HomeMy WebLinkAboutPermit Sidewalk 1997-05-27DATE ISSUED:
DD tr I o
tPntxoFtELO
Z ??
o
PERMIT NUMBER:INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
APPLtgATtoN DATE:
225 FIFTH STREET
ENCROACHMENT PERMTT
NUMBER:
S/RINGFIELD, OREGON 97477
ENGINEERING DIVISION
oFFtcE TELEPHONE (503) 726-3753
-o
PHONE:
PHONE
rL o
0
ZIP: q 7471
ADDBESS:lll!4l-a695Q-urto
4/zJ-4EXPIBATION DATE:
: Er tL6<{,L STATE:ADDRESS:
'LOCATION OF WORK
APPLICANT
SITE ADDRESS:
CITY:STATE:
aA-_
PHONE:
PHONE:
ZIP:
TAX MAP:
TAX LOT:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERVISORT
SUBDIVISION:
OWNER:
CONTRACTOR: \/
Il.lliPECTDNS REOUIRED:APPLICATION FEE / OEPOSIT ACCOUNT NO:
REOUESTED PERMITS:
CITY,OF SPRING LD IT APPLICATION
f, erucnoAcHMENT pERMtr No: .......
VALIO FOR SIXTY 160I OAYS FROM OATE OF ISSUANCEI cur srnerr E BoBE E orxEa
Q ousr coNTRoL (TypE oF coNTRoLt
p corusrnucloN, sroRAGE, srAGtNG
p orxen
I asnxalr DEpostr..........
TYPE OF SECURITY DEPOSIT
Q auaxxer sunEry BoND e sunttw aoruo e casH / cHEcK
E cune cur pERMrr No: .... FT
INSFECTION. CURE / APPROACH AFTER FORMS ARE ERECTED 8UT PRIOR TO POURINGVATID FOR T8O OAY6 FROM OATE OF ISSUANCE.
E $2o.oo /
E$
fl s10.oo+ $.16/Fr.
[ $10.00+ $.1s/FT.
E $5.0o /
E $5.oo /
TOTAL DUi;...i
TOTAL DUE WITH PERMTT S
TIME:
TIME:
DEPTH:HEIGHT:
BACKFILL MATERIAL:
tr
tr
tr
Es
I
$
$
---E secoN'of[ sroewelr
ORIVEWAY (SEE SEPARATE APPUCA
PERMIT NO:.................... FT
VALID FOR I80 oaYsJEOM OATE OF tssuANcE.
ffielaove / REpAtR A
tr S,ANITARY SEWER CONNECTION
vALto FoR stxTy t6o) oAys FaoM DATE oF tsSuANcE
I ro srue E MAIN L|NE (EASEMENT-R/w)
f, sronnn sEWER coNNEcnoN pERMtr:
VALIO FOR SIXrY (60I OAYS FROM OATE OF ISSUANCE
Q rurw PAVE PLANT STBIP
Q srreacx E cuRBstDE a LENGTH
lNspFaTtoN. stoEwALK /DRIVEWAY FOR ALL CONCRETE PAVINGMAOE AFTER ALL EXCAVATING IS COMPLETE ANO FORM WORK
BACKFILL MATERIAL TO BE UTILIZED:
S URFACE REPLACET\4tNT MATERIALS TO BE UTILIZED:
WTHIN THE STREET BIGHT OF WAY. TO BEANO SUE.BASE MATERIAL IS IN PLACE.
I orHrn
fl crrcn BASTN / BUBBLER e srua E MAINLINE
PROOF OF INSURANCE: $SOO,OOO MINIMUM
Q arrrcxeo E REOUTRED AMOUNT
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:
tr PLANS (TWo sETS)ATTAcHED
6
FROM DATE:
TO DATE:
AREA: LENGTH:.WIDTH:
TYPE OF WORK: CUT: eAatrr
OTHER:
EXISTING SUBFACE MATERIAL:
TYPE OF DUST CONTBOL TO BE UTILIZED
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
WARNING DEVICES TO BE UTILIZED:
Advance signing and work zone protoctlon to bo ln complianco with tha Manull on Uniform TrslJic Control Devices (MUTCD),DESCRIPTION:
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5
BEVTS|ONS 8124195 FORM ' 116
OF THE CITY CO CONTRACTOR TO COMPLY WITH MUTCD.
