HomeMy WebLinkAboutPermit Sidewalk 1998-05-12D D D
DATE ISSUED:
atitllo,lrLD
INSPECTION LINE SEE INSPECNONS ON BACK SIDE
APPLtgATtoN DATE:
oFFlcE TELEPHONE (503) 726.3763 ENCROACHMENT PERMTT
NUMBEB:
PERMIT NUMBER: _?5, c .: Q, e
226 FIFTH STREET
SPRINGFIELD, OREGON g?4?7
ENGINEERING DIVISION
.LOCATION OF WORK
STATE:
PROJECT SUPERVISOR:
ZIP,.o
ADDRESS:
CONTRACTOR BEGTSTRATION NO:Lo#EXPIRATION.DATE:L-7-n
L
/e
C.C 4oJ
PHONE:
SITE ADDRESS:
APPLICANT
TAX MAP:
TAX LOT:
SUBDIVISION:
OWNER:
ADDRESS:
-
CONTRACTOa: f Or r e S T Fnr r PHONE:
t Zlpt
r\EPtCTlCNt nlotliros ACCOt,MT NO:
REOUESTED PERMITS:
AP'IJCATIoN FEt
'
OEFOS'T
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o ASPHALT OEPOStT..........
TYpE OF SFCURTTY DEPOSTT
Q ar.rHrer BUnEry BoND I sunrrv eono O cAsH , cHEcK ErI cuna cur pERM]r Nor.................... Ff.E C10.00+t.l6/FT..lflltfc?of,. cun!
'
A?pnoAo{ AFttR aoRME AIt InECTEO n T mparorcunno
OfIEUANCE.
CONCRETE.
Q seconi
@-6iorwau
VALD ?OR tlo oAYtinora oATt
bnvaryey (see SEPARATE
VALD FOi tlo
PERMIT NO! ....................FT..Q 0lo.o0+0.15/FT.OODAVtFnOU OATtOt Etu^xc!.
El New O REMOVE / REPAIB o PAVE PTANT STRIP
tr
.^ ^0 seraacx O cunesroe O I.ENGTHffi li'H.TJffi ["%i'"ffi *tJiffi IiBt[!y!IHll!_rt[ srBrEr nl(lHr oF w^y. ro 8EArito 3u+3^3t rr^TtruAl r il nectSANITARY SEWER CONNECTTON pERMtT: .......VALD FOA txTY GOr OAY8 F8OU OAT! Or tttUANC!E r5.oo /o ro sruB O MAIN UNE (EASEMENT-B/W,E oTHEBtrSTORM SEWER CONNECTION PERMIT:VALD toi uxrv tcot OAYa ?iOM OArl Ot !3U ttc!E r5.oo /o cATcH BAstN , auBBrER O snta e uatNurue
MINIMUM
TOTAL DU6' i] TOTAL DUE WITH PERMIT I
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:Q nurus {rwo sETS] ATTAcHED
AREA: LENGTH:WIDTH:
TYPE OF WORK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEIUTNT MATERTALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UTILIZED
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
WARNING OEVICES TO BE UTILIZED:
DESCRIPTION:
Adv.nca and work tm.
.--.- HEIGHTT
BOREI
BACKFILL MATER}ALI
TIMEI
TIME:
ln oompllrncr drr Mrnud on Tn0lc Conuol Drvlcc
FROM DATE:
TO DATE:
lo b.
WORK
REVtSloNs ,t21tg6 FORM ' ttC
6 OF THE crrY CODE TO COMPLY wlTH MUTCD.
{MuTc0t.
d
SHAIL COMPLY wrm X ARNCLE
PHONE:
BEy|,AN COMME'UTS SPEC'^I
'NSTRUCTIONS:
EFffgXABt#*UPfihlr,d}te,t5{8#9$tid#[tE tffi.E.snNo crr' coDEs AND r-oMPuANcE wrrH CURRENT
Mnrrnrrn {' clllrlncr tt any polnl, rwing'rwry.
Conarr mlnlmrm 4'd.pth. 3'@Oprl.
Tranch to ba 'T' out. t
N.rdr st.t. / County prmlt,
No rbovr ground rnclodngr ln rldcwalk or hrndlccp rrmpr.
Dlamond art A.C./Concrtb vilu. boxcr to grrdr.
Frcrh Oll rlgnr / Gradcd.
Comply rvlth Am.rlcln. wlth Ohtbllhitl Act.
Concr.ta drbt, 72hn cudng tlrno. 4500p3i.
Concrat. rlrbr rrqulrc lolnt rcrl mrtcrlll.
Ddvrwry nquhu dowrlr ovcrY '18'.
Submlt t0lllo control plrn prlot lo cxcrvttion,
Notlty Trrltlo Dlvlrlon bcforc rxcavatign.
Co.. drlll mrln llnc, lnr.rt tcr, 29l mln. gradc.
Murt comply wlth th. ptovlrlonr ol ORS 757.641 to 757.671.
6' Ckculrr holrrH2GVrc.
001 Erotflfi wlth l'mlnur rock.
002 Comprct rvry 18'loor drpth.
OOlt Rrqulrrr oomprstlon wlth r rtrol rollbr.
004 A.C. to m.toh tho gtlrt.r ol ulrthg dtPth o, 'l'.000 AI artt rttlcd lor tln l lilprgdon.
OOC . Trmpo?lry prtch mly br urod rt tho rnd ol th. dty.
OO7 Slgnlng rnd Zonr'prorctlon lo complY wlth MUTCD
008 CW ooncrct. only on rcorc llnat ol aold lolntt.
OOg Sldrwrltr rnd ddvrwryr mln 3.00OprL
OtO Cudlng mln 3,l0oPrl I No prtchwotl brr thrn 3'.
011 Mt.t mh. rcquhrmrntt on ctrt outt, Spld. codt.
012 R..to?. pbnt.d.crcu. Spfd. codr 206.3.06
Ol3 gpcc. to Borc / Jrcl I No A.C. cttr.
014 Mrshrnlscl comptcthg rrqulnd.
01C No prtchwotk rllowrd.
oto Llt.nl o$t to hrvr control d.ntw tlll.
Ot, Cutt to bt potymorlzrd crlcl uhd lor llncl ln.plctlon.
018 Mldntm 2'cuhcd rock I'mlnul.
0r9
020
02t
o22
023
o24
026
026
o27
028
029
03o
03r
032
033
343
Comments: -
THE LANE UTI
"ONE CA
YOU ARE REOUIRED TO CALL
iLlrlrEs coonolNATlNG couNqlL's
t-t- NUwIBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
INSPECTIONS:
I-l SerufeRy SEwER, STORM SEWER, ENCROACHMENT PERMTT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
- 726-97a1,
BE
SIGNATURE:
ara reou&ted at the proper !ime, that project address ls readable from the street'
at all times during construction.
I
Dste
Signature
z-q ?7 I
2 Z-
andand
rnv
the
thlc
4,ot,
I have
AMOUNT RECEIVED:
RECEIVED BY:
lltl[T,'onJi3*"d.,ti'Jt;i]?1"'$liit3f,?f"'B'f t#til3
RECEIPT NO:
i
DATE PAID:
E rnarnc REVIEwED BY: DATE:
E runtHrENANcE,
E penur lssuED BYi
Foa sDEwA* auo cuRB cw PERMtrs Pl-AcE A coPY (aaMPLETED) tN PERMIT DMwER'
IINSPECTIONT :
I, INSPECTION: r
Iirrnr'ae oF coMPLErloN: -
ELWENTH MONTH: . DATE:
I
DATE:
I rructHeERlNG REVtBrt/ED BY:
DATE:
DEPOSIT BETUBNED:
DATE:
DATE:
DATE:
DATE:
DATE:
. WORK IN PROGRESS
DATp:
CUT
CALLED
]NSPECTIONS ARE TO BEBE
woBK rs PLACE BUT
CITY JOBYOUR
NAME
POURING CONCRETE.AFTER
the
to
on