HomeMy WebLinkAboutPermit Curb Cut 1996-06-12I D l D D A a
DATE ISSUED:
ffi
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
APPLICATION DATE:
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503} 726.3753 ENCROACHMENT PERMTT
NUMBER:
PERMIT NUMBER: 9 6 O.1? I
LOCATION OF WORK
TAX MAPI
zn: V7? 77 rAX Lor:
srArE: c?z zre
PHONE
EXPIRATION DATE
a7-
PHONE
7/7
67/7
PHoNE 74/-/Uz
PHONE: 7",/-
APPLICANT
SITE ADDRESS:Qrt
ADDBESS:
CITY:
CONTRACTOR:
ADDRESS
OWNER
cttv: 7;a-f,rty' STATE:
SUBDIVI-SION:
CONTRACTOB REGISTRATION NO
PROJECT SUPERVISOR:
REOUESTED PERMlTS:
ACCOUNT NOIINSPECTIONS REOUIRED: APPLTCATTON FEE / DEPOS|T
f erucnoacHMENT pERMtr No: .....,.
VALID FOR SIXTY 160I DAYS FROM DATE OF ISSUANCE
I cursrnrer E BoRE E oTHER
Q ousr coNrRoL (TypE oF coNTRoL)
I corsrnucloN, sroRAGE, srAGtNG
Q ornrn
Q aseHllr DEpostr
TYPE OF SECURITY DEPOSIT
BLANKET suaEry BoND I suntttv aoruo e casH / cHEcK
CURB C'UT PERMTT NO: .... FT. 7INSPECTION: CURE / APPROACH AFTER FoRMs ARE ERECTEo 8UT PRIOR TO POURING CONCRETE.VALID FOR 180 OAYS FROM OATE OF ISSUANCE.
tr
tr
DESCRIPTION OF PROJECT:
PER]OD OF USE OR TIME OF CONSTRUCTION:
tr PLANS (TWo sETSI ATTACHED.
AREA: LENGTH:WIDTH
TYPE OF WORK: CUT
OTHER:
BORE:
EXISTING SURFACE MATERIAL:
I secorub DRrvEwAy (sEE sEeARATE AppLtcA
SIDEWALK PERMTT NO:...,................ FT. nVALID FOR 180 DAYS FROM OATE OF ISSUANCE.
Q r.rrw E REMovE / REpAtR fl eAVE eLANT srRtp
fl seraacr ll CURBS|DE E TENGTH
INSPF'TION, SIDEWALK / DRIVEWAY FOR ALL CONCRETE PAVING WITHIN THE STREET RIGHT OF WAY, TO BEMADE AFTER ALL EXCAVATING IS COMPLETE , AND FOFM WONT AT{O SUB,EASE MATERIAL IS IN PLACE.
SANITARY SEWER CONNECTTON PERMIT:
VALIO FOR SIXTY 160' OAYS FBOM DATE OF ISSUANCE
I ro srue o MA|N L|NE (EASEMENT-R/W] D oTHER
f sronrvr sEWER coNNEcnoN pERMtr: ........
VALIO FOR SIXTY (60} DAYS FROM OATE OF ISSUANCE
I crrcx BASTN / BUBBLER E STUB e laatrultrue
PRoOF OF INSURANCE: $5OO.OOO MINIMUM
I erracueo O REOUTRED AMOUNT
E S2o.00 /
E$
ff$ t o.oo + $.1 s/FT
E $10,0O+$.15/FT,
T1 S5.OO /U
E $5.o0 /
TOTAL DUE: $
TOTAL DUE WITH PERMIT $
TIME:
TIME:
DEPTH:HEIGHT:
BACKFILL MATERIAL:
tr
$
$
$
tr
tr
tr
E$
_&
FROM DATE:
TO DATE:
BACKFILL MATERIAL TO BE UTILIZED
SURFACE REPLACEIVItNT MATERIALS TO BE UTILIZED
TYPE OF DUST CONTROL TO BE UTILIZED:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT
WARNING DEVICES TO BE UTILIZED:
Advanca signing and work lons prot€ction to b€ in complianco with tho Manual on Uniform Traffic Control Devices (MUTCD)DESCRIPTION
WORK SHALL COMPLY WITH CHAPTER X ARTICLE
REVTS|ONS 8t24t95 FORM , lt6
5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH M UTCD
OF SPRING
t
PLAN REVIEW COM MENTS / SPECIAL INSTRUCTIONS:
BE9T9-EAT-IO-N WORK S-IIA'=L B-E!N_q9r\. UR!!$![CE_W!TH EXISTING CITY CODES ANts rA N D A R D s p E c I F I c A Tt 0 rv S, -e-xb
e Fi As-N titE D-6eLo W. " - -' "' -r clclrpttarvcE wlrH cURRENT
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02s
o26
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029
030
031
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033
343
Backfill with %" minus rock,
Compact every 1 8" loose depth.
Requires compaction with a stsel rolller.
A.C. to match the greater of existing depth or 4".
All cuts sealed for final inspection,
Temporary patch may be used at the end of ths day.
Slgning and zone protection to comply with MUTCD
Cut concrete only on score lines or cold joints.
Sidewalks and driveways min. 3,O00psi.
Curbing min 3,500psi / No patchwork less than 3',
Mest min. requirements on curb cuts, Spfd. code.
Restora planted areas, Spfd. code 206.3.05
Spec. to Bore / Jack / No A.C. cuts.
Mechanical compacting required.
No patchwork allowed.
Lateral cuts to have control density fill.
Cuts to be polymerized crack sealed for final inspection
Mininum 2" crushed rock %" minus.
Minumum 4' clearance at any point, swing-away.
Concrate minimum 4" depth, 3,0O0psi.
Trench to be "T" cut.
Needs Stats / Countv permit.
No above ground enclosings in sidewalk ot handicap ramps.
Oiamond cut A.C./Concrete value boxes to grade.
Fresh Oil signs / Graded.
Comply with Americans with Disabilities Act.
Concrete slabs, 72hrs. curing time, 4SoOpsi.
Concrete slabs rsquire ioint ssal material.
Driveway requires dowels every 18".
Submit traffic control plan prior to excavalion.
Notify Traffic Division before excavatipn.
Core drill main line, insert tee, 2% min' grade.
Must comply with the provisions of ORS 757.541 ta 757.571
6" Circular hole/H2O-Vac.
Comments:
YOU ARE BEOUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"oNE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
ONS:INS
{"u^rcur AND sTDEWALK rNSpEcroNS cALL 726-3769 (RECoRDER) srATE youR DEStcINATED clrY JoBs r.rurvrain-/ieCrvrrr rrrurvreen, JoB ADDRESS, TypE oF tNSpECTtoN REoUESTED, AND wHEN You wlLt BE READY FoR
rr.r-sirdiior.r, CoNTRACion;s on oWNEB;S NAME AND PHoNE NUMBER. REOUESTS RECEIVED BEFORE 7:OO A.I./1. WILL BE
MADE THE SAME DAy;nEOUrSrS AFTER 7:OO A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE To BE
CALLED IN AFTER EXCAVATIONS ARE MADE AND FORM WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE.
SANITARY SEWER, STORM SEWER. ENCROACHMENT PEBMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726-3761,tr
Bv sionature, lstate and aqree, that lhave carefully examined the completed application and.do herebv certifv that all information
HJ,;|X'i;i;L; iii"ii,nU|tl:;?"i ti.i;th'";';;,tii;'ih;it;y;;a';ll ti,t< peito,-n"oihait be done iq accordalrce with the ordinances of the
iii:[s["'rrl:pJt#,:,r+tilL*1",.fiui;lftfltt;Eht#*r*,%lvI!;i:11J1s t1xtffl;ls il?A"""JsoffiBt8'l'?ir ss::J5%riil:
project.
The Citv mav inspect the work site described in this permit at any time during a one year period followinq the receipt.by the City of
Lllri,J*";$t*ff:,:ii::, ,""'"2'r',"$yi[-d!-;i&".'{i; 3!'*"#';ng'"" s""fnlt'il"l;.li;.'r.t11'.i"i'd&'};;',192 ;t n,:f;flH5;3
18,,,r,
davs (3olfrom the orte"Siin?ibti,L:,ii"olliiipriii'inb',i,dr"r.'V{;;[;;t io#ptetio it inij'iin"a ot th6 trrirtv days will be performed by the
eitV anO the costs will be billed to the permittee.
lfurthor aoree to ensure that all required inspections are requested at the proper time, that project address is readaole from the street,
and the ap-proved set of plans will remain on the site at 8ll ttmes durlng constructlon.
SIGNATURE:
RECEIVED BY:
Signature Date
AMOUNT RECEIVED:
RECEIPT NO:
DATE PAID:
VALIDATION:,
f, ernvtr tssuED BY:
FOR SIDEWALK AND CURE CIJT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.
DATE:INSPECTION:#
-DATE:
woRK lN PROGRESS-
AT TIME OF COMPLETION: DATE:
ELEVENTH MONTH: DATE:
b ^1L-9G
f, rranrrurrNANcE
INSPECTION:
f rructrueERlNc REVTEWED BY
TRAFFIC REVIEWED BY:
DEPOSIT RETURNED DATE
DATE
DATE:
DATE:
DATE:
DATE:
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alltaGI:a€L()
PU B LIC IVO N KS DEPA RTAf E N T
4Dh4tNtSt t;ArtoN
t: N G t I't E E R t N6 111 1t1 $'! Qt'l
hr,AlNlE:/,tArttcE
AD^,t^ilStRAttoN/ENG|NEER|NG (503) 726.375j l'Ax (!fr3) 7?6 3689
?i(,- ?25 Fftt.t Stts/)G,/\,Gf r/:( O. ( )t i ,
A,lAt,\lTt:U^r.t-t /4a1t 2-a a-a1 CAv.a^at u'a aa^'
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APPUCANT (PROPERTY k
ADORESS OF:PROPERTY FOR ORIVEWAY ,?7y'77
ApplrcAr{rs TELEPHoNE r.rur"irBER:hat: 7f/- 6717 a* ,': z.t7'o2/3 ax* 170
Please skelch the proposed drivtrvay. lnclude the loltowing applicable ilems: house or building. proposed
driveway. eristing driveway. and street names. lnclude dirnensions and measuremenls lo ptoperly lines. road
intersectioos and bordering driveways. (See altachmenl tor an example.)l:
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AtI NPPUCATIONS OUTSIDE TI{E CITY UIVITTS OF SPRINGFIELD TI{AT ARE TrytTI{IN TI{E URBAN
GROWIT{ BOUI{DARY REOUIRE A TANE COUNTY PERI'IIT.
l.lote: The City of Springfield will nol grant a second driveway permil on an /rrlerial or Colleclor Slreel
APPLICATIQ.II FOR A $ECOND DRIVEWAY / QVERWTDTH DRIVE1VAY
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1- Properly typc: Single Family Resider,." A Duplex O
2. The proposed driveway will take access fiorn wlrich sttee(.4/.4
3. Tho dislance (rorn llre edge ol lhe driveway lo tlro ncaresl cotncr (measutcd lo llto cutb return) is
5? rcet.
'{. The second driveway will givo access lo: garage { carporl- side yard- Other--
5. The dislance from tlreJrroperty line lo llre garage. carporl. fence. wall. ot otlrer. lwlrere ltre velricle is
to bo parked) is { lr"et
6. VUill tlre propbied parking / storage ar€a creale a.vision obslruc-tio.n to adjacenl prcPedY-driveways or.
lo any vehicular movemgnt on a gxrb[c slreet? (See vision clearance allachmetrJ.)-lli2--
Appl-can( hereby agrees lo install Ure requested driveway to City o( Spring,fieU standards. The apptrcant furtlrer
agrEes lo harre 6'o( concrete in ttre sidewak area (adacent to tlre driveway).'and to pave lhe area b€hind Ule
back edge of tIrc sidewatlq or driveway apror\ with a minimum depth o( 3- asphattic concrete or 6- o( podland
cemen( concre(e. The area behind the sidewak shal be paved a minimtrm d( 18 feeL
The appfrent agrees drat il tre/she do€s not pave the area behind Ure sidewalk within 30 days o( cudng lhe
curb opening. the Caty o( Springfietd has (he authority to ctose the drivewzy access by removal o{ Ure curb cul.
A[ incurred costs shall be assumed by Ore appficant and if unpaid. said cost shall Lrccome : lien of tte property.
VVhen lhis appEcation k approved by (he City. lhe appticant musl oblain a curbcuUdriveway permil (rom the
Pub[c Works Department. Engineering Oivision.
Curbcul / Drivervav Permil Fee
a. On an improved slreet (exisling curb): S1O.O0 plus S.15 per [neal loot of cu(b cul
b. On ao unimproved street (no curb): 512.00
c- On currently unimproved st(eets thal are under construction: S12.O0
PROPERTY OWNER'S SIGNAruRE
APPROVED B
BUILOING PERIIIT NO
TRA 9.1
ATTACI{h,lENT: Msion Clearance. Exarnp(e #l
IC DIVISTON
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