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HomeMy WebLinkAboutPermit Encroachment 2019-05-06City 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 Form Alpesh Patel, ALKO 501 LLC 541-554-8440 3111 Franklin Blvd, Eugene, OR 97403 17-03-34-33 Alpesh Patel 541-554-8440 1857 Franklin Blvd 500 Eugene OR HamCon Builders, Inc. 541-826-2777 204091 Dave Hammonds 541-826-2777 al@alkohotels.com Demo existing ADA ramp and construct new ADA ramp per Site Plan Review approval (Case # 811-19-000064-TYP2) N/A - NO UTILITIES INVOLVED Reset 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 N/A - NO UTILITIES INVOLVED Crushed Rock Concrete Concrete N/AVariesVaries 10"