HomeMy WebLinkAboutPermit Sidewalk 1998-05-15I.a
]NSPECTION LINE SEE INSPECTTONS ON BACK SIDE '
APPLI9ATTON DATE:DATE ISSUED:
aPittto?trLD
PERMIT N
226 FIFTH STREET
ENCROACHMENT PERMTT
NUMBER:
SPR]NGFIELD, OREGON 97477
ENGINEERING DIVISION
oFFtcE TELEPHONE (5031 726.3753
.LOCATION OF WORK
ADDRESS:
EXPIRATION.OATE:
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PHONE:
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PHONE:
PHONE:
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APPLICANT
SITE ADDRESS:
CITY:STATE:
SUBDIVISION:
CONTRACTOR:
OWNER:
TAX MAP:
TAX LOT:
CONTRACTOB BEGISTRATION NO:
PROJECT SUPERVISOR:
ADDRESS:
1(lP!CT|ON! REOU|REDT APnIcATlOil FE! roEaosn ACCOI,I{f NO:
REOUESTED PERMITS
I erucnoAcHMENT pERMtr No:E i20.00 t _vALp FOn Stxw lrot o^yt rRoM o^rr oF !8UAr,Et
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Q ousr coNTRoL (TypE oF coNTaoU
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TYPE OF SECURIW DEPOSIT
Q aunrr sunEry BoNo e suntrw aono E casx , cHEcK tI cuna cuT pEBMlr NO3.................... FT 10.00+ C.'t 6/FT.trllllgllQ& CUn! , Appno^cH AFITR FOsMt Ai! lnECTlO arr tilon TovAtD FOA tlo OAYI iRolt oArl oF ESUAI|CE.o SECONO ORIVHA'AY ISEE SEPARATE
Q sneweLK pERMlr Nor....................
VALD f,Oi tlO OAy! FROM DA?r Ot ttUANC!.O.0O+ C.1E/FT.lo "r>
El.tew 0 REMovE, BEpAtB CI pAvE pt.lNT srntp
Qierarcx ecunasroe 0LENorH
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l{fqFlloll+rolw^Lr, DRtvEw y Fo8 ALL ColitcisTt,AvtNcMAoE AFrEi Au ExcAvAnNo r courtsrr.-en6'rdiiil6i-i !!!IH!N Tltt STREET itOHT OF w y. To BEANo tultASE MlTsalet r n rtle:.tr SANITARY SEWER CONNECTION pERMtT: ................VALD Fioe I|XTY taot OAv8 FROM OAT! Ot EgUAtilC!D o
Q ro srua E MA|N uNE TEASEMENT.R/W O OTHERI sronru SEWER coNNEcIoN pERMtr: ..............v^tD FOA AXW tool o^ya ?ioil D tt o, !8UAr€a
Q cercx B stN , BuBBTER E srua e uanuHr
PROOF OF INSTTRANCF. C600,000 MINIMUM
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Q rrrecxeo O REoUIRED AMouNT_TOTAL DUE;' i c)
TOTAL DUE Wrffi PERIUIT I
DESCRIPTION OF PROJECT:
LD RMITAPPLICATION
PERIOD OF USE OR TIME OF CONSTRUCTION:. Q pr.nrus fiwo sETsIATTAcHED
FROM DATE:
TO DATE:
TIMEI
TIME:AREA: LENGTH:WIDTH:
TYPE OF WORK: CUT: EAEE,
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SUBFACE REPLACEI4tNT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE
NAME OF OTHEB UTILITIES IF THIS IS A JOINT
WARNING DEVICES TO BE UTILIZED:
DESCRIPTION:
Adv.nc. rlgnlq rad worl rono prorcdon ro bo ln oomdl.nc. wlth
WORK SHAIT COMPLY WITH X ARNCLE 6 OF THE
DEPTH:HEIGHT:
tho Mrrurl on Unlform Trigo Drvlcrl
iEvrs|oNs uz1lgc FORM ' III
cnY coDE,CONTRACTOR TO COMPLY WITH MUTCD.
CITY: STATE:
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BEVIEW COMMENTS / SPECI ^I. TNSTRUGTIONS:
gFilgtr^B'J[#P'fd^ifS}I,'5,U#?[EWB'E[dW.OOSTING CITY CODES AND ITdICMPUANCE WITH CURRENT
001 Erclllll wlth I'mlnul locl.
OO2 Comprct lvrry 18'loor drPth.
OC)II Roqulrcr comprstlon wlth. tr.l tolll.r.
OO4 A.C. to mttah tho gr..rr ol rxlrthg drpth or 4'.
000 AI outt rrrlcd lor tlnd lnrPoatlon.
0O0 . Trmponry prtch mry br ulcd .t th. .nd ol th. daY.
OO7 Slgnlng rnd Zond proralon lo complY wlth MUTCD
OOB Cut ooncrctt only on rcorc llncl ot aold lolntr.
OOg Eldrwdtr.nd dtlv.w.Y! mln 3,000PrL
OtO Ortlng mln 3,loOprl t No prtchwott hr thrn 3'.
011 Mt.t mh. rcqulnmcnt. on c{r! orit, sPld. cod!.
012 Rttton pltnttd.rrmr, Spld. codr 20C.3.08
Ol3 8p.4. lo Borr I Jlat I No A.C. cur.
01,t Mrchrnlcelcomprctlngnqulrrd.
01i No Pttchwott l[ow.d.
Oto lltlt l outt to hrvr control drndty llll.
Ot7 Cutt to bt polYmcdzrd crlct ulcd lor llncl lnrpcctlon.
Ot8 Mlnlnum 2'cuhod rock I'mlnur.
019
020
021
o22
o23
024
026
020
o27
028
020
030
031
032
933
343
Mlnurnum 4' cbrrrncr tt .ny polnt, lwing'rwry.
Concntr mlnlmunr 4' dopth. 3,0o0pol.
Tranch to ba T' out. l
N.rd. St.t. / iountY prrmlt.
No rbovr ground rnclorlngr ln rldcwrlk or hlndlc.p rlmpt.
Dlcmond clt A,C./Conmt. vrlu. boxrt to glldr,
Fruh Oll rlent / Grudrd.
Comply wlth Atn.rlctn. wlth Oltlbllltltt Act.
Concrcr drbt. 72hn cudng tknO. 460opsi.
Concrrtr rlabr rtqulrc lolnt rcal m.tcrl.l.
Ddvrwry nquku dowrlt rvcry 18'.
Submlt trolllo control plln prlot to rxcrvttlon.
Notlly Trrlllo Dlvldon bcforc cxcavatign,
Corc drlll mtln llnr, ln!.rt tcr, 296 mln. gradc.
Murt comply wlth tm provlrlonr ol ORS 757.541 to 757.671.
6' Chculrr holr/H2O.Vrc.
Comments:t
t.
rHE LANE ulL#if6-Ub"8HbiftAhN-c- QQU N grl's
"oNE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
I
INSPECTIONS:
tr fiU['igffiA[P'"lu',ff#H]t"'iBB8l5"+]!Jt? ''^?33.8'18i1'f3-,i-iJt'q',ii['iiE[iif-,lWl.ilEt8ipy ren --iNEPiCTibI.i, CiJI.iiRA.TOFrS bN-OWUER,S NAME AND PHONE NUMBER. REOUESTS RECEIVED BEFORE 7:OO A.M. WILL BE
ii/iAbE iHE SAME-OAV, NECiUlSrS_IrrEN Z:OO A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE
cAur-Eo rr.r arren eichVaiious Anr uaoe AND FoRM woBK ts tN PLAcE BUT PRIoR To PouRlNG coNcRETE.
fl SEruTRRY SEWER, STORM SEWER, ENCROACHMENT PEBMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
- rza-9761,
SIGNATURE:
I furthor rsrrc to onsurc that all rsqulrcd lngpectlons are tequ&ted a.t the proper.time, that project oddress ls roadable from the streot,
and the ap;proved 8et of plaru wlll remaln on tha EIto at all times duflng constructlon.
/c: ti (71+w,*-
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AMOUNT RECEIVED:
RECEIVED BY:f2'z'? fbZ
VALIDATION:
Slgnature
i
DATE PAID:
RECEIPT NO:
E rnarrtc REVIEwED BY: DATE:
I nalrrureNANcE:
-
E pEnur tssuED BYi
FON SDEWALK AND CURB CW PERMITS PIACE A COPY (COMPLETEDI IN PERMIT DRAWER,
lNSPEcrloN: DATE:
DATE:
DATEI
lNSPECTION:
DATE:
OEPOSIT BETURNED:DATE:
DATE:
DATE:
DATE:
E enarrueEBtNc REVTEWED BY:
irnr,,te oF coMPLEttoN:DATE:
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