HomeMy WebLinkAboutPermit Encroachment 2019-06-15City of Springfield
Application to Work in the Right of Way
Once the application has been approved, a permit will be issued
225 Fifth Street
Springfield, Oregon 97477
Engineering & Transportation Services Division
Phone (541) 726-3753
Step 1-Location of Work
Applicant:
Phone:
Site Address or Location :Tax Map
Owner:Phone:
Address:
Tax Lot
City:State:ZIP:
Contractor:Phone:
Contractors Registration (CCB) #:Expiration Date:
Project Supervisor:Phone:
Email Address:
Step 2: Description of Project
Project
Description:
Utilities
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:
Franchise Agreement License
Does your utility company have a franchise agreement or license with the City?
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.
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.
Please identify which type of agreement you currently have with the City.
Insurance
Proof of Insurance, minimum $500,000 coverage limit
Placing new facilities in the right of way
Repairing/maintaining existing facilities
This application can be emailed to LDS@springfield-or.gov.
You will need to complete application, save as, then attach to
email or print and bring to Public Works City Hall.
You will need to come to Public Works, City Hall to process permit.
Print FormReset Form
Page 2 of 3
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.
Safety and Environment
Type of Dust Control to be utilized:
Stormwater Pollution Prevention
Air Quality
Traffic Control Plan Criteria for City of Springfield Traffic Control Plan Submittals
Wastewater Spill/Overflow Prevention
Description:
To Stub
Wastewater Connection
System Connections to City Infrastructure
Other:
Stormwater Connection
Catch Basin/Bubbler
Stub
Main Line
Backfill material to be utilized:
Existing Surface Material:
Surface replacement material to be utilized:
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.
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.
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 Emergency Response Team 541 953-3428 in the event of a spill.
Sawcut slurry runoff
Dewatering Soil Erosion
Bypass pumping
HeightWidthLengthDepth
Other:BoreCut
Step 2a: Work Site Area
Temporary plugging of sanitary main
Main Line
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.
You are required to call: The Lane Utilities Coordinating Council's "One Call Number"
811 or 1-800-332-2344
48 hours before digging.
Site runoff/sedimentation
Plan submittal for Wastewater main line work
Are you storing material/objects in the right of way other than during hours of work? If yes, continue at Step
3: Submit a Work Plan
Are you working in the right of way or connecting to City facility? If yes, continue at Step 2a: Work Site Area
STOP: Answer these questions next
From Date:To Date:
Period of use or time of construction: 7am to 6 pm only, unless it's an emergency.
Daily Start Time:Daily End Time:
Hazardous material storage/spill prevention
You are required to call: The Lane Utilities Coordinating Council's "One Call Number" 1-800-332-2344,
48 hours before before digging.
Date:
Page 3 of 3
Fee
Encroachment/Placement Permit $301.00
Fees that may apply
-A 5% Technology Fee will be applied to the total cost of the permit for processing the application.
-A $926.00 Asphalt deposit is required when the asphalt will be disturbed.
-Additional financial security may be required.
Work Plans attached in an email to Land Development; send to LDS@springfield-or.gov. Reference site location and name in subject line.
Show location of utilities within right of way. Identify pipe
size and type, mainline connection location, and
connection type.
Identify extent of excavations
or bore locations.
identify staging/material
storage areas.
Outline limits of disturbance/
of work area.
Site location and vicinity map
include North arrow.
What kind of work plan do you need?
You will need to submit a copy of the work plan, which includes:
Step 3-Submit a Work Plan
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.
Signature
Step 5: Signature
Information
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.
When do you need an Encroachment permit?
Municipal code 3.208 Work On or Under Surface—Encroachment Permit Required (http://www.qcode.us/codes/springfield/)
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 ( http://www.qcode.us/codes/springfield/) defines
when you need a placement permit.
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).
Owner Applicant Contractor Utility Project ManagerCheck one:
The TCP shall be a legible hand drawing, or a computer aided design with the following information:
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's Traffic Control Handbook website: www.
oregon.gov/ODOT/HWY/TRAFFIC-ROADWAY/docs/pdf/OTTCH_06.pdf?ga=t
Traffic Control Plan form is located at www.springfield-or.gov/menuonlineforms
68025/NT15TH STQ ST18340AT POLE #5151/NT: LOWER 4' TO 22'-3" PLACE (N) RISER ON (E) PWR BRACKETS NW QUAD TO MEET (E) CONDUITAT POLE #68025/NT:COMPLETE POLE TRANSFER5151/NT4 4504004234391NOTE:NO TEMPORARY TRAFFIC CONTROL PLAN IS REQUIRED.FOLLOW MUTCD AND STATE OF OREGONSTANDARDS FOR TRAFFIC CONTROL.SHEET TITLE:1NTSREV DATE DESCRIPTION BYPROPRIETARY INFORMATION:THE INFORMATIONCONTAINED IN THIS SETOF CONSTRUCTIONDOCUMENTS ISPROPRIETARY BY NATURE.ANY USE OR DISCLOSUREOTHER THAN THAT WHICHRELATES TO CARRIERSERVICES IS STRICTLYPROHIBITED.ISSUED FOR:PROJECT INFORMATION:PREPARED BY:CLIENT:SHEET TITLE:PROJECT MANAGER:SHEET NUMBER:PROJECT NUMBER:DATE:SHEET OFJB-832765TH & Q ST DEVELOPMENT1812 5TH STSPRINGFIELD OR, 97477COMCASTOR/SW WA MARKETSCALE:163 SW ACADEMY STDALLAS, OR 97338503.400.744011308 SW 68TH PKWYTIGARD, OR 97223800.266.227806/26/20191APPROACH PLANJANE BAIN0DRAFTED06/26/20190CHFIELDED06/21/2019JBAPPROACH PLANAPPROACH PLAN1NLABORAERIAL: TOTAL POLES =2COMCAST MAKE READY =23RD PARTY MAKE READY = 0TOTAL AERIAL FOOTAGES = 0'PERMITS TO BE SUBMITTED BY 06/26/2019:POLE ATTACHMENT CITY OF SPRINGFIELD (06/27/2019)