HomeMy WebLinkAboutPermit Encroachment 2019-07-08Reset 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 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: 2O l D t 27y7
AV! I
Applicant: j'r M,
Tax Map
Tax Lot
Contractors Registration (CCB) #: 13 % j 6� Expiration Date:
Project Supervisor:
Insurance
F_ Proof of Insurance, minimum $500,000 coverage limit
Phone:
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. r Franchise Agreement F_ 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 foryour 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.
1,—, Placing new facilities in the right of way
F_ Repairing/maintaining existing facilities
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Project
Description:
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.spriNfield-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.
orenonAov/ODOT/HWY/TRAFFIC-ROADWAY/docs/pdVOTTCH 06.pdf?1rta=t
F- Traffic Control Plan attached in email to Land Development; LDS@springfield-or.gov
No Traffic Control Plan
r There are no public traffic safety issues with this application.
Step 3 -Submit a Work Pan
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
I— include North arrow. or bore locations.
Outline limits of disturbance/
r Show location of utilities within right of way. Identify pipe
of work area.
F— size and type, mainline connection location, and
identify staging/material connection type.
F_ 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 3.205 Work Ono Under Surface—Encroachment Permit Requiredhtt_;(Iwww,gcode.us1co_2slwringfIo.1di7
defines when you need an encroachment permit.
When do you need a Placement permit?
Munici I code 3.224 Placement of Devices or Structures in the Public Way hm://www.Q code.us/codesisprin�c NeIM defines
when you need a placement permit.
Step 5: Signature !!//
Signature Ah� Date: 7 — — 2/5 1 cl
Check one: 'Owner r- Applicant r-, Contractor 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.
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