HomeMy WebLinkAboutPermit Encroachment 2019-05-16q — 000i I
225 Fifth Street
Springfield, Oregon 97477
Engineering & Transportation Services Division
Phone (541) 726-3753
Step 1 -Location of Work
EGON
Who is filling out the application?
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: 41 � 0 ` l ( r' C)O 7 1-79 Tax Map
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Email Address:rDfAC;C"r!�✓1L'pY1g`Ei/+Lt i0✓I�C %l��q/�VIL�f (.�yy,/t Phone: 54
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Owner:
Phone:
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City: corValr' State: ZIP:
--------------- -------------------------
Contractor: y Q,19 Z,_ Phone:
Contractors Registration (CCB) #: Expiration Date: 55 -,W
Project Supervisor ( U,Phone:Sq/-
Insurance
(i -V 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 type 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.
lacing new facilities in the right of way
F_ Repairing/maintaining existing facilities
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Project
Description:
Period of use or time of construction: 7am to 6 pm only. unless it's an emergency.
From Date: To Date:
Daily Start Time: 17 Avlv Daily End Time: S� Pyr
STOP: Answer these questions next
F— Are you working in the right of way or connecting to City facility? If yes, continue at Step 2a: Work Site Area
t/0
Are you storing material/objects in the right of way other than during hours of work? If yes, continue at Step
r 3: Submit a Work Plan
Step 2a: Work Site Area
D�Cut 17- Bore Other:
Length Depth
Existing Surface Material:
Width
Height
Surface replacement material to be utilized:
Backfill material to be utilized:
3M v�A i vJ us
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.
jT Wastewater Connection r Stormwater Connection
F- To Stub r Catch Basin/Bubbler
5 --vain Line r Stub
f` Other: r Main Line
Description:
Safety and Environment You are required to call: The Lane Utilities Coordinating Council's "One Call Number" f
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,
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.
f Dewatering r Soil Erosion i— Hazardous material storage/spill prevention
F- Sawcut slurry runoff I— 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 or
•gency Response Team 541953-3428 in the event of a spill.
Plan submittal for Wastewater main line work
F- Bypass pumping r Temporary plugging of sanitary main
Traffic Control Plan Criteria for City of Snrinafield 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.s.Prinafleld-o oy/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. ODOT'sTraffic Control Handbook website:
oreaon.gov/ODOT/HWYfrRAFFIC-ROADWAY/docs/pdf/OTTCH 06.pdf7ya=t
F_ Traffic Control Plan attached in email to Land Development; LDS@springfield-or.gov
No Traffic Control Plan
There are no public traffic safety issues with this application.
Step 3 -Submit a Worr Pan
What kind of workplan doyou 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. or bore locations.
Outline limits of disturbance/
FCZZ�.of work area. Show location of utilities within right of way. Identify pipe
SGT size and type, mainline connection location, and
lj–
identify staging/material /v 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 $335.00
Fees that may apply
-A 5% Technology Fee will be applied to the total cost of the permit for processing the application.
-A $1030.00 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 Required rhttp lwww gcode.uslcodes/springfieldi)
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 ( httuilwww,gcode.uslcodes/springfieldll defines
when you need a placement permit.
Step 5: Signature
Signature Date:
Check one: j– Owner r Applicant Contractor F_ Utility Project Manager
You are required to call. The Lane Utilities Coordinating Council's 'One Call Number" 1-800-332-234,,
48 hours before before digging.
Page 3 of 3
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