HomeMy WebLinkAboutPermit Sidewalk 1999-03-23INSPECTION LINE SEE TNSPECTIONS ON BACK SIDE '
APPLICATION DATE:
ENT PERMIT
lritxonlrD
9PRIN6FI
ENGINEERINO DIVISIONorilet TILIFHONI t!O3l ENCROACHM
NUMBER:
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Vo >8?.2PERMIT NUMBER: ?
DATE ISSUED
72C-3763
ETNETT
OREGON g?47?
.LOCATION OF WORK
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EXPIRATION.DATE:
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ZIPI
PHONE:
PHONE:4az,F}
n ADDRESS:
tl,
(D-PHONE 22
STATE: 1 t.-
CITY:
/ooct64
ADDRESS:
CONTRACTOR:
-o3 -
oo
SITE ADDRESS:
APPLICANT
TAX MAP:
TAX LOT:
CONTRACTOR REGISTRATION NO:
PROJECTSUpERVTSOR2'{a.n,
STATE: /i\
SUBDIVISlON:
OWNER:
}!l?lc?rcil! EoulilDr A??uc^?lofl it!rorrc&T ACCOIJT{? NOI
PERMITS:
Q erucnoAcHMENT pERMtr
----
E c'ao.oo
Ec
or
E t10.00+t.l6/FT.
Q 010.00+0.16/FT.
E 06.0'0 /
E C6.oo /
vAtD roi axw tlol oAYt tnoM o^?t ot EEUATIC!tr cursrREEr EBonE EoTHER
Q ousr coNTBoL trypE oF coNTRou
Q corsrnuctoN. sroHAcE srAGrNo n
Q orxen n tr
tr
tr
I
I
IQ esexllr
TYPE OF SECURITY DEPOS]T
Q aurxersunETyBoNo e sunttw eoHo O cAsH / cHEcx
DESCRIPTION OF PROJECT:
TOTAL DUE;*I] TOTAL DUE WTH PERMTT I
DEPTH:
TIME:
TIME:
HElGHT:
on Unlform TnOc Dcvlccr
PERIOD OF USE OR TIME OF CONSTBUCTION:Q nl.nrus ffwo SETsI ATTAcHED
AREA: LENGTH:
FROM DATE:
TO DATE:
TYPE OF WORK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEIUTNT MATER]ALS TO BE UTILTZED:
TYPE OF DUST CONTROL TO 8E UTILIZED
NAME OF OTHER UTILITTES IF THIS IS A JOINT PROJECT:
WARN]NG OEVICES TO BE UTILIZED:
DESCRIPTION:
Advrncr rlgrnlng and wo,k tonr Prot.cdon to b. ln compllrnca
WORK SHATL COMPLY WITH CHAPTER X ARTICLE 6 O
EACKFILL MATEBIAL:
REV|SIoNS Ct2qe6 FonM , ttt
F THE CTTY CODE.
wlth tht
TO COMPLY WTTI MUTCD
IMUTCO'.
El_tr-_
P IT AI'[)LICATION
BryIEW COMM ENTS
'
SPtsCIAL INUI.TTUSII()NU:
8iffiBHB"$#Bf#o+thB,'518#9LimtE UdlH.
o(snN G ctrY coDEs au _.6ttvtPuANcE wlrl{ CURRENT
00t
002
oo3
004
006
000
007
008
009
0r0
011
012
o13
014
ol0
018
017
,018
Erclflll wlth I'mlnue tock.
Comp.ct rvrry I 8' loorl drPth.
Brquh[ oomprotlon wlth. .t..1 rolll.t.
A.g. to mltch thr gnrrr o, rxltthg drPth o,4'.
All autt rtrlcd lor tlnrl lnrprotlon.
Trmporury pttch mtY br urrd at th. atd ol thc dcY.
Slgnlng rnd Zond prot.clon to comPlY wlth MUTCD
Cut oonctcto onlY on tcora llncr ot cold lolntl.
8ldrwrlkr rnd ddvlwrYr mln 3,000pr[
Cudlng mln 3,l0opd I No prtchwort lrrr thrn 3'.
Mrat mh. rcqulrmrnb on culb outt, Spld. cod..
Rlttor. pltntod.anm. Spld. codr 208.3.06
Spcc. to Eorr I Jrck I No A.C. ctnr.
Mrchanlcel cornPrcthg rrqulrrd.
No pltchwork rllowrd.
bt.r.l out. to h.v. aonrol d.n lty tlll.
Cutt to bc polymcdzrd crrck t.!bd lor llnal lntprctlon'
Mlnlnum 2'crurhod rock I'mlnur.
THE LANE UTI
"ONE CA]
Mlnumurn.l' chtnncl rt rny polnt. twing'rwry.
Conqrta mlnlmum 4' drpth. 3'0o0prl.
Trrnch to b. T' out.
Nccdr St.t. / iountV Pcrmlt,
No rbovr ground rnclorlngl ln rldcwalk or hrndlcop rumpr'
Dlamond cut A.C./Concrctl valu. boxrr to grrdc,
Frcrh Oll rlgnr I Gradrd.
Comply wlth Amrrlcanr wlth Olttblllti.t Act.
Concrtr rlrbr, 72hr. curlng tlrnc, 4500ps1.
Concrrtr rlrbr rrqulro lolnt aall mtttthl.
Drlvrwry rcquku dowrlr lvrrY 18'.
Submlt trrtllo conttol plrn prlor to cxcrvrtlon'
Notlly Trclllo Dlvldon bclorc cxcavatlgn.
Coro drlll mrln llnr. lntcrt t.!, 2% mln. gtadr'
Murt comply wlth th. provlrlonr ol ORS 757'541 to 757'671'
6' Ckculrr holr/H2O.Vrc.
010
020
021
o22
023
024
025
026
o27
028
020
030
031
032
p33
343
Comm6ntss
l.
YOU ARE BEOUIBED TO CALL
LmliS' C06nolNATlN c- 9A U N glL's
uL ntUvtBER', 1 -800-332-2344
48 HOURS BEFORE DIGGING
INSPECTIONS:
SEWER, STOBM SEWER, ENCROACHMENT PERMIT AND OTHER ]NSPECTIONS CALL CITY MAINTENANCE AT
,E
B E
N SANITARY- 7za-97o1,
SIGNATURE:
B$jfi+fliilt;ii[iftiEr:hll*!ffi]F:$.$iif'ii"$ffi$*!f**nii[$tlJliHf^f''hi,i'ifi:']ilit'$]i{;,1"'6ffi$t*ili'
m$f,'rn;iS*?.Jl',u;i;il*'$iii?",f;?f"'B?ffh'i':R: ll';fmtJ'J"il$3"B!",33[,!rme'
that proiect address rs readabre rrom the street'
a
DateSignature
ofathlc
a0ythcnottoa
t
DATE PAID:
BECEIVED BY:
AMOUNT RECEIVED:
RECEIPT NO:
VALIDATION:
I rnerrtc REVIEWED BY: DATE:
E untmreNANcE,
fl penur lssuED BYi-
FoB sIDEwAtK euo aURB cW PEnMITS PLACE A COPY (COMPLETED) IN PERMIT DMWER.
WORK IN
,TE:
DATE:
I eNctrueEBlNG REVIEWED BY:
DEPOSIT BETUBNEDI
ELEVENTH
DATE:
DATE:
INSPECTION:
INSPECTION:
DATEI
DATE;
ir rtue oF coMPLErloN:
IN AFTER
STATEcur
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TO BE
JOB
READY FOR