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Home My WebLink AboutPermit Sidewalk 1996-12-16225 FIFTH STREET SPRINGFIELD, OREGON 97 477 ENGINEERING DIVISION OFFICE TELEPHONE (503) 726.3753 SP,lINOTIELD h,ENCROACHMENT PERMIT NUMBER: PERMIT NUMBER: DATE ISSUED: 7LINSPECTION LINE SEE INSPECTIONS ON BACK SIDE APPLI9ATIoN DArE : / Z- /A -7b 'LOCATION OF WORK APpLTcANT '-l)a x Cc:uxsr:.+l PHoNE +9.( -oAG SITE ADDRESS: ?ZZ,,4 tt' Crcv fre o'4*t*UD STATE d lt-- SUBDIVISION TAX MAP IAA LUI:oo il-l i -f \\e I D OWNER: \nJ, ADDRESS 2 CONTRACTOR '4".t 1-L "/PHONE CITY: 5 ADDRESS STATE:ztP et.r PHONE: lEc C) 7L?-@7LCONTRACTOR REGISTRATION NO: PROJECT SUPERVISOR: .lr d\€ XPIRATION DATE 7- z"-?7pHorue REOUESTED PERMITS: f, erucnoacH[nENT pERMlr No: VALID FOR SIXTY 160) DAYS FROM OATE OF ISSUANCE I cur srneer fl BoRE O oTHER I ousr coNrRoL (TypE oF coNrRoL) I colrsrnucloN. sroBAGE, srAGtNc INSPECTIONS REOUIREO: APPLTCATTON FEE / DEPOSIT E $20.00 / Es E $10.00+$.15/FT 94{,OO ;- $. i 5iFT. I / ACCOUNT NO: tr tI I nsrualr DEPostr.......,.,. $ $ $ tr tr tr Es TYPE OF SECURITY DEPOSIT I euruxer sunEry BoND E suRnry BoND e cesH / CHECK I cuna cur eERMtr No:......FT INS?!CrtoN: CTJRB / AppROACH AFTER FORMS ARE ERECTEO BUT PRIOR TO POURING VALID FOR 180 DAYS FROM DATE OF ISSUANCE. _-..E secorub DRivEWAy isEE sEeARATE ApplrcAroN) ffstorwaLK pERiv,ltr No: ................,... FT. vAL rD Frr.r6o DAy s gete!/DA ffliew B/ervrove {o tr ,TE Oi ISSUANCE. / REPAIR E PAVE PLANT STRIP Q seraecr ll cURBSIDE e lelrcra INSPF'TION. SIDEWALK / ORIVEWAY FOF ALt CONCRETE PAVING MAOE AFTEN ALL EXCAVATING IS COMPLETE, ANO FORM WORK WITHIN THE STREET RIGHT OF WAY, TO 8E AND SUB.BASE MATERIAL IS IN PLACE. tr SANITARY SEWER CONNECTION PERMIT: VALID FOR SIXTY (60) OAYS FROM DATE OF ISSUANCE I TO STUA E MAIN LINE (EASEMENT-R/\^/) E OTHER STORM SEWER CONNECTION PERMIT: VALIO FOR SIXTY (60' OAYS FROM OATE OF ISSUANCE I carcx BASTN / BUBBLER I srua O MAtNLtNE PROOF OF INSURANCE: $5OO,OOO MtNtMUM Q arracreo D REoUtRED AMouNT DESCRIPTION OF PROJECT: PERIOD OF USE OR TIME OF CONSTRUCTION: tr PLANS (TWo SETS) ATTACHED tr ABEA: LENGTH TYPE OF WORK: CUT OTHER: E $5.00 / l--i $5.00 /lJ TOTAL DUE: $ TOTAL DUE WITH PERMIT $ D EPTH: 5o FROM DATE TO DATE:h TIME TIME .\I/IDTH HEIGHT BORE: EXISTING SURFACE MATERIAL BACKFILL MATERIAL: BACKFILL MATERIAL TO BE UTILIZED SURFACE REPLACEN4TNT MATERIALS TO BE UTILIZED TYPE OF DUST CONTROL TO BE UTILIZED NAME OF OTHER UTILITIES IF THIS IS A JOINT PBOJECT WARNING DEVICES TO BE UTILIZED: Advancs signing and work zone protection to bo in compliance with lhe Manual on Uniform Traflic Control Devices (MUTCO) DESCBIPTION WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD REVTSTONS 8/24195 FORM ' ',r 16 APPLICATIONCITY Or<7o "-.- ZIP: Q o+ren PLAN REVIEW COMMENTS /INSTRUCTIONS: BESTORATION WORK qHALL BE IN CONFORMANCE WITH EXISTING CITY CODES AND IN COIVIPIIAruCE WITH CURRENTSTANDARD SPEcIFIcATIoNS, ExcEPT AS NoTED eeLoW. 001 Backfill with %" minus rock. 002 Compact every 1 8" loose depth. 003 Requires compaction with 8 steel rolller. 004 A.C. to match the greater of existing depth or 4". 005 AII cuts sealed for final inspection. 006 Temporary patch may be used at the end of the day. 007 Signing and Zone protection to comply with MUTCD O08 Cut concrete only on score lines or cold joints. 009 Sidewalks and driveways min. 3,OO0psi. 010 Curbing min 3,500psi / No patchwork less than 3'. 011 Meet min. requirements on curb cuts, Spfd. code. 012 Restore planted areas, Spfd. code 206.3.05 013 Spec. to Eore / Jack / No A.C. cuts. 014 Mechanicalcompactingrequired. 