.i, f, ...
n
n
REVIEW COMMENTS / SPEC'.I. INSTRUCTIONS:
8Fil,BmB'S#P'ff^iTd$!l %t*'8JF?[bi8#[tE Yd[U.
ExrsrrN G crrY co DES AND ._ JCTUPUANCE WITH CURRENT.
Minumum 4' clearance at gny point, swing'away'
Concrotc mlnlmum 4" depth, 3,000psi'
Tronch to be 'T' cut.
N6eds Stato / County Psrmit.
No above ground oncloslngs in sidowalk or handicap ramps'
Diamond cut A.C./Concrete value boxes to grade'
Fresh Oil slgns / Graded.
Comply with Americans with Disabilitigs Act'
Concratc rlabs, 72hrs. cuting timo, 4500psi'
Concrete slabs rcquire loint saal matsrial'
Driveway rcqulrea dowels every 18n.
Submit traffic control plan prior to oxcavation'
Notily Traflic Dlvision bafore excavatign'
Core drill main line, inssrt to6, 2% min' grade'
Must comply with the provisions of OFS 757'541 to 757'571'
6" Circular hole/H2O'Vac.
001
002
003
004
006
006
o07
008
009
010
011
012
013
014
015
016
017
018
Backfill wlth J(' minus rock.
Compact every 18' loose dePth.
Requlres compactlon with a steel rolller.
A,C. to match tho'groltor ol exlsting dspth or 4''
All cuts gealed lor final ln3pectlon.
Temporary pstch may be used 8t th6 end of tho dEy'
Slgnlng and Zoni protection to comply wlth MUTCO
Cut concrete only on score lines or cold loint3'
Sldewalks and drlVewaya mln. 3,OoOpal'
Curblng min 3,6OOpsl / No patchwork leea than 3"
M6at min. roquiremento on qurb ctts, Spfd' cods'
Rostore planted areas, Spfd' code 206'3'05
Spec. to Bore / Jack / No A.C. cuta.
Mechanlcal comPactlng requlred.
No patchwork allowed.
L.t.rll cut. tg h.vr control d.ntlty fill.
Cut8 to bo polymerlzed crack soalcd lor llnrl lnspectlon'
Minlnum 2' crushed rock l('minus.
THE LANE UTI
"ONE CA
YOU ARE REOUIRED TO CALL
iLrTl lis"co-o nol NAr! N-G- Ca u N I I L' s
lL- NUMeEn" 1 -800-332-2344
48 HOURS BEFORE DIGGING
019
020
021
o22
023
024
o25
026
o27
028
029
030
031
032
033I
Comments:
NS:
tr ;l3r5f;rl sEwER, sroRM sEwER, ENcRoAcHMENT PERM
EB
IT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
irrsisji!""?lil:,i'i;iliq'El{*fr,.$F[iHi{'3i[iliftr"*$flnilir#*ffi:d}[1ii,e,r.ffii,]ii.,i:4fri;{t$'{i;,fd$ti};t**t'
3:Y"fflfffl39Ji35'ftproject.
g,gfi,t*lurllfi*t34p1;$.p'H"{!:tiftli fldn!$.ttt{flflffi'"'l,iffftrukdfi'*"
SIGNATURE:
I furthor
and the
€l 7k7/o . {()
ensurs that all requlred lnspections
set of plans will remain on the site
8re reouested at the Proper time,
lliimes during construction.
Date /,
RECEIVED BY:
DATE PAID:AMOUNT RECEIVED:
that project address is readable from the street,
RECEIPT NO:
VALIDATION:
f, rnnrrtc REVIEWED BY:
I ultrureNANcE ,
I eenur lssuED BYi
INSPECTION: DATE:
AT T]ME OF COMPLETION:
ELEVENTH
IN PROGRESS. WORK
DATE:
DATE:
DATE:
DEPOSIT RETURNED:DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
E eructrueERlNc REVIEWED BY:
: INSPECTION:
CUBB
JOB
ARE
AND SIDEWALK
MADE THE
CALLED IN AFTER
, FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.
I