HomeMy WebLinkAboutPermit Encroachment 2019-05-31I . ResLt Form. I
225 Fifth Street This application can be emailed to Springfield,Engineering
LDS@springfield-or.gov. ,
Oregon You will need to complete application, save as, then attach to
• • : • • email or print and bring to Public Works City Hall.
Phone You will need to come to Public Works, City Hall to process permit.
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.
-------------------------------------------------------------------------------------------------------------------------------M i- --------------------------
Site Address or Location : G Tax ma
�O LC;_ cT711r�_ P
moi' �
Applicant: ��� )may •�� Tax Lot
Email Address �._-y2, �rv�Zi`v1 Phone2j-� &0
Owner:
Address:
City:
Contractor:
Contractors Registration (CCB) #:
Project Supervisor:
Insurance
State: ZIP:
C Proof of Insurance, minimum $500,000 coverage limit
Expiration Date:
Phone:
Utilities
Does your utility company have a franchise agreement or license with the City?
Phone: 't
Phone:
Please identify which type of agreement you currently have with the City. [7i Franchise Agreement r 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.
F7. Placing new facilities in the right of way
F.` Repairing/maintaining existing facilities
Project
Description:
Pe iLoctof use ortime of construction: 7am to 6 pm only, unless it's an emergen
From Date.
Daily Start Time:
To Date:
Daily End Time:
.... -........ ........ _........ _........ _........ _....... _..._...-.............. ... -........ _................... --------- --...... -......... -........ ......... -......... ......... ....... ._........ _........ _...... - -- -� __ _.— ---- — ----_ ---
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
Are you storing material/objects in the right of way other than during {fours of work? if yes, continue at Step
i= 3: Submit a Work Plan
Step 2a: Work Site Area
r Cut F-1 Bore Other:
Length Depth �_ Width Height
Existing Surface Material:
Surface replacement material to be utilized:
Backfill material to be utilized:
System Connections to City Infrastructure
Directions: Submit plans that identify in detail the scope of workto 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.
r Wastewater Connection
To Stub
Main Line
Other:
Description:
Safety and Environment
Air Quality
Type of Dust Control to be utilized:
Stormwater Pollution Prevention
r Stormwater Connection
Catch Basin/Bubbler
C Stub
r Main Line
You are required to call: The Lane Utilities Coordinating Council's "One Call Number"
811 or 1-800-332-2344
48 hours before digging.
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.
Dewatering r Soil Erosionj Hazardous material storage/spill prevention
F7 Sawcut slurry runoff r. 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 541 726-3615 or
541 726-3761; After hours Emergency Response Team 541 953-3428 in the event of a spill.
Plan submittal for Wastewater main line work
r Bypass pumping r7 Temporary plugging of sanitary main
Traffic Control -Plan Criteria for Citv of Sdrinafield 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.sorinafield-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.
oregon.gov/ODOT/HWY/TRAFFIC-ROADWAY/docs/odf/OTTCH 06. d�flga=t
I^ 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:
r/�ite location and vicinity map r Jdentify extent of excavations
�� include North arrow. L�'or bore locations.
,._,,,Outline limits of disturbance/
I� of work area. ow location of utilities within right of way. Identify pipe
size and type, mainline connection location, and
r 'Identify staging/material 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 far 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?
uni i al code 3.208 Work On or Under rface—Encroachment Permit Re uire h www code.us codes s rip field
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",' http:/twww.gcode.us/,codes/sorinafleld/S defines
when you need a placement permit.
Step 5: Signature j
Signature:A Date: L j��j 4p,:ki
ZI
Check one: Uwner )- Applicant 1- Contractor [ 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.
SITE NOTES
Section 5.15-125 ADU Development Standards:
The ADU meets setbacks, height, and does not exceed maximum
parcel coverage
ELECTRIC CONNECTION
A separate electric meter will be installed per Utility requirements.
Allow 36" clearance around meter location.
SANITARY CONNECTION
Connect ADU sanitary line to existing public sewer in the alley
between E and F Streets, per EDSPM section 2.02.8.
Verify the proposed sewer connection point meets plumbing Code,
OPC, and tie to lateral line.
STORMWATER CONNECTION
SDC runoff from existing structure/garage must be directed to an
approved system. The new roof system must tie into the existing
system. No additional stormwater area is calculated (net increase =
0)
PUBLIC IMPROVEMENTS
First 18 feet of alley must be paved.
ENCROACHMENT PERMIT
Adjust grading and review in the field with City Inspector. Design
grading to prevent stormwater draining to adjacent properties
UTILITIES
Water utilities to connect to existing system and meter
ENTRY
A 3 feet wide walkway must be provided from ADU entry to adjacent
alley and sidewalk network
ADDRESS
A separate address must be assigned by the Postal Service for the
ADU for this Permit
PARKING
A parking space 9 x 18 feet must be dedicated for ADU. The existing
parking spaces meet this requirement
GARBAGE
Garbage and recycling is to be located within existing garage area
r_,-�__Architectural Site Plan
AS-" SCALE: 1" = 20'
UTILITY SERVICES. Existing
services from Residence shown
for reference
ADU RENTAL UNIT within
existing Garage footprint
FENCE. Existing --
fence around Patio
Driveway/Parking
12 vehicles)
Parking inside Garage
(1 vehicle)
N
"F" Street
RfiGON- "�-
SEi/5898: fl
_F 10
3 a:
v U
�N O'.Z
U m_ r=�ytQ
aha
m E oa
p maw
X
W
a
CONTACT: Julia
Matthew E
:PERMIT SET
AS -001
PORTLAND l Ei1ENT CNI RETE ?AVENIENI
1/2 MY 01 WAY IDTP
`c. +--------- :l2 PAVENEN11110TH -�Ik
12' MIN u
11 MAI SLOPE
zx MINy 2X.IMR
s
o
7" PCHIIANO CERENT CONCRETE
E 0E MIN
ve US CNIISNED RCCK
�RRM COMPACTEH 51:6GRAOE
CON R—E PAVEIAENT JOINTING NCTES
R ER IC ;TINOAP.O THAWING 3-9 FOR JOINTING CETAILS PF EN SECTIONS I; !T OR LESS
SAWC i iRAXSV[RS[ CO R 1T Q-15 11 ON CENTER
"'.—ON"'.-ONT SECTIONS MORE TUN 15 R CE
S %1.JI IRA—1,1E 1,1E CO TRACTI06 10 I' R ON TER; MD
SFV'UI 104.ZI:CINAL CONTRACTION JOINT AT CENTER— OR POUR
HALVES SEPARATELY WITH LGN TLOINAL CONSTIRLIVION JONI 01-T WAY;
NOTES
_. ER _..
# STRUCTURAL 1HItlWE55 10 TERM M THESE SECTIONS ME THE NMIML16 FOR DRY FIRMLY LOMPXCRp SIBGAA� THE CRY INSPECTOR MY REOLXAE
MER DOVATIOH (8" MRI AND THE PLACEMENT OF CEOTE W FABRIC ANO ADOIIbN1L CRUSHED ROCK TO ELSLRE A FIRM PAVEMENT BASE
# REPER 10 SPFXNEIF1D SWICARD SPEC "ITEMS FOR RONIRAY SIRUCIURE CCMPACROII REDLIREMEMS
# CATCH e M TINEW aU RIGHTS OF MAY SN41 II BICYCLE
PROOF CRATES-
# SDEIRNMAMPS
. ACCESS R, FMO REiIDENTRA DRIVEWAYS SIWL BE 7000 FS FIELD 5IIEN'IH (]150 P9 L1M STRENGTH) 6.0 WN MIX CONCRETE
# CURDS t COMMA DRIVEWAYS SULL BE 3500 PSI FELD STRENGTH (1075 PSI TAH STRENGTH) 63 WK MIX CMCRETE
# CONCRETE PAVEMENT SWL BE 9000 PSI FIELD STRENGTH (9600 PL IAB SIRM. 1) 2.0 SACK MIX CMCRER M1 112 -WINDS FRMIUREO KGREGATE.
PMEMENT W DESIGNS SNAG BE SUBMTIED TC THE CITY FOR APPROVAL PRIOR S-0 THE SCHEgIIID PAWNG MTL
w Rwrsml rTC Br CM OF FTI TYPICAL SECTIONSsTexnarso
ALLEY PAVING
u P—MIrrt+c
�...
12
.—.—. iDEPT. OF PIBLIC IIORKS ' __. La by mq—Y am � 2009 ;
ALLEY PAVING STANDARD
SCALE: 1" =20'
New Electrical Panel —
Existing Electrical Panel
1.5 sq ft
SEAVEY
HOUSE
Connect to Existing Cold Water
r IanLcl
1 I
I
I
I
I
new I
ADU I
I
i-�
0.000'
O
/
/I Im-pd-m WA WAY D
Cq
/ co
.5'
I
NEW alley paving
standard
i
I
-- 26.263'
I
I
° D o• IDD _ �° °
v o
D
O
fisting alley
avel v v
° v i• � L
o
I
18'
I
I
_ I
1
I
I
I
New Sewer Line connnection
at center of Alley
�� Enlarged Architectural Site Plan
AS -002 SCALE: 1" = 10'
c = D
(SS �
j W
EC !I\
rn to �<
U ICEO Q
E6 y
m �t�
W 2 `J
CONTACT: Julia a
Matthew Bu
:PERMIT SE
AS -00: