HomeMy WebLinkAboutPermit Encroachment 2019-06-26 (2)
ENCROACHMENT PERMIT
APPLICANT:
LOCATION:
PERMIT:
DATE:
CITY OF SPRINGFIELD, OREGON
DEVELOPMENT AND PUBLIC WORKS
Contact Todd Thompson at (541) 912-1389 a minimum of 24 hours prior to beginning work, for scheduling of all other
inspections, and for all construction related questions.
Refer to City of Springfield Municipal Code 3.208 for information on Encroachment Permit requirements.
Work within public right-of-way shall only be performed only by contractors and employees certified pursuant to ORS
701.026. All materials and workmanship shall, at a minimum, meet City of Springfield, Department of Public Works
“Standard Construction Specifications, 1994” as amended in 1998 (or current edition). The City has the right to require
additional work not shown/described here in but necessary for the restoration of the City’s ROW infrastructure.
A spill kit is to remain on-site for the duration of all construction activities. The spill kit shall, at a minimum, contain
absorbent, spill booms, and spill pads. The spill kit is to be placed in an area where it is easily visible and accessible in case
of a spill emergency.
CONDITIONS OF APPROVAL
By signature, I state I have carefully examined the approved permit and do hereby agree to comply with
the requirements of the permit and I certify any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield, applicable City Standard Specification and Drawings, and the
laws of the State of Oregon pertaining to the work described herein. I further certify only contractors and
employees who are in compliance with ORS 701.055 will be used for this project.
I agree for myself, my contractors, and employees, that the approval of the right of way permit in no
manner presumes or implies the approval or terms of approval of any other future p ermit required by the
City for the site and indemnifies and holds harmless the City regarding any future approval of a future site
plan, partition, subdivision, or any other required permit that may cause any work completed in
compliance with the right of way permit to be altered to conform to the final permit approval.
I understand and agree the City may inspect the work site described in this permit at any time during a
one-year period following the receipt by the City of notice of completion of the described work and
specify, at the City’s sole discretion, any additional restoration work required to return the site to a
standard acceptable to the City. I will be notified in writing of any work required and will have 30 days
from the date of the notice to complete the work. Work not completed at the end of the 30 days will be
performed by the City and the costs will be billed to me.
I further agree to ensure all required inspections are requested at the proper time and the approved
permit and set of plans will remain on the site at all times during construction and until removed by
the City.
I shall defend, indemnify and hold harmless the City from and against all liability or loss and against all
claims or actions based upon or arising out of damage or injury to persons or property caused by or
sustained in connection with performance if this Contract by the permittee except, pursuant to ORS 30.140,
for losses, claims, or actions resulting from the sole negligence of the City.
I shall assume all responsibilities for the work, and bear all losses and damages directly or indirectly
resulting to the permittee, the City, or to others on account of the character or performance of the work,
unforeseen difficulties, accidents, or any other causes whatsoever. I shall assume defense of, indemnify
and save harmless the City, its officials, agents, and employees from all claims, liability, loss, damage, and
injury of every kind, nature and description, directly or indirectly resulting from activities in the
performance of the Contract, the ownership, maintenance or use of motor vehicles in connection therewith,
or the acts, omissions, operations, or conduct of the permittee or any Subcontractor under the Contract or
any way arising out of the Contract, irrespective of whether an act, omission or conduct of the City
connected with the Contract is a condition or contributory cause of the claim, liability loss, damage or injury
and irrespective of whether act, omission, or conduct of the permittee or Subcontractor is merely a
condition rather than a cause of a claim, liability, loss damage or injury. I shall not be liable for, nor be
required to defend or indemnify, the City relative to claims for damage or damages resulting solely from
acts or omissions of the City, its officials, agents, or employees. The permittee's absence of or inadequacy
of the liability insurance required by the City of Springfield shall not negate permittee's obligations in this
agreement.
PERMITTEE:
Printed Name: ___________________________________________
Signature: _______________________________________________
Date: ___________________________________________________
ENCROACHMENT PERMIT
APPLICANT:
LOCATION:
PERMIT:
DATE:
CITY OF SPRINGFIELD, OREGON
DEVELOPMENT AND PUBLIC WORKS
Contact a minimum of 24 hours prior to beginning work, for scheduling of all other
inspections, and for all construction related questions.
Refer to City of Springfield Municipal Code 3.208 for information on Encroachment Permit requirements.
Work within public right-of-way shall only be performed only by contractors and employees certified pursuant to ORS
701.026. All materials and workmanship shall, at a minimum, meet City of Springfield, Department of Public Works
“Standard Construction Specifications, 1994” as amended in 1998 (or current edition). The City has the right to require
additional work not shown/described here in but necessary for the restoration of the City’s ROW infrastructure.
A spill kit is to remain on-site for the duration of all construction activities. The spill kit shall, at a minimum, contain
absorbent, spill booms, and spill pads. The spill kit is to be placed in an area where it is easily visible and accessible in case
of a spill emergency.
CONDITIONS OF APPROVAL
By signature, I state I have carefully examined the approved permit and do hereby agree to comply with
the requirements of the permit and I certify any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield, applicable City Standard Specification and Drawings, and the
laws of the State of Oregon pertaining to the work described herein. I further certify only contractors and
employees who are in compliance with ORS 701.055 will be used for this project.
I agree for myself, my contractors, and employees, that the approval of the right of way permit in no
manner presumes or implies the approval or terms of approval of any other future p ermit required by the
City for the site and indemnifies and holds harmless the City regarding any future approval of a future site
plan, partition, subdivision, or any other required permit that may cause any work completed in
compliance with the right of way permit to be altered to conform to the final permit approval.
I understand and agree the City may inspect the work site described in this permit at any time during a
one-year period following the receipt by the City of notice of completion of the described work and
specify, at the City’s sole discretion, any additional restoration work required to return the site to a
standard acceptable to the City. I will be notified in writing of any work required and will have 30 days
from the date of the notice to complete the work. Work not completed at the end of the 30 days will be
performed by the City and the costs will be billed to me.
I further agree to ensure all required inspections are requested at the proper time and the approved
permit and set of plans will remain on the site at all times during construction and until removed by
the City.
I shall defend, indemnify and hold harmless the City from and against all liability or loss and against all
claims or actions based upon or arising out of damage or injury to persons or property caused by or
sustained in connection with performance if this Contract by the permittee except, pursuant to ORS 30.140,
for losses, claims, or actions resulting from the sole negligence of the City.
I shall assume all responsibilities for the work, and bear all losses and damages directly or indirectly
resulting to the permittee, the City, or to others on account of the character or performance of the work,
unforeseen difficulties, accidents, or any other causes whatsoever. I shall assume defense of, indemnify
and save harmless the City, its officials, agents, and employees from all claims, liability, loss, damage, and
injury of every kind, nature and description, directly or indirectly resulting from activities in the
performance of the Contract, the ownership, maintenance or use of motor vehicles in connection therewith,
or the acts, omissions, operations, or conduct of the permittee or any Subcontractor under the Contract or
any way arising out of the Contract, irrespective of whether an act, omission or conduct of the City
connected with the Contract is a condition or contributory cause of the claim, liability loss, damage or injury
and irrespective of whether act, omission, or conduct of the permittee or Subcontractor is merely a
condition rather than a cause of a claim, liability, loss damage or injury. I shall not be liable for, nor be
required to defend or indemnify, the City relative to claims for damage or damages resulting solely from
acts or omissions of the City, its officials, agents, or employees. The permittee's absence of or inadequacy
of the liability insurance required by the City of Springfield shall not negate permittee's obligations in this
agreement.
PERMITTEE:
Printed Name: ___________________________________________
Signature: _______________________________________________
Date: ___________________________________________________