HomeMy WebLinkAboutPermit Sidewalk 1996-08-05tr
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ENCROACHMENT pERMtT NO: ........r/ALIO FOR StxTy (60) DAys FROM Oo* or,rrro*ii'I cursrReer e BoRE p orxen
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E $20,00 /
E$
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$
$
$
DESCRIPTI ON OF PROJECT:
PERIOD
tr pLA
AREA; L
OF USE OR TIME OF CONSTRU
NS (IWO SETS) ATTACHED
BE
o $5,00 /
E $s.00 /
TOTAL OUE:- S
TOTAL DUE WITH PERMIT $
DEPTH;HEIGHT:
E$
c $10,00+$,.ts/FT
E $r0.Oo+$.15/FT
TIME;
TIME:
FROM DATE:
TO DATE:
@
WIDTH
TYPE OF WORK: CUT
OTHEB:
EXISTING SUBFACE MATEBIAL
BAC KFILL MATERIAL TO BE UTILIZED
SUBFACE BEPLACEMTNT MATERIALS TO BE UTILIZED;TYPE OF DUST CONTROL TO BE UT ILIZED
NAME OF OTH
WARNING DEV
.DESCHIPTION:
ENGTH
SHALL COM
CTION:
PBOJECT
signing and work zone
X ARTICLE 5
BORE;
BACKFILL MATERIAL:
protoction to be in complianco
EB UTILITIES IF THIS IS A JOINT
ICES TO BE UTILIZED
PLY WITH
Advance
CHAPTER
with the Man;al on Uni totm fralfic Control Osvi ces (MUTCD).
s ai 1la
Da Da T 0.ffi
DATE ISSUED:
PERMIT NUMBER:INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
APPLtgATtON DATE:
225 FETH STBEE-
EN.CIO_ACHMENT PERMTTNUMBER:
SPRINGFIELD, OREGON 97 477
ENGINEERING DIVISION
oFFtcE TELEPHONE (503) 726-3753
'LOCATION OF WORK
-'Go
PHONE
STATE:
STATE:
SS
PHONE:
PHONE;
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L
NO
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1=/ZP: 9 ?./
t/ZIP: ??v
2-9 Q
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6
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Cd g€-680t
ON
EXPIRATION DATE:
ADDBESS
CONTRACTOR
CITY
APPLICANT
SITE ADDRESS
CITY TAX MAP
TAX LOT:
CONTRACTOR REGISTRATI
PROJECT SUPERVISOR;
SUBDIV
OWNER
INSPECTIONS REOUIRED
ACCOUNT NO:
RE QUES DTE MPER SIT
APPLICATION FEE /DEPOSIT
WORK
BEVISIONS 8t24t95 FORM , 116
OF THE C ITY CODE.TO COM PLY WITH M UTCD
I
PHONE:
PLAN REVIEW COM MEN TS / SPECI/' INSTRUCTIONS:
8Fi'-t'hl'##P'tr^?it^!5,'.'/8r8?[tom""'[AIU'
Backfill with %" minus rock,
Compact everY 1 8" loose depth'
Bequires compaction with 8 steBl rolller'
A.C. to motch the greater of existing depth or 4"'
All cuts sealed lor final inspection'
Temporary patch may be used 8t the end of the day'
Signing ana Zone protection to comply with MUTCD
Cut concrete only on score lines or cold ioints'
Sidewalks and drivsways min' 3,OOOpsi'
Curbing min 3,500psi / No patchwork less than 3"
Mest min. requirements on curb cuts' Spld' code'
Restore planted areas, Spfd' code 206'3'05
Spec. to Eore / Jack / No A'C' cuts'
Mechanlcal comPacting required'
No patchwork allowed.
Lateral cuts to havo control density fill'
Cuts to be polymerized crack sealed for final inspection
Mininum 2" crushed rock %" minus'
"ONE CALL
DES AND ltL-€flIPLlANCE WITH CURRENT
Minumum 4' clearance at any point, swing-away'
Concrete minimum 4" depth, 3,000psi'
Trench to be "T" cut.
Needs Stats / CountY Permit.
No abovs ground enclosings in sidewalk orrhandicap ramps'
Diamond cut A.C./Concrete value boxgs to grade'
Fresh Oil signs / Graded.
Comply with Americans with Disabilities Act'
Concrsts slabs, 72hrs. curing time, 4500psi'
Concrete slabs require ioint seal material'
Driveway requires dowels every 18"'
Submit traffic conlrol plan prior to excavation
Notily Traf f ic Oivision bef ore excavatr?tr'
Core drill main line, insert tee, 2% min' grade'
Must comply with the provisions of ORS 757'541 to 757'571
6" Circular hole/H2O'Vac.
EXISTING CITY CO
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003
004
005
006
007
008
009
010
01 1
012
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o23
o24
025
026
o27
028
029
030
UJI
032
033
343
Comments:
YOU ARE REOU IRED TO CALL
THE LANE UT ILITIES COO RDINAT ING COUNCIL'S
NUMBER 1-800 -332-2344,,
48 HOURS BEFORE DIGGING
INSPECTIONS:
26-3769
SEWER,SToRMSEWER,ENCRoACHMENTPERMITANDoTHERINSPECTIoNSCALLCITYMAINTENANCEAT
726-3761,tr
AY
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SANITARY
SIGNATURE
Date
Signature
b?
22 7 gvAMOUNT RECEIVED
RECEIPT NO:
RECEIVED BY
DATE PAIDoo
VALIDATION
f rnnrrtc REVIEwED BY:
FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY rcOMPLETED"T "",JOlT
D EPOSIT RETURNED
WER
f enctueERlNc REVIEwED BY
f untrureNANcE
f eenutr lssUED BY:
ELEVENTH MONTH
WORK IN PROGBESS
DATE
DATE
DATE:
DATE:
INSPECTION:
INSPECTION:
DATE:
DATE:
DATE:
DATE:
DATE:
BE
Yearthis
not
on
the
ate
t0
, that proiect address is readable from the street'
I lurthor
and the
to
I have
AT TIME OF COMPLETION: