HomeMy WebLinkAboutPermit Curb Cut 1998-10-07V O
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTBUCTION:Q nurus fiwo sETSIATTAcHED
FROM EATE:
TO DATE:
TIMEr
TIME:AREA: LENGTH:
TYPE OF WORK: CUT:
OTHEB:
EXI9TIN6 SUBFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEI\4tNT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UT
NAME OF OTHER UTILITIES ]F THIS IS A JOINT PROJ
WARNING DEVICES TO BE UTILIZED:
DESCRIPTION:
WOBK SHALL COMPLY WITH
I{IDTH:
BORE:
BACKFILL MATERTAL:
Advracr rlgnlng rnd worl tonc prot.cUon to bo ln complhnct wlth thr Mrrul on Unllom TrrUlc Control Drylor
X ARNCLE 6 OF
D I I
DATE ISSUED:
tPitr{o7t:LD
h,T PERMITENCROACHMEN
N
?
PERMIT NUMBER:
226 FIFTH STREET
TNSPECTTON LINE SEE INSPECTIONS ON BACK SIDE '
APPLtgATtoN DATE:
SPRINGFIELD, OREGON 57477
ENGINEERING DIVISION
oFFtcE TELEPHONE t503) 72S-3763
'LOCATION O
PHONE
TAX MAP:j(
ON:
STATE:
DATE:
tr'/
C4
EXPIBA
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PHONE:?l 7A'til-7+k9q f*zrr
STATE:
PROJECT SUPERVISOR, L
PHONE:
Zt?t
APPLICANT
SITE ADDRESS: 2
CITY:
OWNER:
ADDRESS:
CONTRACTOR:
CONTRACTOR REGISTRATION NO:
wrcL{r
ta
$€PCST|ONS AEOUATOI At?uc^trcN Ft!roEFo8tf ACCOJNTNOT
REOUESTED PERMITS:
I erucnoAcHMENT pERMrr E s"ao.oovArD FOR S|XTY tSot oAYE ;ROM oATt oF IS8UANCE
E cursrREEr EBORE OOTHER EoQ ousr coNTRoL (TypE oF coNTRoU
Q consrnucloN, sroRAGg srAolNG tr
tr
tr
I
I
IQ asexlur DEposlr,
BTANKETsunEryBoND EsunlryBoND EcASH/cHEcK tro
CURB CUT PERMIT NO: ...............'2..... Ff
-
El' cl0.00+ c.lE/Fr.SOllrsPFt-nOH.cuRS
'
Appso^cH rrreR ronus enE IRECTCO ilrIvAtD FoR tlO Orvr raou oert ?8pn ro P(ruRtNo
tr oF tsEUAr.tCE.
SECONO ORIVEWAY (SEE SEPARATEI sorwaLK pERMtr No:
VALD TOR tlo DAYt FROM DAT! OF f,l 010.00+0.16/FT.
WAY, TO BE
tr PtlcE.
E S5.00 /
I sronm sEwER coNNEcloN PERMIT:E 05.00 /VALD ron Stxw tlot DAY! FROM OA?t ot BSUAJitCtocATcH alstN , BUBBTEB e srua e uaruuue
PROoF oF INSTIRaNCF: $5oo,ooo MTNIMUM. f,l arncxeo E REoutRED AMOUNT
TOTAL DUE WITH PERMIT T
R€V|SIONS t/2ars6 FoaM , tt!
THE CTTY CODE TO COMPLY WTH MUTCD
lMuTCot.
ZIPI : .. , TAX LOTI
TOTAL DUE;' i
/ SPECIAL INSTBUCTIONS:
MANCEWIT}I E(!sTINO CITY CODES ANE
,TOTED BELOW.
WITH CUBRENT
001 Brclflll wlth l'mlnul ,ocl.
002 Comprct rvcry t8'loorc drpth.
003 Roqulru oomprotton wlth . tt..l ,olll.r.
004 A.C. to mttch thr groltcr ol rxlrtlng dtpth or 4'.
00t A[ outt rcrlcd lor flnd lmpcotlon.
00C . Trmponty pltoh mty bl urrd .t tht urd ol thc dry.
