HomeMy WebLinkAboutPermit Plumbing 1998-06-22v a
PERIOD OF USE OB TIME OF CONSTRUCTION:
' Q nmNs ffwo sETS] ATTAcHED
AREA: LENGTH:W]DTH:
TYPE OF WORK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEIUTNT MATER]ALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UTILIZED
NAME OF OTHER UTILITIES IF THIS IS A JOINT PR
WARNING OEVICES TO BE UTILIZED:
DESCRIPTION:
WORK SHALT COMPLY WITH CHAPTE8 X
Adv.nc. rlgrnlng rnd work ton! prot.clton to bo llr complltnc. wlth Or Minurl on Unltorm T[glc Comrol Drvlco MUTCOI
FROM DATE:
TO DATE:
DEPTH:
BORE:
BACKFILL MATERIAL:
ARNCLE 6 OF THE CrrY
TIMEI
TIME:
HEIGHT:
DATE ISSUED:
aPillaoarl.D
S2
APPLI9ATION DATE: b' L-z *
226 FIFTH STREET
INSPECNON LINE SEE INSPECNONS ON BACK SIDE '
ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER: 'i ? u t
SPRINGFIELD, OREGON 97477
ENGINEERING DTVISION
oFFICE TELEPHONE (503t 726.3753
.LOCATION OF WORK
NE
OS PHONE:
STATE:
EXPIRAT]ON.DATE:
PHONE:
ZIP,.
ADDRESS:
APPLICANT
SITE ADDRESS:
STATE:
SUBDIVISION:
OWNER:
ADDRESS:
CONTRACTOR:
CONTRACTOB REGISTRATION NO:
PROJECT SUPERVISOR:
TAX MAP:
TAX LOT:
PHONE:
ZIPI
CITY:
I6PCCTK)N8 nEOUtAtOt Aruc^?bt{ FEtroEFoSlT AGCOII}{T NO:
REOUESTED PERM ITS:
I erucnoAcHMENT pERMtr No:tr 020.00vALp FOn SuTY tlot DAYE rROM OAr!OF ESUAIICCfl cur STREET tr BOBE EOTHER EoQ ousr coNTRoL (wpE oF coNTRou
Q coHsrnucroN, sroRAoE srAorNc ortrr
Er
Er
Q lsrxlur oEpostr.............. .. .. ..4...... ......... ... ..
TYPF OF SFCURITY DEPOSTT
Q auxxer sunEry EoND O suRttw BoND E cAsH , cHEcK
I cuna cur pERMlr No:.......E 110.00+t.rltlPFeto^r. cuR!, A?pROACll AFIEA FORMS
VAID FIOR ltooSECOND ORVN^'AY I8EE SEPARATEtrSIDEWALK PERM]T NO:FT.
-
E 010.00.+ C.tE/FT.VALD ioR tlo o^vt FeoM oATt Ot BTUANCE
B NEw O REMovE / BEpAtR El pAvE prANT srntp
Q'seucx ecunasroe ELENoTHHfqlrFuioew^Lx
'oRVEwAy
FoA AUCONCTST! levlNoMADE AFrEn AlL cxcAvlnNo n courtcri.-ii-i6tii friinfl wlTHIN THE STREET NOHT OF wAY. TO 8E
?tACE.u ANO SUEBASE MATERIAL t8 tN
SANITARY SEWER CONNECTION PERMTT:E rgor 2c:9-VALD FOR EtxTY tcot oAYS F80M OAT! O'rs3UAt{Cttrro sruB O MA|N LINE IEASEMENT-RM o orHER
Q sronru sEWER coNNEcnoN pERMtr:E 05.oo /VALE 70i
Oce
arxTy ttot oAyS tiorao tlot [tu ,lct
,TcH BAsrN , lu8arn O srUB El MAINUNE
PROOF OF INSTIRANCF.$500,000 MtNtMuMtrATTAcHED O REoUIRED TOTAL DUi;*i Zooo,
TOTAL DUE WTH PERMIT t
DESCRIPTTON OF PROJECT:
IT APPLICATION
aEvEtoNS a2qg6 FOnM ' tt!COIITRACTOR TO COMPLY WTH MUTCD.
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El_n
RB/IEW COMMENTS
EiilgXfrB"$ltrP'ido!fdit!,'518#?X'T8H['E[Jff ,
B(ISTINO CffY CODES ETOWCtNAPUANCE WITH CURRENT
0ol Brckflll wlth l'mlnur rccl.Ol9 Mlnumum 4' cblrrncr tt rny polnt. rwing'rwry'
002 Comprcl rvtry 18'loot. dtpth.O2O Concrrr mlnlmun 4' drpth. 3.00Opal.
OO3 Rcquhrt oomprotlon wlth . tt.ol rolll.r.02t Trrnch to b. T'out.
OO4 A.C. to mrtoh tht gr.rttt ol .xldlng dcPth ot 4'.O22 N..d. St.t. / Counti Prrmlt,
006 A[ autt tcrlod lor llnd lnrpcotlon.O23 No rbovr ground lnclorlngt ln !ld!w!lk or hrndlccp rrmpr'
008 . TrmponrY p.tch mry bl ulcd rt tht !d ol thc dry.024 Dbmond clt A.C.ttoncrltc v.lu! boxu to grldo'
OO7 Slgnlng rnd Zon'prot.ctlon to compv wlth MUTCD
OO8 Cut ooncr.tc only on tcor. llncr ot aold lolnr.
OOe SErwrlkr md dtlv.wlY. mln S.OOOprL
OIO Cutlng mln 3,60oprl , No p.tchwott hrr thln 3'.
011 Mcrt mh. rcqulr.mlntt on G1rb outa, 8Ptd. aod!.
012 Rtstor. pltnt.d.rr[r. Spld. codr 206.3.06
ol3 Spcc. to Borr / Jrct I No A.C. cu$.
014 Mrchrnlcel aomp.cthe rrgulrcd.
01C No Pttchwott l$owrd.
OtO lrt.trl outt to hlv. oonttol dmttty ,lll.
Ot 7 Cutt to bl polymcrlt.d cnck t.alcd lor llnal lnrpcctlon'
018 Mlnlnum 2'cruohcd rock l'mlnut.
026 Frrrh Oll rlgnr I Orudcd.
026 Comply wlth Am.rlclnr wlth Dl.lblllti.t Acl.
O27 Conffrr rhbr, 72ho. cudng tlrnc, 4600psi'
028 Concr.t. tlcbr rrqulrc lolnt rcal mlt.rl!1,
O29 Drlvrwry nqukrr dowolr lvcry 18'.
O3O Submlt tnlllo conttol pl.o Prlot to rxctvltlon.
031 Notlly Trrlllo Dlvlrlon bcforc cxcovatijn.
032 Co.. dtlll mrln llnr. lnt.rt t.., 216 mln. gradc.
033 Murt comply wlth th. provldonr of ORS 757.641 to 757'671'
6' Clrcul.r holr/tl2O.Vrc.343
Commonts: -
t
THE LANE UTI
"ONE CA
YOU ARE REOUIRED TO CALL
iLMES COONPINATING COUNCIL'S
[u ruuvtBER" 1 -800-332-2344
48 HOURS BEFORE DIGGING
INSPECTIONS:'a
ftU['igH,IAIf,,'1,',:il,#H]tfiBTRlL'.li]!"3? ''^13P.&13iTf-"-,iJ+'p'.[tfliEE[ffiifi..iE{EEpy fen --iNSiEcNbI.i, co['ii-RA.ioh;5bh-oryryEn,s IIAIUE enD PHbNE NUMBER. REOUESTS RECEIVED BEFORE 7:OO A.M. WILL BE
ii4-AbE tXE dEME.OAiIiECiUlSr-S AFTEN i:OO A.M. WII.U BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE
cA[r-Eo rr.r AFTER EiahvATlor.ts Ane Meoe AND FoRM woBK rs tN pLAcE BUT PBtoR To PouRlNG CoNCRETE.
Z} SAruTARY SEWER, STORM SEWER, ENCROACHMENT PERMTT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
- 72a-g7al.
SIGNATURE:
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rre raou&ted at the orooer time,
at all times durlng cohstruction.
lnsoectlons
r ori the aite
that all reoulrcd Iplinr wlllrbr,naln
readablels thefromthataddress street,projectto0n8uro
set of
AMOUNT RECEIVED:
RECEIVED BY:
i
DATE PAID:
RECEIPT NO:
VA
I uerrurENANcE:
fl pEnur tssuED BYi
FOR SIDEWALK AND CURB CW PEBMITS PI-ACE A COPY (COMPLETED) IN PERMIT DRAWER.
DATE:INSPECTION: ,
ivnrvre oF coMPLErloN:
DATE:ELEVENTH MONTHT -
'INSPECTION:
tr BEVIEWED BY:
I erucrrueEilNc
OEPOSIT BETUBNED:DATE:
DATE:
DATE:
DATE:
DATE:
. WORK IN PROGRESS DATE:
DATE:
DATE:
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