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Home My WebLink AboutPermit Encroachment 2019-07-23Reset Form i I Print Form 225 Fifth Street Springfield, Oregon 97477 Engineering &Transportation Services Division Phone (541) 726-3753 Step 1 -Location of Work Who isfillingoutthe Wlication? In 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. 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: I g -r I� _C Tax Map % y b 3 ! q oo Applicant: Sa:5; e,&5 Loc.:, i L,4 -Ci LOV5Vlyd 1/ [AMr6Lot x Email Address: j C, 15 i :5 •7 -,M Phone. 511 Owner: Address: Phone: City: State: ZIP: - — -- -- —.------------------- Contractor: -- Contractor: _� � ,� y�j�- --� { e"b K Phone: Contractors Registration (CCB) #: ) I 9 3 Expiration Date: Project Supervisor:v,. J 171 2- �s� Phone: ! G// Insurance F- Proof 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. I- Franchise Agreement I- 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 We 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. j -i Placing new facilities in the right of way I -I Repairing/maintaining existing facilities 3o" r C 6/ic tre cert e h-%ot, + In rr �pNc �-rs TU Project tis V1/.� Ct,v� Description: -P Period of use or time of construction: 7am to 6 pm only, unless it's an emergence, From Date: To Date: Daily Start Time: Daily End Time: 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 F 3: Submit a Work Plan Step 2a: Work Site Area It F Cut Bore Other: . Length Depth Width Height Existing Surface Material: Surface replacement material to be utilized: Backfill material to be utilized: System Connections to City Infrastructure 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. j— Wastewater Connection Stormwater Connection F- To Stub F— Catch Basin/Bubbler r Main Line i — Stub F— Other: r Main Line Description: Safety and Environment You are required to call: the Lane Utilities Coordinating Council's "One Call Number" 811 or 1-800-332-2344 Air Quality 48 hours before digging. 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, 541 726-5489. 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. r Dewatering i— Soil Erosion (— Hazardous material storage/spill prevention F— Sawcut slurry runoff r Site runoff/sedimentation 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 541 726-3615 or 541 726-3761; After hours f mergency Response 1 earn 541 953-3428 in the event of a spill. Plan submittal for Wastewater main line work j— Bypass pumping r 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. Page 2 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.gov/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 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. ODOTs Traffic Control Handbook website: www. oregon.govIODOT: HWY.TRAFFIC-ROADWAY/docslpdf/OTTCH 06.1 df? -a=t r Traffic Control Plan attached in email to Land Development, LDS@springfield-or.gov No Traffic Control Plan F There are no public traffic safety issues with this application. Step 3 -Submit a Work Plan 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 Identify extent of excavations include North arrow. F or bore locations. ,.,.,/ Outline limits of disturbance/ Y of work area. Show location of utilities within right of way. Identify pipe Osize and type, mainline connection location, and identify staging/material 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). Information Fee Encroachment/Placement Permit $345.00 Fees that may apply -A 5% Technology Fee will be applied to the total cost of the permit for processing the application. -A $1061.00 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 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 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 Rmuired.ihttp:: /www.ncode.us/codes/sF,ringfield/) 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 ( htW://www.gcode.uslcodeslspringfield; i defines when you need a placement permit. Step 5: Signatur -V14W 4&4-"Bti; Z-+- c i L_ C, Signature Date: 7-23 Check one: 191lowner f pplicant 0-tontractor r 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. 11 Page 3 of 3 -ENCE EX FEN 8'X 10' o SHED -#� 40.00' �I PROPOSED ADU 0 Q 11.00' "' 800 SF p 0 PROPOSED 415 RAIN GARDEN 0 88 SF 8. 1" EX SANITARY LINE INW1 C tj - (o 34 LF 480 S=8.21 CONNECT TO C418 EX 30" FL=472.71 1235 480.547 JI IMIYVI ILLUS UR ------- GRAS DRIVE' -� EXISTING i � I PARKING -J1 I�11 EXISTING GARAGE 1 I 1 1 i ,�------ -- GRAVEL - - DRIVEWAY STDRMWA TER 7'REA TMENT PLAN FOR BESSETT19 S LUCKY LLC S. E. I/4, N. W. 1/4 SEC. 3 1, T 1 75., R.2ry. W M• TAX LOT 1800 SPRINGFIELD, LANE COUNTY, OREC01V OWNER/DEVELOPER LONNY BESSETT ENGINEER OLSQN & MORRIS 380 4 STREET SIJffE 200 SPRINGFIELD, OR 97477 SITE ADDRESS 412 39TH STREET P IN FIFO, OR 97478 ---'GRAVEL DRIVEWAY F i'3 5 I II i II � III X OM54 AT��Pp1E��IN II j II I a j it Iii li i10S J 479. 0 AT R METER � II� IIS ��III rt oL 1036 *48Q.38 WATER �u I Ik III III E SII III IR III SII SII ill III II II X11 r, SII �y � SII CURB INLET � x'46599 III RIM=479.61 ` II II 1,9 1� c< okp � o o� i LEGEND -� BMW ROWN EMW FENMJ RG ST ' # 01 ►J D(STM ClXT Ty Poff OWRWJD BCW LOVE PRO STORE DRMKpCE Sys-rEm SITE DATA SUMMARY IMPERVIOUS AREA BOO SE I< 8DO SF FACIUTY SIZING FACTOR 0.11 RESULTING CMDE SIZE 88 SF TW T1: 1. NEW BUILDING ADDITION TO INCWDE APPROXIMATELY BOO OSE FEET OF IMPEWOUS AREA 2, PROPOSED FAUN W D EN TO TREAT AND CDS STORMWATER RUNOFF FROM NEW BUILDING ROOF AREA. . RAIN WREN OVERFLOW TO POS STORMWATER TO EXIS-flNG 30" PIPE ON SfTE.. k All PLUMBING SHALL MEET REQUKMENTS OF OREGON PLUMBING SPECLALTY COBE 2017. 5, GOOROINATE TAP OF 30` PUBLIC PIPE FTY. NOTES: I. ELEVATIONS SHORN ON THESE PSS ARE QED ON BENCHMARK SURVEY DATA PROVIDED BY B LSC N & MORRIS. BEN BWK: 3388 ELEVATION: 482.74 QATUM- NAV 3. SITE SOIL AWBNG U R BAN LAND 12226k HSG D. 4. NEW BUILDING DiTION TO INCLUDE APPROXIMATELY 800 SQUARE FM OF IMPMMOUS ROOF AREA 5. PROPOSED RAIN ADEN TO TREAT AND CONVEY OR WATER RUNOFF FROM NEW BUILDING ROOF AREk 6. TIME OF WVE'L ZONES FOR THIS AREA INDICATE A TIME OF TRAVEL OF 20 YEARS. S. (�DST CONSTRUCTION NOTES: 415, COQ RAIN GMCEN PER DETAILS ON SHEET C-2.0. 418, OOM INS T -A -TEE 4X30'. 479. CONST 4' SCHEDULE 40 PICC W[TH SOLVENT WEW JOINTS, 460. CONST 4} STORM OMS PIPE', D3034 PIC WfTR RUBBER GASKET JOINTS. i I� z L. u L4 okp or i �opm cp pn ca LEGEND -� BMW ROWN EMW FENMJ RG ST ' # 01 ►J D(STM ClXT Ty Poff OWRWJD BCW LOVE PRO STORE DRMKpCE Sys-rEm SITE DATA SUMMARY IMPERVIOUS AREA BOO SE I< 8DO SF FACIUTY SIZING FACTOR 0.11 RESULTING CMDE SIZE 88 SF TW T1: 1. NEW BUILDING ADDITION TO INCWDE APPROXIMATELY BOO OSE FEET OF IMPEWOUS AREA 2, PROPOSED FAUN W D EN TO TREAT AND CDS STORMWATER RUNOFF FROM NEW BUILDING ROOF AREA. . RAIN WREN OVERFLOW TO POS STORMWATER TO EXIS-flNG 30" PIPE ON SfTE.. k All PLUMBING SHALL MEET REQUKMENTS OF OREGON PLUMBING SPECLALTY COBE 2017. 5, GOOROINATE TAP OF 30` PUBLIC PIPE FTY. NOTES: I. ELEVATIONS SHORN ON THESE PSS ARE QED ON BENCHMARK SURVEY DATA PROVIDED BY B LSC N & MORRIS. BEN BWK: 3388 ELEVATION: 482.74 QATUM- NAV 3. SITE SOIL AWBNG U R BAN LAND 12226k HSG D. 4. NEW BUILDING DiTION TO INCLUDE APPROXIMATELY 800 SQUARE FM OF IMPMMOUS ROOF AREA 5. PROPOSED RAIN ADEN TO TREAT AND CONVEY OR WATER RUNOFF FROM NEW BUILDING ROOF AREk 6. TIME OF WVE'L ZONES FOR THIS AREA INDICATE A TIME OF TRAVEL OF 20 YEARS. S. (�DST CONSTRUCTION NOTES: 415, COQ RAIN GMCEN PER DETAILS ON SHEET C-2.0. 418, OOM INS T -A -TEE 4X30'. 479. CONST 4' SCHEDULE 40 PICC W[TH SOLVENT WEW JOINTS, 460. CONST 4} STORM OMS PIPE', D3034 PIC WfTR RUBBER GASKET JOINTS. i I� z L. u L4 okp or �opm cp pn LEGEND -� BMW ROWN EMW FENMJ RG ST ' # 01 ►J D(STM ClXT Ty Poff OWRWJD BCW LOVE PRO STORE DRMKpCE Sys-rEm SITE DATA SUMMARY IMPERVIOUS AREA BOO SE I< 8DO SF FACIUTY SIZING FACTOR 0.11 RESULTING CMDE SIZE 88 SF TW T1: 1. NEW BUILDING ADDITION TO INCWDE APPROXIMATELY BOO OSE FEET OF IMPEWOUS AREA 2, PROPOSED FAUN W D EN TO TREAT AND CDS STORMWATER RUNOFF FROM NEW BUILDING ROOF AREA. . RAIN WREN OVERFLOW TO POS STORMWATER TO EXIS-flNG 30" PIPE ON SfTE.. k All PLUMBING SHALL MEET REQUKMENTS OF OREGON PLUMBING SPECLALTY COBE 2017. 5, GOOROINATE TAP OF 30` PUBLIC PIPE FTY. NOTES: I. ELEVATIONS SHORN ON THESE PSS ARE QED ON BENCHMARK SURVEY DATA PROVIDED BY B LSC N & MORRIS. BEN BWK: 3388 ELEVATION: 482.74 QATUM- NAV 3. SITE SOIL AWBNG U R BAN LAND 12226k HSG D. 4. NEW BUILDING DiTION TO INCLUDE APPROXIMATELY 800 SQUARE FM OF IMPMMOUS ROOF AREA 5. PROPOSED RAIN ADEN TO TREAT AND CONVEY OR WATER RUNOFF FROM NEW BUILDING ROOF AREk 6. TIME OF WVE'L ZONES FOR THIS AREA INDICATE A TIME OF TRAVEL OF 20 YEARS. S. (�DST CONSTRUCTION NOTES: 415, COQ RAIN GMCEN PER DETAILS ON SHEET C-2.0. 418, OOM INS T -A -TEE 4X30'. 479. CONST 4' SCHEDULE 40 PICC W[TH SOLVENT WEW JOINTS, 460. CONST 4} STORM OMS PIPE', D3034 PIC WfTR RUBBER GASKET JOINTS. i I� z L. u L4