HomeMy WebLinkAboutPermit Curb Cut 1998-10-14a
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:I rurus fiwo sETs] ATTAcHED
FROM DATE:
TO
TIME:
TIME:AREA: LENGTH:WIDTH:DEPTHI
TYPE OF WORK: CUT: RnErEr
OTHER:
EXISTING SURFACE MATERIAL:BACKFILL MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SUBFACE REPLACEIUTNT MATERIALS
TYPE OF DUST CONTROL TO BE UTII|ZED:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJ
WARNING OEVICES TO BE UTILTZED:
HEIGHTT
TO BE UTILIZED:
D
DATE ISSUED:
aPitxo?ltLD
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226 FIFTH STREET
PERMIT NUMBER:INSPECTION LINE SEE INSPECTIONS ON BACK SIDE '
APPLIPATION DATE:
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FNQROACHMENT PERMITNUMBER:
SPRINGFIELD. OREGON 97477
ENGINEERING DIVISION
oFFtcE TELEPHONE (503) 72S-3763
.LOCATION OF WORK
STATE:
EXPIRATION,DATE:
CI E
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PHONE:
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CONTRACTOR:ADDRESS:
APPLICANT
SITE ADDRESS:
CITY:
ADDRESS:
TAX MAP:
TAX LOT:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERVISOR:
SUBDIVISION:
OWNER:
STATE: 6/-
PHONE:-
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r{'PCSTION! iEOUIREDI AraJcATlOlt FE! , oEPOS|T ACCOIJIT ilOr
REOUESTED PERMITS:
I erucnoAcHMENT pERMlr No! ............E +'eo.oovALtO FOB SIXW (00, oAY8
'ROM
DAII OF t88UAt{CEocursrREEr OBOnE EOTHER tro
Q ousr coNTRoL (wpE oF coNTRou
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trc
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fl asexrlr DEposlr.......,..
TYPE OF SECTIRTTY DFPOSIT
sunEry BoND e sunttw gor,to E cAsH / cHEcK
E 010.00+t.l6/FT.
I soeweLK pERMlr No3...............o....
VALD FOe rto DAYS FaOM OAT!Of BSUANCT.
FT.- . E- Elto.oo*0.18/FT.
E New Q neuove / REpAtR e reve rLANT srRtp
Q'serercx E cURBstDE E) LENoTH
lNqDF.rr^N. GloEwALx / DRIVEWAY FOB AU
M^OE AF'ER ALI EXCAVATINO 18 COUrurrg
coNcegTt t^vlNo wrTHtN THE STREET BIOHT OF WAY. TO BE?t cE.tr ,
^NO
FORM WORI( ANO 8U&8ASE MATERNT E N
SANITARY SEWER CONNECTION PERMIT:E S6.00 /VALD FOR slxTy tcot oAyS FAoM DATE Ot |SSUANC!
Q ro srua EI MA|N UNE (EASEMENT.R/WI
I sronru sEwER coNNEcloN pERMtr:
El orHEn
VALD rOR stxTy t60t o^ya FRoM OAII Or ESU ltct
E cercx BAstN , BuBBLEn 0 srua e uatHune
PRoOF oF INSURANCE: SEOO,OOO MINIMUM
D E r5.oo /
Q erncHeo E REOUTRED AMOUNT TOTALDUE: I
TOTAL DUE WTH PERMIT C
DESCRIPTIONI
WORK SHALL COMPLY WITH
Adv.nc. alenlne rnd work toa. p,otccdon to b. ln cornpll.no.wlth thr Mrmrtl on Unlform Tnglo Conuol D.vlcr |MUTCOI.
X ABNCLE T OF
REvrstoNs u21lg6 F08rL ilo
THE CITY COD&CONTRACTOR TO COMPLY WIT}I MUTCD.
APPHCATION
E-tr-__
E-
tr
VALD FOR IlO BEUANCE.tr sEcoNo bnrvewly (sEE sEpARATE
REI/IEW COMMENTS /SPECIAL INSTRUCTIONS:
gFfl [,gXfrB'Jf #BldoIfdltl,'eryiFf l-]8HB'EUdW.POSTINO CTTY CODES AN}TT C.ICTUPUMICE WITH CURRENT
0Ol &ctflllWlth I'mlnw rocl.
002 Comptct cvcrY 18'loo't drPth.
OO0 ilqulnr oomraotlon wlth a .t..1 ?olll.t.
oo4 A.c. to mttch thr gnltcr ol rxlrtlng dcpth or 4'.
001 Allouu rmlrC lot flnrllnrprotlon.
00! . TmponrY pltch mry br urcd rt thr rnd ol thc dly.
OO7 Slgnlng rnd Zonr'prorctlon to comply wlth MUTCD
OOB Cut ooncrctr only. on lcorc llnct o( cold loln$.
008 Sldtwrlkr tnd drlvrwryr mln 3,000pr1
OtO Gr'blng mln 3,!0opd t No prtchwort hrr thrn 3'.
011 Mcct mh. rcqulrrmrnu on cu]t outr, SPld. codt.
012 Rrtor. pltnttd.arcu, Spld. codr 200.3.06
013 Spcc. to Borc I Jrck I No A.C. anr'
Ot4 Mtohrnloal oomplctlng rrquhd.
OtC No prtohwort rllowld.
Oto L.trnl out! to hrv. oonttol drnrlty flll.
017 Cutt to b! potvmcrlrrd cract lcrlcd lor llnal lnspcctlon.
OtB Mlnlnum 2'orulhrd rocl l'mlnur.
0r0
020
o2t
o22
023
024
026
020
027
028
029
030
031
032
933
T
Mlnumurn 4' clalrtncl tt .ny polnt. rwing'awry.
Concr.ta mlnlmum 4' dtpth. 3,000pr1.
?tanoh to ba Gf' out. I
N.rdt sttt. Ieountf Pcrmlt.
No rbovr ground .nclo3lngl ln lldrwllh ot hrndlclp nmpr'
Dbmond cgt A.C.lConcrltt vlluc boxrt to gtrdc.
Frcrh Oll rlgnt IOrudcd.
Comply wlth Amrrlccnr wlth Dlttbllltlct Aot.
Concrrr rlrbl, 72hn. curlne tlmc, 4600pgi.
Concr.t. drbr nqulrc lolnt ltll m!t!rhl.
Dilvrwry rqukrr dowrlr lvcry 18'.
Submll trutfla control plln prlor to cxcrvltlon.
Notlly Trrlllo Dlvlrlon bclorc cxcavctlgn.
Corc drlll mrln tlnc, lnr.rt tcc, 2% mln. gradc.
Murt comply wlth th. provhlonr of ORS 767.641 to 757.671.
C' Clrculrr holr/tl2O-Vrc.
Comments:I
t.
YOU ARE REOUIRED TO CALL
THE LANE UTILIflES COORDINATING CQUNqIL',S
"oNE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
INSPECTIONS:.[.I
CUNA CUT AND SIDEWALK INSPECTIONS CALL 729.3765 IRECORDER} STATE YOUR DESIGINATED CITY JOB- ttuMaEnnenMF HuMaen, JoB ADDRESS, wPE oF lNSPEcrloN REoUESTED, AND WHEN You wlLL BE READY FoR
iIIsCeCTioH, corurnAcron,s on oWNER,s NAME AND PHONE NUMBER. REOUESTS RECEIVED BEFORE 7:OO A.M. WILL BE, TvIAoEJHE SAME DAY, REoUESTS AFTER 7:OO A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE
CALUo tN AFTER ExcAvATtoNs ARE MADE AND FoRM woBK rs rN pLAcE BUT PRIoR To PouRlNG coNcRETE.
I serureny sEwER, sToRM sEwER, ENCROACHMENT PERMTT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
7288741.
SIGNATURE:
t furthor ror6c to 6n8urc that rtt reoutrcd lngpectlons are requdsted at the proper time
and the ap-proved sot of plam wlll r'epaln ori tho !it6 at all times during cohstiuction.
I
1a-3 c
Slgnature
8ny
thonot
o
I have
Date ,za
, that project address ls readable from the street,
RECEIVED BY:
AMOUNT RECEIVED:
RECEIPT NO:
I
DATE PAID:
VALIDATION:
I eennar rssuED BYi
FOR SIDEWALK AND CURB CW PEBMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.
INSPECTION: DATE:
IINSPECTTON! DATE:
WORK IN PROGRESS DATE:
AT TIME OF COMPLETION:- DATE:
E rnnrnc REVTEwED BY:
ELEI/ENTTI DATE:
DEPOSIT BETURNED:
DATE:
DATE:
DATE:
DATE:
I uarrureNANCE:
I enotrueEnrNc REVTEWED BY:
and
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