OO7 Slgnlng rnd Zonc'protcctlm to comply wlth MUTCo
008 Cut oonclato only on rcorc llncr or cold lolnb.
009 Sldrwrlkr lnd ddv.wtY. mln 3,000pr1
OIO Cudlng mln 3,60opd, No pltchwort lur thrn 3'.
Otl Mcit mh. rcqulromrntr on art ottr, Spld. codr.
012 Rtlton pltntd.lrcrt, Spfd. codr 208.3.06
O13 sptc. to 80rc / JrcI I No A.C. c-trtl.
Ol4 MochrnleclcomPtctlngrcqrrlnd.
O'10 No prtohwork rllowrd.
Oto lrtonl outt to htv. oontrol d.nttt, tlll.
Ot7 Cutt to b. polymcrlt.d crack rcrlcd lor llnal lnrpcctlon.
018 Mlnlnum 2'cruchcd rock I'mlnur.
0r9
020
021
o22
o23
024
025
026
o27
028
029
030
031
032
933
T
Mlnwnun,l' chrrrncr at lny polnt. rwlnC'rwry.
Concrr mlnlmurn 4' dcpth, 3,OOopol.
Trrnoh to ba 'T' out. t
Nrcds Sut. / County pcrmlt.
No rbovr ground rnclorlngr ln rldcwllk or handlccp rampr.
Dlamond cgt A.C.Eonorcta vrlu. boxrt lo gtldc.
Frcrh Oll rlgnl / Grudcd.
Comply wlth Amrrlcanl wlth Olgrblllticc Act.
Concnr drbr, 72h0. curlng tlmc, 46O0prl.
Concntr rlrbr rqulrc lolnt rcal mrtcrlrl.
Ddvrwry nqulnl dowrlr rvcrY 18'.
Submlt trulflo control plln prlor to cxcavatlon.
Notlly Trrlllo Dlvlrlon bcrotr rxc!v!tl?n.
Coru ddll mrln llnc. lntlrt $c, 2tt min. gradc'
Murt comply wlth th. provlrlonr of OBS 757'641 to 757'671'
6' Clrcuhr tiolc/H2O-Vrc.
Comm8nt8: -
I
THE
YOU ARE REOUIRED TO CALL
LANE UTlLlfl Es co0RDINA:r-lNG- qQUNclL'sttoNE eAtl- NUMBER" 1 -800-332'2344
48 HOURS BEFORE DIGGING
INSPECTIONS:
'tr ftU[,igffiAtF'fl,',##H]t'JiBT3]S'if]FJEPi^?3iqff,E-iTfil-iJflf.ilHfn'Ef$-,:fi.'-:.Ei?ipv ren -
tNSpEcloN, coliiiA6ioh;5-oi-oWryEi,s r,rarvrE'axo pHor.rE i.r0tvt-sen. hebuesrs BECEIVED BEFoRE 7:00 A.M. wlLL BE
MADE THE sAMsDAi;iEciul5i's AFtEii i:bb A.M. Wrr-u aE MnDe fxe ruexr woRKtNG DAY. lNSPEcrloNS ARE ro BE
cALLED tN AFTERlich'Ve-rloni Ane r',tAoE-Ar.ro FbnM WoBr rs rN pLAcE BUT PBIOR To PouRlNG coNcRErE.
O sarutfany SEwER, sToRM SEwER, ENcRoAcHMENT PERMIT AND OTHEB INSPECTIONS CALL clTY MAINTENANCE AT
72A.a7A1.
SIGNATURE:
t[t$3'."r{:..,:"d.JB",J?;l]X,r{l,iii|]fi'#B'fst[ilS 3luitHtJ'Jrifif3"B"'ffl,lime', that proiect address rs readabre from the strest'
I have
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Slgnature
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€,RECEIVED BY:
AMOUNT RECE]VED:
i
DATE PAID:
RECEIPT NO:
VALIDATION:
E rnerrtc REVtElilED BY: DATE:
E uatrurENANcE:
E penur tssuED BYi
FOB SIDEWA* EUO CURB CW PEBMITS PI.ACE A COPY (COMPLETED) IN PERMIT DRAWER.
DATE:
WORK IN PBOGRESS ,
ATTIME OF COMPLETION: -
INSPECTION:
I eruetnrERtNc REVIEWED BY:
OEPOSIT BETURNED:
ELEVENTH
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
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