HomeMy WebLinkAboutPermit Encroachment 1996-11-23i o DI Tr'T DD Etr E o
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INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
//-2710DATE ISSUED:
3Pnrr{oTrELD
APPLTGATIoN DArE ,// - ?S 7b
PERMIT NUMBER:
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
oFFrcE TELEPHONE (5031 726-3753 ENCROACHMENT PERMIT
NUMBER:
LOCATION OF WORK
PROJECT suPERVTsoR: a n2 U**r ,, -
ONE
ZIP:
PHONE
EXPIRATION DATE:
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PHoNE: 72b- /93 (
Clair'
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TcoNTRACTOR:
CONTRACTOR REGISTRATICN NO:
ZIP,.
793
7q2- ,o'
CITY:
PHONE:
APPLICANT
SITE ADDRESS:
STATE:
SUBDIVISION
OWNER:
ADDRESS
8z@7
STATE:
Ts^
TAX MAP:
TAX LOT:CITY:
XaoonEss,
REOUESTED PERMITS:INSPECTIONS REOUIRED: APPLICATION FEE / DEPOSIT ACCOUNT NO:
fil rrucnoAcHMENT pERMrr E $20.00 /
E$
I ousr coNTRoL (TypE oF coNTRoL]
I consrnucloN, sroRAcE, srAGtNc tr
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$
$
$
Q orHen
I asexaur DEposrr.....,.... ....,,...,,..,.,..,.,i..
TYPE OF SECURITY DEPOSIT
Q auaruxer sunEry BoNo O suRilTy BoND I cesx / cHEcK E$
tr CURB CUT PERMIT NO FT,fl $10.00 + $,1 S/FT
INSPECTION. CUBE / APPROACH AFTER FONMS ABE ERECTEO BUT PRIOR TO POURINO. VALIO FOR I8O OAYS FROM DATE oF IsstjANcE.
f,l secoruo oRtvEwAy (sEE SEnARATE AppucATtoN)j
tr SIDEWALK PERMIT NO: .....,.......
VALID FOR I8O OAYS FSOM DATEOF ISSUANCE.
.....FT._E $10,00+$.1s/FT.
[ ruew 0 REMovE / REpAtR fl PAVE PLANT srntp
I ssrarcx E CURBS|DE I ueruorx
INS'F'TINN. SIOEWALK / ORIVEWAY FOR ALL CONCRETE PAVINO WTHIN THE STBEET RIGHT OF WAY. TO BE
MAOE AFTER ALL EXCAVATING IS COMPLET€ . ANO FOBM WORK ANO SU&BASE MATEBIA! IS IN PLACE.
I slrvraRy sEWER coNNEcloN pERMtr:
vALto FoR stxTy {601 DAys FRoM OATE OF TSSUANCE
tr n s5.00 /ll
flro srue E MA|N L|NE (EASEMENT-R/1V) E orHER
f, sronnn sEwER coNNEcnoN eERM tr- E $5.0o /
VATIO FOR SIXTY (60} OAYS FROM DATE OF ISSUANCE
Q carcH BAsrN / BUBBLER E STUB I t',latrulrrue
PROOF oF INSURANCE: $500,000 MINIMUM
TOTAL DUE: $
TOTAL DUE WITH PERMTT $
DESCRIPTION OF PROJECT:
oc ll
/'/ "-1
BORE:
BACKFILL MATERIALT
WORK SHALL COMPLY WITH X ARTICLE 5 OF THE CITY CONTRACTOR TO COMPLY WITH MUTCD .
i,4
(MUTCD}.
DEPTH: I C
u^ lN
Advcnce and zonesiOni prot6ctlon beto tn thewith onManual niformU Trsff ic Controlcompliance
e uJ q.l
PERIOD OF USE OR TIME OF CONSTRUCTTON:
HEIGHT:
,adoo
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
e-WARNING DEVICES TO BE UTILIZED:
eDESCRIPTION:
SUBFACE REPLACEN/tNT MATERIALS TO BE UTILIZED:
BACKFILL MATERIAL TO BE UTILIZED:C-t-
..WIDTH;
FROM DATE:
TO DATE:
TYPE OF DUST CONTROL TO BE UTILIZED: IN O T\ A
TYPE OF WORK: CUT:
OTHER:
tr PLANS (TWo sETS)ATTAcHED
AREA: LENGTH:
EXISTING SURFACE MATERIAL: C..C'T- E N'If-
TIME:
TIME:
REVISTONS 8t24tg6 FORM
'
ll8
ITY OF S I crllo pilrurr APPLTcATIoN
.t
VALID FOR SIXTY {60I DAYS FROM OATE OF ISSUANCEI cur srnrer E BoRE Q orxen
Q arracxeo E REOUTRED AMoUNT_
PLAN REVIEW COMMENTS / SPE''\L INSTRUCTIONS:
RESTORATION WORK SHALL BE tN CONEhMANCE WITH EXISTING CITY CODES AND\fl CTTUPINruCE WITH CURRENT
STANDARD SPECIFICATIONS, EXCEPT AS NOTED BELOW.