015 No patchwork allowed. 016 Lateral cuts to have control density fill. 0l7 Cuts to be polymerized crack sealed for f inal inspection 018 Mininum 2" crushed rock %" minus. Comments 019 o20 021 o22 o23 024 o15 o26 o27 o28 o29 030 031 033 343 Minumum 4' clearance at any point, swing-away. Concrete minimum 4" depth, 3,000psi. Trench to be "T" cut. Needs State / County permit. No above ground enclosings in sidewalk or handicap ramps. Diamond cut A.C./Concrete value boxos to grade. Fresh Oil signs / Graded. Comply with Americans with Disabilities Act. Concrete slabs, 72hrs. curing time, 4500psi. Concrete slabs require joint seal material. Driveway requiros dowels every 18". Submit traf f ic control plan prior to excavation. Notily Traffic Division before cxcavatigrr. Core drill main line, insert tee, 27.o min, grade. Must comply with the provisions of ORS 757.541 to 757.57'l 6" Circular hole/H2O-Vac. rH E LAN E urlr+if6^'ffi"6'Hbifuf+lN G cou NcrL's"oNE CALL NUMBER" 1-800-332-2344 48 HOURS BEFORE DIGGING INSPECTIONS pf- cuna cur AND SIDEWALK tNspEcloNs cALL 726-3769 (REcoRDER) srATE youR DESTGTNATED ctry JoB NUMBEB/PEBMIT NUMBER, JOB ADDRESS, TYPE OF INSPECTION REOUESTED, AND WHEN YOU WILL BE READY FOR INSPECTION, CONTRACTOB'S OR OWNER'S NAME AND PHONE NUMBEB. REOUESTS RECEIVED BEFORE 7:00 A.M. WILL tsE MADE THE SAME DAY, REOUESTS AFTER 7:00 A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS AilE l-O Eq CALLED IN AFTER EXCAVATIONS ABE MADE AND FORM WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE. SANITARY SEWER. STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CAIL Cll''r ,.4AINTE|JA.NCE AT 726-3761tr SIGNATURE Bv sionature, lstate and aqree. that lhave carefullv examined the comoleted aoolication and do herebv certifv that all informationh6reii is trud and correct, End i f urther certifv that anv and all work peif ormed'shall be done in accord6nce with the Ordinances of the Citv of Sorinqfield, aoolicable Citv Standard soecifications and Drawinos. and the laws of the State of Oreqon pertaininq to the work described heiein. I fiirther certify'that only cohtractors and employees"who are in compliance with ORS 70-1 .055 will bd used on this pro,iect. The Citv mav inspect the work site described in this oermit at anv time durino a one vear oeriod followinq the receiot bv the Citv of notice cjf corirpletion of the described work and specify, at the Cit'v-'s sole deicression, an'i additional resioration wbrk iequired io return the site to a standard acceotable to the Citv. The oermittee will be notlfied in writino of anv work reouired and will have thirtv {ays (30} from the dqte of the notice to complete'the work. Work not completed at the en? of the thirty days will be performed by the City and the costs will be billed to the permittee, lfurthor agree to.ensure that all required inspections are requested at the proper time, that pro.lect address is readable from the street, and the approved set of plans will remain on the site at all times during construction. /z-Date L? ,0.^- VALIDATION: Signature RECEIVED BY DATE PAIDAMOUNT RECEIVED RECEIPT NO: FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY rcOMPLETED) IN PERMIT DRAWER DEPOSIT RETURNED: DATE fl ernvrr rssuED BY f rrlnrrureNANcE f, erucrrurERrNc REVTEWED BY: f rnnrrrc REVTEWED BY INSPECTION:DATE: DATE: ELEVENTH MONTH DATE: AT TIME OF COMPLETION:DATE: WORK IN PROGRESS DATE DATE DATE DATE DATE I INSPECTION: