HomeMy WebLinkAboutPermit Sidewalk 1997-06-13a
INSPECT'ON t,NE SEE
'NSPECTIONS
ON BACK SIDE
APPTICATION DATE:
DATE ISSUED:
F'ELD
225 s
7 4 77
OFFICE
7 26-375 3
PERMIT NUMBER:
fiufifl?fl:HMENT PERMr
LO CA TI ON o F KWOR
PHONE
ZIP,2{oa
PHONE:
STATE
EXPIRATION . DATE:
PHONE:
3V
E.
tIIDA
CITY: .9 -6
ADDRESS:
CITY:
CONTRACTOR:
SITE ADDRESS;
ADDRESS:
PHONE:
TAX MAP:
TAX LOT:
CONTRACTOR REGISTRATION NO:
PROJECT SUpERVtSORT
APPLICANT D
SUBDIVISION:
OWNER:
STATE: 6
ACCOUNT NOr
R EOUES TED PER rTsM
INSPECTIONS REOUIRED:APPLICATION FEE / oEPOSTT
\
f, ervcnoAcHM
VALIO FOR SIXTY
Q cur srneer
ENT PERMIT NO:
160I DAYS FROM OATE OF ISSUANCE
E BoBE O orHEB
I ousr coNrRoL (TypE oF coNTRoL]
Q corusrnucfloN, sroRAGE, srAGtNG
Q orxen
Q rserllr DEposlr.,........
TYIE OF SECURTTY pEPOS|T
Q er-aNrer suBETy BoND e suntrv aoruo
E 920.00 /
E$
E $10.00+$.1s/FT.
E $1o.0o+$.1s/FT.o
E $5.00 i
E $s.oo /
TOTAL DUE: $b
TOTAL DUE WITH PERMTT $
TIME:
TIME:
DEPTH HEIGHTT
tr
a
tr
tr
$
$
$
E CASH / cHEcK
wAY, TO 8E
PLACE.
BASTN / BUBBLER ESTUB e uatrulrrue
$500,000 MtNIMUMtrATTAcHED E REoUIRED AMouNT
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTTON:
n PLANs (TWo sETS)ATTAcHED
AREA: LENGTH:TWIDTH:
TYPE OFWORK: CUT:
OTHER:
FROM DATE:
TO DATE:
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 PROJECT:
WARNING DEVICES TO BE UTILIZED:
Advrnco signing and work zons protoctlon to bo in compliance wlth tho Manual on Uniform Tra(ic Control Devices (MUTCO)
DESCRIPTION:
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD .
REVTSIONS 8/24/95 FORM ' 116
ffi
4
t ZIP:
a
LAN REV lEw c INSTRU
[b.,(.HB'Etdt#
CTIONS:
EXISTING
I bMPLIANCE WITH CUBRENT -
OO1 Backfill with 1(" minus rock'
002 Compsct ev8ry 1 8" loose dePth'
003 Requlras comPaction with I stsol rolller'
004 A.C. to match th8 grester ol exlsting dePth or 4"
005 All cuts soalod for tinal lnsPoction'
end o, ths daY'
006 TemPorarY pstch mEy b6 used at thg
with MUTCD
OO7 Slgnlng and Zond protBction to complY
OO8 Cut concrets only on scoro lines or cold ioints.
009 Sidewalks and drivewaYs min' 3 .0OOPsi.
010 Curblng min 3,500Psi / No Patchwork less than 3'
011 Meot min, requirements on curb cuts,Sptd. code'
012 Rostore plantsd 8rsas, SPld'code 206.3.05
013 SPoc, to Bore / Jack / No A'C' cuts'
014 Mechanlcal oompacting required'
015 No Patchwork allowed
016 Loteral cuts to have control dsnsitY till'
0 17 Cuts to be PolYmerized crack sealed lor final insPection'
01 I Minlnum 2" crushEd rock l(" minus
clrY CODES AND
-'
019
020
021
o22
o23
024
o25
026
o27
028
Minumum 4' clearance 8t any point' swing'away'
'ai^.,.it
",'"*um
4" depth' 3'000psi' n
Trsnch to bo "T" cut'
n ".0, Stttt / CountY Permit'
iff;;;;;;';d enclosinss in sidewalk or handicap ramps'
ffi;;;il^.c'/concrete value boxss to srade'
Fresh Oil signs I Graded'
;;il ;ifi Americans with oisabilities Act'
I"tt"r.,. slabe, 72hrs' curing time' 45o0psi'
il,;;; iiutt t.quitt ioint sealmatsrial'
il;;tY requkos dowels evarY 18"'
t"ornni"titl control plan prior to excavation'
r.roiirv frottic Oivision belore excavati'n'
iort ottf, main line, insert toe' 2olo min' s'u9:'- - -
Must compty with the p'o'iJont of oRS 757'54'l to 757'571
6" Ckcular hole/H2O'Vac'
029
030
031
032
0s3
343
Commentsl
T HE LANE U
"ONE CA
YOU ARE REOUIRED TO CALL
TILITIES CO ORD INATIN G COUNCIL'S
LL NUMBER ,,1-800-3 32-2344
48 HOURS BEFORE DIGGING
INSPECTIONS:
7?,6-3769
SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
LL BE
E
n SANITARYu 726-9761.
SIGNATURE:
Bv sionaturs. I state and aoree, that I have caref ully examined the completed application. and do hereby certifY that all inf ormation.
HJr;iX'i;Ti.rio ii,riijjt, Ei.,Aliijrtiie;'6lftitv'Irrat'ariv-iriii'iitworti peitorinEa'shalt be dgne irlaccordalrce with the ordinances of the
biii'ijt'soiinliieio, ippiii'auiiiciiv'Stahoaio'ipijclfiCitions-and Drawinss. and the laws of the state^oj-ofeg-oepgrtaining to the work
described heiein. lftjrther certify that only contractors and employees who are in compliance wlth OltS /Ul.Ubb wlll 0e used on tnls
project.
The Citv mav inspect the work site described in this permit at any time durins a one vear period followins the receipt bv the Citv of
notice cif corholotion of tho described work and specify. at the Citv's sole deScression, anV additional restoration wbrk iequired to' return the siteto a standard acceotablo to the Citv. The permittee'will bo notified in writin'q of anv work reouired and will have thirtv
d^eis (3Q) .from the delq of. the notico to complete'tho work. Work not completed at tho en? of thi, thirty days will be performed by the
City and the costs will be billed to the permittee.
Signature
(/
/Date
b -/g-77
I furthor aoree to
and the ap-proved
reouested at the proper time
,ll times during cohst'ruction.
that all required insoections
plans will r'emain ori tho site
are that address res aad,fromble theproject street,
at a
DATE PAID:AMOUNT BECEIVED:
RECEIVED BY:RECEIPT NO:
VALIDATION:
I rraerrurENANCE:
f, eenrrltrr tssUED By:
FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.
AT TIME OF COMPLETION: nnTtr.
DATE:
.DATE:
" WORK IN PROGRESS
ELEVENTH DATE:
DEPOSIT RETURNED:DATE:
DATE:
DATE:
DATE:
DATE:
INSPECTION:
, truSeeCttOru:
DATE:
I rnnrrrc REVTEWED BY:
f, rxcrrueERrNc REVTEWED BY:
DESIGINATEDSTATE CITY JOBYOURSIDEWALKANDCUTCURB FORBEADYWILLBEYOUWHENJOBA.M.7 :0OBEFORERECEIVEDPHONEOR TOAREINSPECTIONSDAYNEXTTHEBEMADEWILLA.M.7:00AFTEBTHEMADE CONCRETE.POURINGTOINBUTPLACEISANDMADEFORMAREWORKINAFTERCALLED
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FIRECHANGETRANSf,cTIoNsUIII{ARYo6/|3/g?l1r19t22Trc2ooA-!!
HAVE YOU A;i;; ABOUT LIPE INSURANCE?L, 3054-24-?8
DI./AOt. 16/39s
ITEII Cfl6 EFE.
NO CODIi DI.TE
1. 23 06/13
IN$URED: PAUL DAVID HAXBY
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