prlntrd Nomor
Dole:
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Otyof Sprlngflcld . 225FlfthStrcot . Sprlngflold, 0197477 . 94t,726,3?53 . 5111,736.102lFrr
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Fnglnt.f rin(, & Iraosportolion 5r,ry1(r:i [)lvr]i.)r)
lrho^r (5411 72b ll53
5trlr nd(lrsrs or l..x,rti(rrt
Ap olicunt:
l:tnirllArldl,,r\l
owner: R,fiChgl-A(,(lrr,i\: |ra'bUc)
xQqm.ar.'.l,,csrt.none:.{.11 .^ -lef .: 2.! 3 2
tdfi
5tep I l.ocation of Work
Who is fillirrg uut the application?
lr thll r(f(ri(,n, y(,u will ,tcfil to idr.,rrttly the Apptlcant. Ownct of fho aht,!tlng proPeTty, und thc Cu^ttil(tor, if ,rpplicnble.
loltn Do,.. it tltc Owilet ol the abutttng l)tOpeny, YoU would need to put rlJryrf., d(r(lr!$r dtld (orltilct [rJOtrttaltOfr,
,ane Doe li the Applt(r,tr. lhlr 1s rhn porJon fllliilg crl.,t tlrts ulrpllcotlon a,td filirlu fr)r a Petmir. You would p(l( in the (Onlrt(r lAformation.
cont'.t(t lrr..n(rn'\ lrtf0/,rtilti(,1\.
Conu'dctor Ooe is lhc who wlll be dot^o th8 work ln rhe ,ight of wdy You wrll nead to pr,rt thi! crrnl.lr.t ,rlr(l lr(4,\)e i0f,,rtnnliun.
) Y(st 11:,n,n g[ie OQql{'f$ r'rrr,rrrr
ar l.ot
.., Phonel
(illY;CqrvaLLit -. .";.\;iij-;[ \,a
Cctl5rado l,.l k
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ta,f,aite L-"- ..i;;:;;;:;:1/li.:.?z;)--u:13
rnn, O9't5^20
('ontractor:
Conr,rr:tnrr Ragislr,rtiOil (( (:B) ,,:a g3.aa":-._-__^-.Explrirtion
['rolcct Su t hor,a.,';t/ / - /O / - c/OJl
lrt)t)rd r\ (e
19 lrorlf ol tnrttronro, mlttltnUm 9S00,000 (t)vrlt'|llr'lrtilil
Utilities
Ooe t yout tttttlty company havo o hanchlsc oqrcemcnt or llc'tnsu whlt tlt* l'ltyl
Flt,lst irlenrity which type of agrccnrcnl you (sreotly have w,th lhc Clty. l'- lronthr$e lg/pemenr
N,rmr. ol rrrhor rrtltithr ll rht( l( n ,olnt liroipcr ;
L icense
lntent of p.oi€ct I(, utlvtr \ttlllly wh0 will
nwn i^y faclllllcr Flir:pd irt ?luht o, wdy:
Step 2: Description of Project
Whol type of werk do you nqetl to do?
l,r tlrir rc(tit t! you wlll dftcllbe lh. locatlon, Intcndrd uro..rnc, whrrt tn(f,rturcs you ors ilrrplcrn(nhrt0. ,,$(h rl) lr,ilrl( I otlt(ol
rw.erures. duet control moil:iltr(t, .rrrd typer of backllll rrrotctiol to ltt ured,
.ltrovld., the rtiln and end daict, ,tart thn( ()f rlay ,:nd enr! tinre ol doy, (rf yrrtrr rrroreil. lt is important that yov givc
tirrre 9( {;1y 1f1;11 you (r/a r0qrxrilinlt tor your lrro1e{t wrrrk. Tlrore lrc rodct ,.rnrl insnottktnt tltut 4rrr timt gnrrritlve.
.ldcntlfy yorrr m.thod o, lt'rln/tton lrtl0 rlto su,hrcc ol lha r;qht ol wxy, ru(h or (ur, horc, ur rlrlllirrrl
'D6!crllx the ,urfa(e irea le^9th, wl(lth, d(!tr(h, ilild htlght of rour prolocr.
ldenrily what ly;)c 0f rrrrlace mrteri.l is cur,dntly thurc, what yorr wlll do with thir nt.Jfl,hl, whrl lr lhp ,eplerernentlyFe
of rutfocn rnatcrial you will t,lc, .rrrrJ wh.rl type of brrk{lll nrterinl yotl wlll b? r,slnq.
.Arry rnqulrrd rrrlrilr,rlli)n tu$rlr olho, 16rllltlc!.
fi,ur,n,r,rr*r,cliri4rinrherishtorway 1" SOE| , AI"t\, *l'e R
[- nrlrairrrrs/rnohrr.rtnt^r,r..rrrlnqlr(trrria$ BOge. 0^/ / nr{ .TS€,eTe E,
t^{:d, \\t(glo l-+qr.t Proiect aLAp Y:rrt we're uhfrqrr€os f.i/fi€ .
,\iy\t_ o.ryr na4givthi 5a,^wido:WQ.-e\flJ^ O^ Q-yJ'uJnlr..r't 1nc,.lta- Y,
fr,oo,,l,[,,on, t@c rryi* o;{ Cutaodl;'1 tv if at)t*' a- nal^J so-lt i4c' ' utz''
r/qrqrrnrloni'-rnontnl gu/ef L;p' nf h''rt*) L"n<''
Prhl FormRcrtForm
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Appf ication to Work in the Rig
will be issuedahos beenOnct the
ht of Way
arrd to compla. rp?llc!tlon, rtve lr, thtn
P.rmlt,
Pcrlod of ure ot tlme ol conrlru€(lont 7!m to 6 t)m only, unlo3t lt'J rn Cmcrgon(. r.
From oate:
Drlly Srtrt Tlmo;rl Avv:.
To Dttei
Doll, tndTlmcl 5en
r:':'iii: l,r r.,....,,;;),...,, ,1,,,. 1,..,,,,, t,/ I I
- lrcWttnelne rlght of way or connectlng to Clty fa(illtv? lf yes, contlnue et
- Areyoustorin!material/objecslntherlghtofwayotherthan durlnghoursofwork?lfyes,condnueat',t',;,| 1 \rrl,nul ,r t'y',ttk l'l,rtr
A) ct
,..,..,.. ,..,,).: ,.:i .,.r.1,,
Othor:
0oprh wtdrhLcngth Helghr
Exlrtlng Su/occ Malerlrl:
Surf!ce r.D,!r!m?nt molerlDl to ba utlllu adi
oackflll nrorerlel 1o be utlllzed:3/{ nninqg
System Connectlons to Clty lnfrastructure
Dlr6166* Submh pl{ns lhit ld€iltiry in dcte ll thc r€opo of wotl to be pcrfurmed ln lhe Clty tlohl of w.y/e.temcnt Tho work shrll be
perfo,med by a lrccnscd conrra(ro, thDt ls awarr of waerewrlcr spllls/oveilow tcponlng roqultomcnlt !nd Clly drrl0a rlrndordr, Your
peamlt thall have lpecific lnsrruct onr from thc Clry lnspa(or on how to perform lhe work. Keca these lnst7u<tlons on ilte.
!J W0rrcwotir Co^nccllon slorrnwrl?l Conno(tlon
I ToSruO Cat(h8asln/8ubblc,
.F.utrin Llno stub
I Otherr Moln Llnr
Derrtplloru
Safety and Envlronment
'rypc ot Dutt Control to be utilized:
',r i,r,r ..,/.)l( I i',,fltr,t,,rl l'1 r.,' r't1,,rr
Dlrecionr: TheClty isrcqulrudbyFcdffrlrndStrtrlrwtomoaltorthrdlrchargeolconrruclonrtormwatetondrherunoff, Appllcants
sh.ll d6,elop lnd submlt a Stormwrter Pollurlon Prevendon flan (SWPPP) thsr mhlmlzcs to tht rn0xlmum ertcnt OrECtlceblc lh0
dlrcharge of sedlment end othar pollutrnu to tho publlc rtormwater ryrtem, Call IOAP wlth qsettront,
tlilcd bclow a/c lomc ol tho mocl common l$uo, on rlghl of rvry conrtru6lon pro,lac$, How wlll yo\, lddrcil thatt llomt o^ yout
SWPPP? Plerrc b! awrrG lh!t c.ch prorcct l, unlquc rnd moy pfficnt <hrllcngcs not addrrssed ln ftls s.t of cramphs.
DoivrterlnE f- Soll Emlton Hazardous mrterlalstorage/splll pre\rentlon
Srwcut rturry runolf l- Sltc runofflrodlmqnrctlon
;tl 1 ,t1.r,11 1 r 'i, lrllr(;V,:l lll;l tl'r,,vr:, rl tr:t I
Dlre(tlonsr Clty pollcy rcqulrct thrt rll work 9crlo.m.d h lhr (lry ,lghr ol wryhrrement ls ln lull compllancc wlth DEQ End tPA
ro9uLrlont, No arrllltga of /tu/ tawega !htll o(cur dudng connructlon. lacludlrE SDllhgr ln rn oDcn trrnch or crcrvarlon. Yhc contrrttor
shrll takr rll rersonable p,eoutlon to rvold ipllli rnd thlll lmmedla(€ly notlfy Clty of sp,ingfield Malntenanre or
ln thc event of a rplll,
Phn rubmlnol lor Waltowrlcr moln llnc work
l-0yparrpvmphtg I-femporarypluggingofsanlrirym.in
,,,'lrl1..,r);;r:J'lll:r'!1,.f(,1li,irit..,1',lrrrrrlli:,lrl'1.llri/,rrriirrlJrl,Irr,,rlilr,,l;1.,
Dlrealonr: You wlll neod to rubrnlt a I rafflc Co^lrol Plan, whlch wlll need to be ln (onrplh^cc wlrh rho Manuol on Unlform
Trafflc Control Deylcca (MUTCOI .nd Oregon lcmporary Trafrlc Control Handbook.
Plcn Submltol roqulGmentri
Submlt your T,lfllc Control Plrn lTclrl wlfh th. fo[owlng ln(orrnatlon on 0,5'rl I " o, I l "xt 7' Drpor, Flll out rnd iubmlt thlr form wtth
yout ICP,
Page 2 of 3
8 / L 'sevd 99ZIL9ETV9 t?:8T 6T0Z' LZ'Ivqt
(c,r l-' Sore
Tha TCP rhrll bc c lcglbh hand drrwlng, or a computer alded dctlgrl wlth rhc followlnE laform.rtlon:
?nfilcControl Planforrnlrlocetedm. r I r, ,, ..) , r'r. ,'r'r:' ,i, ,,i,',
A vl(hhy lnop;
fhrt lnciuder the north arour. rold nrmat, lnlcita(tlon/drlvcway ac(0rt polnlr, curt llne5. lhe wod zone. rnd aoy specirl hrturGs tuch
m bulldlngr, a(cp$ Doinr, rightobltrucilonr. lhet (ould,ffe( the'fCP,
locttlon:
Whcr€wllrheTCpbao(ttvo? Thlrgtnboallncdr.hrhgoffheworlzone(rlrnd/orrmopth.t(lo0rlylnditat(\twhorotrafflrcootrol
dcvlcet wlll be pbc!d, hcludhg trxlng and sone tape6.
Artr(hmentr olthe epproprlnc rralflc (ontroldlegrum(tt u shown ln tho currlnl MUTCD and/or the ODOI Oregon femporuyTrafllc
Control Hrndbool th,,t ?rflGd rho wo'k rone mry be lncludrd or e rtcndutd lcfmnco. OOOri Trrr0c (ontrol Hrndbool r,lcblltc:
Traflic (ontrolfla^ rnached in omrllto [rnd Dev?lopme^r, IDS0rpdngfield-ot.gov
No Trrfflc Convol Plon
r,Yllh
;)n
What klnd of work plan do you n€ed?
vou wlll ncrd to rubmlr i copy o, thr wotl plin, whlch lncludct:
. - Slre loc!ilon rnd vlcinlt, ,rup r ldentlfy ertenlof erc.vatlont
,,}{alnclude No(h anow. ,,{)or bore locatlonl.
'- outllnollmlt:oldlstutbrnso/ showlo(nlonolutlll0esyrrrhlnilghtolwor, ldontr(yprpo,':''" 'bf worl rrcl rrTc lrrc rnd rypa, mrrnilne connscron ro<arroo andq- ldentlt3trglng/m0torlll ,Aionn.<rriirypr,
.. J' -[totaqc aaaEt.
.Construction ol AOA rrmpr or othar A0A racllitlcr roqulrc submitt0l ol detalled lopo3raphic survey and design rheals rtrmpcd
by I Profcaslonrl Enlineer licensed in the Stete ol Oreton. DesiSn ol ADA frclllticr rhell rt I minimum maat thc curT.nt f.derll
Tcchnir:sl Requlrementr at dstcrlbed ln thc Unttcrl Strtcr Accits Eorrd's 201t PToporld Accestihllily Guldalinet for Pcd$trl0n
Frcililior ln tha Publlc nlsht.ot Wry Notlcr ol Propor.d Sulcm.klng INPnM),
Irrlor rrt;r(irtrr
Fee
Encrorchment/Phccm.nt Prrmlt S3rl,00
Fccs that mty rpply
-A 5t6 Tcchnology Fcc wlll bo .rppllcd to th! totil (ort ol thr prlnh for procerilng thc eppllcotlon,
-A t 1 030.00 Arph.ll dep05lr t5 r€qutGd when the r3phllt wlll bo dllturbrd,
-Addl(lohal llnrnclal recutlty may be requlTed.
oeposlts and Flnanclal Securlty
ProJecB lnvolvlng work wlthln publlc rlght of way ln rhe Clty of Sprlngfleld are subJecr Io deposlts o, othet apptoved forms
offlnanclal securlty thar may lnclude perform.nce bonds, set-aslde letters, oi krevo(able letters ofcredlt. The tyPe of
flnaachl t€curlry ls dcrormlned by the prolocr'r 5h€, scops, and potontlal lmgact to publlc lnflasvuctuie. €xamplel of ryt l(al
lmpe <r thrt wlll requlre flnanclal recurlry lnclude atghalt rench curs tnd sewcr fepllt3 lhtt lnvolve cuts to 0 moln lltlc,
Warrantles
Frnancial secu,ity is held by the Clty 6t1rrin9 6 we rronty perlod Oat trpicrlly lettr onc yc.r .rnd lreglns when the Pro,lcct
parrer ,lnrl conSvuctlon lntpectlon. The wanrnty pcrlod !llow, the Clty to monllor thc aouctur!l lnlegrlty of toPrlt! 0nd
derermlnc rholr long-rGrm vlablllty. Flnanclal re(urlry provlde5 lhe Clry wllh the mean, Io repll, lnflarlructure should
fallures thar remaln un(orTeced by rhe appllcant or appllcant'r representatlve occur during the wananry perlod. A flnol
watranv l6rp6ctlon wlll bc cotlductcd elevon montht aftor tho flnal conrtrucllon lnsDcctlon. Flnanclul secutlly wlll be
releared when the watranty perlod has parretl llnal lnspectlon.
Restorotlon of City facillties
tr wlll br dctcrmlncd by rh. Publlc Workr Dlrcctor at thc tlmr ol thc I I monlh lnrpcctlon ar rcqulrcd ln Munlclgrl
Cort! ,,222 thst rhc work r,!, ln thc publlc rlght-of.way lr ln as good a condltlon or bencr lhan lt was before the
lssuance of the encroachment peimlt., Munlclpal Code 3,210 QL
whan do you nlrd an En(torch,na^t p.rrnlt?
Mrinlclrrrl codc 3.2e1Wcrk 0n or Undrr Sstloeo-tncuchntnt Prrmlt lhquhrd ,'
deflncr whca you need an encrolchnenl Petmlt.
whio do you oltd I flc(cmrnt ,,ctmtll
'riurlc[rtl (odt l,22rl Plotomcnt al or..vlcol ot Slructvrel ln the Puhllc Way .
r,rh!n you Ico6 o Pl!(amont !flmlt.
.i ,, '..r&fin1t
Step 5:
Signrture
Slgnature
oe* Qf ,11.q
[- Appllcrnt .frrconn .,o, f" UtllltyProfoctMlnl0cr
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o.Id
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i
tlCheck one:[" Ownrt
riri I ,, lllrt
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