HomeMy WebLinkAboutPermit Encroachment 1998-02-03D D
DATE ISSUED:
aPitxo?ttLD
.t
,a)
PERMIT NUMINSPECNON LINE SEE INSPECNONS ON BACK SIDE '
APPLI9ATION DATE:
FIFTH STREET
ENCROACHMENT PERMIT
NUMBER:
SPRTNGFIELD, OREGON 97477
ENGINEERING DIVISION
oFFtcE TELEPHONE (603t 726.3753
.LOCATION OF WORK
OWNER:
ADDBESS: DH6NET
CONTMCTOR REGISTRATION NO: 422/ EXPIRATION.DATE:
cltlz 4,?zt x bfi np STATE:6 tz-
PROJECT SUPERVISOR:
37,
o
PHONEI
74 N N,,Q/g
GlTYr STATB_ t Ztpt
ZI?2. 1-14 7'I TAX LOT:
SUBDIVISION:
SITE ADDRESS:
APPUCANT 2a-
TAX MAP:
ADDRESS:
coNrRAcroez EllLftJ* .t...;1,
REOUESTED PERMITS:r,GltgnoNt ntouf,tDr AtruC^tror{ m , O!FOs|T ACCOU}Jf NO:
E grtcnoAcHMENT PERMIT No! ..........,....................y^tt toaaxwlt01 o yttioMo^rlo[lalr ]Gt
QcursrRcEr OBOnE OoTHER
,
E t2o.oo t _
Q ousr coNrBoL ltypE oF coNTRou .80
Q orxea
-
D-tr
tr
o
I
I
0flrsar.llr
TYPE OF SFCURITY NEPOSIT
O aurxer sunEry EoNo
EJiune cur pERMrr No:
osuRrrYBoND ECASH TCHECK Ec
tr0
Eo
E$1
aa aa a a a a ataa a aaa aa a a 10.00+ t.l6/FT.
10.00* $.1E/FT.
U!!EEDQ&,CU8!, AP?aOACH AFllR FOATI|8 AfittREgTtO
vAt D FOi tto oAYt Fnoil o TIoFBSU NCt.tr SECOND ORIVEVVAY ISEE SEPARATEtrSIDEWAIK PERMIT NO8.................... Ff.v LD 70i tao oAv! taort DA?t ot taux{ca 7c
O rew E BEMovE, BEpAtB Cl pAvE prANT srRtp
Q'seraecr O cuRBstDE Cl LENoTH
tr
NaD""raN' eloEw^lr roiMrw^Y^ro_illl cot{c|rtt t^vF{o wrHN rHr 8TREET ilo}rr oF w^y, To 0EMAoE ArrEa Au :xclv^Te{o E coururr .
^rro
ronra irriiia eno ruailr:i irreidiilrr.'n'ir necr.
SANITARY SEWER CONNECTION pERMIT: ..........YAID FO8 3IXTY ttot o^y8 Faoil o^t! ot tssu tEt
Q ro srua O MA|N UNE (EASEMENT.R/W Et orHER
5.0'o /
I srcinrvr sEwER coNNEcnoN pERMtr;D-E. C6.oo /v^tD ior axw 6oN DAvt tioil o ?:
Q cercrt BesN , arsarli
or Esu t{cr
Osrua fluanure
PRooF oF |NSURANCET a60O,OOO MINIMUM, Q errecxso El REoU|RED AMoUNT:TOTALDUE: I
i TorAL DUE WnH PERMTT I
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:
Q runs (Two sETSI ATTAcHED
FROM EATE:
TO DATE:
AREA: LENGTH:WIDTH:DEPTH;
TYPEOFWOBK: cUT:
-
BoRE:
OTHER:
EXISTING SURFACE MATERTAL:BACKFILL MATER}ALI
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEIUTNT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE
NAME OF OTHER UTILITIES IF THIS IS A JOTNT PROJECT:
WARNING OEVICES TO BE UTILIZED:
Advrncr rlgnlrp
DESCRIPTION:
WOBI( SHALT COMPLY WITH
TIMEr
TIME:
HEIGHT:
wgrl ton!to b. ln oompllrnct wlth thr Mrnurl oo Unlform ?nlllc Dcvlco {MUTCO|.
X ARNCLE 6 OF
nEusK)NS u24le5 iORil,ll!
THE CTTY COilTRACTOB TO COMPLY Wfi MUTCD.
E-
i
REI/IEW COMMENTS /INSTRUCTIONST
sfilgxfrBo#l8Prrdhlffr}t,r68#9}1, nrsid[cFEuJff.BosTrNc crry coDEs AND r,, ctrupuancE wlrH cuRRENr ,
001 8rct0[ wlth I'mlnu rccl.
002 Comprct tvrry 18'loor dtpth.ooit Frqulnr oomprotlon wlth I rtlll ,olllx,
004 A.C. to mttoh thr gnrtcr ot lxlrthg drpth or 4'.
001 A{ orl$ rrrlcd lor tlnd lilprotlon.
00C . Trmporrry prtch mry br wcd il tho rltd ol thc dry.
OO7 glgnlng md Zonr'prorctlon to comply wlth MUTCO
008 Cut oonflttr only.on rcoru llncr ot oold lolntr.008 Sldrwrlkr rnd ddvrwryr mln 3,000pr1
0t0 Cudlng mln 3.600pr1I No prtchworl hrr thrn 3'.
011 Mcit mln. nquhrmcn$ on curt outr, Spld. oodr.
012 irrtoo phntcd.rrcu, Spfd. oodr 20C.3.06
O13 sp.a. lo 8on l Jrct l No A.C. our.
01tl Mrchrnlcclao.nprotlngnquhd.Oll No p.tahwork r[otvrd.
010 btl'.] our to hrv. cmtrol drrulty fl[.
017 Cur lo br polymcdrd c'tck ttllcd lor llnal lnrpcctlon.
018 Mlnlnum 2'oruehod rock I'mlnw.
0r9
020
02r
o22
023
024
026
020
o27
028
029
030
03r
032
933
343
Mnunun,l'chmncr .t my polnt. rwlng.rwry.
Cmorrb n{ntnrfn 4'drpth, 3.0OOpd.
Tnmh to ba T out. i
N..dr 8ht. / County prrmh.
No rbovr groud rndodng. ln ddrw.lk or hrndlcrp rampl.
Dlrmond out A.C.lcono''t. vllul boxr to grldr.
Frrh Oll rhnr / Orodd.
Comply wlth Arrrrlsrnr wlth Olr&llltl.. Act.
Concr.t rlrbr. T2hc oulng trn.. 460oprl.
Concntr drbr nqrdrc tolnt rtd mrbrbl.
Ddvrwry nqtdnr dowrlr rvrry t 8'.
Suborlt tntflo control pltn ptlot to .xctvltlon.
Notlly Tnlllo Dhldm bclorc rxcrvatlln.
Corc drlll mrtr [no, lmon tt!. 2!b mln. gndr.
Murt comply wlth th. provlrlonr ol ORS 767.541 to 757.671.
6' Chculrr liolr/H2O-Vra.
Comments:
t.
rHE LANE urLdiE6^ilffdHbiflr?ttrNc couNcrL's"oNE CALL NUMBER" 1-800-332-2344
48 HOUBS BEFORE DIGGINO
INSPECTIONS:
'D cuna cdr axo sIDEWALK tuspEcnoNlt cALL 72aa7as (BEcoRDERI srATE youn DEstctNATED crw JoB- NUMBER/PEBMIT NUMBER, JOB ADDRESS, TYPE OF TNSPECTION REOUESTED, AND WHEN YOU WILL BE READY FOR. INSPECTION, CONTRACTOR,S OR OWNER,S NAME AND PHONE NUMBER. REOUESTS RECEIVED BEFORE 7:OO A.M. WILL BE: MADE THE SAME DAY, REOUESTS AFTER 7:00 A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ABE TO BE
, CALLED rN AFTER EXCAVATTONS ARE MADE AND FORM *OBK.rS tN PLACE BUT PRIOR TO POURTNG CONCRETE.
I saruraRy sEwER, sronM sEwER, ENcBoAcHMENT pERMrr AND orHER tNspEcfloNs cALL ctry MATNTENANCE AT
724.3781,
SIGNATURE:
26-G (7
I have
thlg
'I
DatoSlgnature
are
at
ofahyy0arrttnv
thb
a
and
I furthor lorco to ensuro
End the ap-proved oet of , that project addreaa ls readable from the streot,
/70
BECEIVED BY:
AMOUNT RECEIVED:
RECEIPT N0r
p
DATE PAID:
VALTDATION: ,//:,/
I rnarnc REVIEwED BY:
fl renur tssuED BYi , , ,
FON SDEWALK AND CURE CW PENMffS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.
Af nrvre OF COMPLETION: DATE:
ELWB{TH MONTHI OATES
I
TE:
DATE:WORK IN PROGRESS
DATE:
OEPOSIT BETURNED:DATE:
DATE:
DATEI
DATE:
DATE:
I naarrurENANCE:
.
INSPECTION:
; tnspecloN:
I rucrrueEnrNc RB/TEWED BY:
ar8