001 Backfill with 1" minus rock.
002 Compact every 1 8' loose dapth,
003 Requires compaction with a stesl rolller.
OO4 A.C, to match tha groator of existing depth or 4".
OO5 All cuts sealed for final inspeciion,
006 Temporary patch msy be used at the snd of the day,
007 Slgning and Zone protectlon to comply with MUTCD
008 Cut concrete only on score lines or cold joints.
009 Sidewalks and driveways mln. 3,O00psi.
010 Curblng min 3,500psi / No pstchwork less than 3',
011 MsEt min. requiremqots on curb cut8, Spfd. code.
012 Restoro planted areas, Spld. code 206.3.05
013 Spac. to Bore / Jack / No A.C, cuts.
014 MochanicBl compactingrequired,
015 No patchwork allowed,
016 Lateral cuts to have control donsity fill.
017 Cuts to be polymerizod crack sealed for f inal inspection
018 Mininum 2" crushed rock %" minus.
019
020
021
o22
023
024
025
026
o27
028
029
030
031
032
033
343
Minumum 4' clearance at any point, swing.away.
Concrete mlnimum 4" depth, 3,OO0psi,
Trench to be 'T' cut,
Noods StEto / County permit,
a
No above ground enclosings ln sidswslk or handicap ramps.
Diamond cut A.C./Concreto valuo boxes to grade.
Fresh Oil signe / Graded.
Comply with Americans with Dlsabillties Act.
Concrete clabg, 72hrs. curing time, 4500psi.
Concrote slabs require lolnt seal material.
Driveway requires dowels every 18".
Submit traffic control plan prior to sxcavation.
Notify Trafflc Division before excavatign.
Core drlll main llne, insert tee, 2% min. grade.
Must comply with the provislons of ORS 757.541 to 757.571
6" Circular hole/H2O-Vac.
Comments
rHE LANE uru+iEd'ffiBHilflrthNc couNctL's"oNE CALL NUMBER" 1-900-332-2344
48 HOURS BEFORE DIGGING
INSPECTIONS:
I cuna cur AND SIDEwALK lNSpEcnoNS cALL 726-9769 (REcoRDER] srATE youR DESTGINATED ctry JoB
NUMBER/PERMIT NU['' R, JOB ADDRESS, TYPE OF INSPECTION REOUESTED, AND WHEN YOU WILL BE READY FOR
INSPECTION, COt''- ^. )R'S OR OWNER'S NAME AND PHONE N[JMBER. REOUESTS RECEIVED BEFORE 7:00 A.M. WILL BE
MADE THE S^ .,.TI 1UESTS AFTER 7:OO A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ABE TO BE
CALLED lr g\fri t 'loNS ARE MADE AND FoRM woRK rs rN pLAcE BUT pRtoR To pouRtNG coNcRETE.
I SAruMNNV S $ -.,OBNI
SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT726-3761 t
SIGNATURE:
Fy signature, I s?te and agree( lhat I have gare.fully examined the completed application and do hereby certifv that all informationhereln.ls true and correqt, andl furt_her certify tha!.any and all.ryork peiformed shall be done in accordance with the Ordinances of the
Qitv ql Springfield., applicable Qity.Standard specifications and Drawinss, andlhe liws ofihe-State oi-O;Adti i,eidin'inq'io'iFr-;;or'i'-clescribecl herein. I further certify that only contractors and employees-who are in compliance with ORS 7d1 ,055 will bd uied bn thisproject.
The City-may inspecttl"re work site described in this permit at any time durinq a one vear period followino the receiot bv the Citv ofnotice of co.mpletion of the described work and speclfy, at the Citv's sole deicressiori, an'U additional resloiaiion-wbikreouire?-do-'return -the siteto a standard acceptable to the City. The permittee'will be notified in writin'q of any worfieoulred ,nd wilTh;ve iFirtv
{gf :-t!9lJ,f A !1,_e qq}".91 !h9 ,n9li99 to coqlplete'the w6rk. work noi comptiiteri Ji trei 6n? ot tiia ihfuy'id/i'iiltilj6 pijiioi-'"ia'tjv ir,eurry ano tne costs wilt De Dliled to tne permtttee.
llu,rl[gr 1SJ9-g !o,e-lqulg tFaJ al!.(pau!1e{ inspections are requested at the proper time, thatproject address is readabte from the Etreet,ano tne approveo set ot plans wtll remarn on the srte at all times during construction.
-?b
RECEIVED BY:
DATE PAID:
Signature
AMOUNT RECEIVED:
RECEIPT NOr
Date l/-^7-7/
VALIDATION:
.FOR SIDEWALK AND CIIRB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.,
ELEVENTH MONTH: . DATE:
DEPOSIT RETURNED: DATE:
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tr PERMIT ISSUED BY:
,MAINTENANCE:
ENGINEERING REVIEWED BY:
TRAFFIC REVIEWED BY:
. .INSPECTION:DATE:
DATE
DATE:
WORK IN PROGRESS DATE:
DATE:
DATE:
DATE:
DATE:
INSPECTION: -t
AT TIME OF COMPLETION: