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Home My WebLink AboutPermit Encroachment 2019-02-11Application to Work in the Right of Way Oncethe application has been approved, o permitwill be issued apptication can be emailed to LDS@springfi eld-or.gov. will need to complete application, save as, then atElch to ofSpringfield will needto come to Public Workt City Hall to pro(ess permit- ! or printand bring to Puhlic Works Gty Hall. 225 Street Springfield, Orego 97477 Engineering & Transportation Services Division Phone (541 ) 726-3753 Hffi* Step 1-Location of Work Who is filling out the application? ln this section, you will need to identiry the Applicant, Owner of the abutting property, and the Contractor, if applicable. Example: John Doe is the owner of the abutting property. You wouid 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 Applicant: Email Address: Owner: Address: City: Contractol: Contractors Project Supervisor: lnsurance ()tsef{Tax Map Tax Lot Phone:j,.ll-fdr- $fr Phone: Phone: €1l-6C;Z -42OV -r_ ZIP:. (CCB) #: I )tl Expiration Date: chone: S'll 'ffi,- €jHfl f Proof of lnsurance, minimum 5500,000 coverage limit State: Utilities Does your utility company hove a franchise agreement or license with the City? Please identifo which type of agreement you currently have with the City. l- Franchise Agreement l-* License Name of other utilities if this is a joint project : lntent of project for other utility who will own any facilities placed in right of way: Step 2: Description of Project What tvpe of work do you need to do? ln this section you will describe the location, intended use, and what measures you are implementing, such as traffic control measures, dust control measures, and types of backfill material to be used. -Provide the start and end dates, start time of day and end time of day, of your project. lt is important that you give time of day that you are requesting for your project work There are codes and inspections that are time sensitive. -ldentifu your method of intrusion into the surface of the right of way, such as cut, bore, or drilling. -Describe the surface area length, width, depth, and height ofyour project. -ldentiry what type of surface material is currently there, what you will do with thls material, what is the replatement type of surface material you will use, and what type of backfill material you will be using. -Any required separation from other facilities. l- Placing new facilities in the right of way I Repairing/maintaining existing facilities la<ut^r^n.rh-^ Project Description: (ata^+ -C p,Ulc Asr<--9.$Jte Ld:'tt-. n<k) From Date:t/tt n a To Date:a/rq/a Daily Start Time , f, '.OO j^ Daily End time: 4, tn 6"STOP: Answer these questions next you working in the right of way or connecting to City facility? lf yes, continue at Step 2a: Work Site Area t*Are you storing material/objects in the right of way other than during hours of work? lf yes, continue at Step 3: Submit a Work Plan Step 2a: Work Site Area /Cut l-- Bore other: Length 4' Depth s IL Lll Width t t 30 A &lL) Height Existing Surface Material: Surface replacement material to be utilized: Backfill material to be utilized:le System Connections to City lnfrastructure Directions: SubmitpiansthatidentifiTindetail 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. Uo{-. sor t t-l3Yq fr^t *^t ,'- rt"uo Connection l] Stormwater Connection l- Catch Basin/Bubbler f Stub f Main Line fl Main Line l-'] orhFr. DescriPtion: $r*l D*.Jrr.o | *-${o:t Safety and Environment You are required to call: The Lane Utilities Coordinating Councii's "One Call Number" 81 1 or'l-800-332-23214 48 hours before digging.Air Quality Type of Dust Control to be utilized: 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 72G5489. 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 ofexamples. f Dewatering |-l Soil Erosion l-- Hazardous material storage/spill prevention /Sawcut slurry runoff [-: Site runoff/sedimentation Wastewater Spill/Overfl ow Prevention Directions: City policy requires that all work performed in the City right of wayleasement 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 notifi7 City of Springfield Maintenance 541 726-3615 or 541 726-3761; After hours Emergency Response Team 541 953-3428 in the event ofa spill. Plan submittal for Wastewater main line work f Bypass pumping f Temporary plugging of sanitary main Traffic Co.ntrol Plan Criteria for City of Soringfield 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: SubmityourTrafficControl Planfl-CP)withthefollowinginformationonS.5"xll"orll'xl7"paper. Fill outandsubmitthisformwith-youiTcP. Page 2 of 3 I The TCP shail be a legible hand drawing, or a computer aided design with the following information: Traffic Control Plan form is located at www.sprinofield-or.qov/menuonlineforms 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 affed 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 ofthe appropriate traffic control diagram(s) as shown in the current MUTCD and/or the ODOT Oregon Temporary Traffic Control Hand book that reflect the work zone may be included as a standard reference. oDoTs Traffic Control Handbook website: www. oregon.oov/ODOT/HWY/TRAF FIC-ROADWAY/docs/pdfIOTTCH 06.pdf?ga=t l- Traffic Control Plan attached in email to Land Deveiopment; LDS@springfield-or.gov - No Traffic Control PlanL Th"r" are no public traffic safety issues with this application. Step 3-Submit a Work Plah 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 excavationsr- include Nonh arrow. | - or bore locations. - Outline limits of disturbance/L "f *.rtrr"r. Showlocationof utilitieswithin rightofway. ldentilpipe - identify staging/material l-- size and type' mainline connection location' and '- storage areas. connection type' 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 byaProfessional EngineerlicensedintheStateofOregon. DesignofADAfacilitiesshall ataminimummeetthecurrentfederal Technical Requirements as described in the United States Access Board's 2O11 Proposed Accessibility Guidelines for Pedestrian Facilities in the Public Right-of-Way Notice of Proposed Rulemaking (NPRM). lnformation Fee EncroachmenVPlacement Permit S335.00 Fees that may apply -A 5% Technology Fee will be applied to the total cost of the permit for processing the application. -A 51030.00 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 begiris 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 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 I 1 month inspection as required in Municipal Code3.222 that the work area in the pubiic right-of-way is in as good a condition or better than it was before the issuance of the encroachment permit. . Municipal Code 3.21 0 (2). When do you need an Encroachment permit? Municioal code 3.208 Work On or Under Surface-Encroachment Permit Required (htto://ww.ocode.us/codes/sprinofieldn defines when you need an encroachment permit. When do you need a Placement permit? Municipal code 3.224 Placement ofDevices or Structures in the Public Way ( http://www.qcode.us/codes/sprinofieldn defines when you need a placement permit. Step 5: Signature Signature Date:7r,/t? Check one: [: Owner [- Applicant fiatrador f Utility Project Manager to 48 hours before before digging. l: The Lane Utilities nating e ,rra?S,, h 7d0H /rn -2)r0o{-o-o,.rS <;L? ."?o$rd Ft/rx: itsr /cl B zi"t') (--la (t,9 A EIif -- I T0 -- P LL-N CIrII b .=\,4 F'PAD\F\ t- 'lt