HomeMy WebLinkAboutPermit Curb Cut 1996-05-07o Di -t'I iC II Da T I otrEDE
ENCROACHMENT PERMIT
NUMBER:
I
DATE ISSUED:
iffi .1
PERMIT NUMBER:
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
APPLI9ATION DATE:
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
oFFtcE TELEPHONE (s03) 726-3753
LOCATION OF WORK
PROJECT SUPERVISORT pHONE:
ONE
ZIP:
PHONE:
;[-c^ € ADDRESS:
EXPIRATION DATE:
c
c
6
e ? ctrY
Jda
CONTRACTOR REGISTRATION NO:
Jo^ t-
STATE:
q. ^' \-OWNER
ADDRESS:
PHONE:
>6-(<,
+
SUBDIVISION:
APPLICANT OrV
SITE ADDRESS:
CITY STATE:
TAX MAP:
TAX LOT;
CONTRACTOR; 5-.+t.
ZIP: I
REOUESTED PERMITS:INSPECTIONS BEOUIRED: APPLICATION FEE / DEPOSIT ACCOUNT NO:
fl erucnoAcHMENT eERM E $20.00 /
VALIO FOR SIXTY (60} OAYS FROM DATE OF ISSUANCE
I cur srneer O BoRE Q ornen t]E$
Q ousr coNTRoL (ryPE oF coNTRoLl
tr
tr
tr
$
$
$I aseHaur DEPosrr...,...,...
TYPE OF SECURITY DEPOSIT
7 E auruxer suREw BoNo E suR[Ty BoND I cesx / CHECK
d cuarcur PERMTT No: ,... FT. /C {-lNsPFCrroN: CUBE / APPFOACH AFIER FO8MS ARE ERECTEO BUT PRIOR TO POURTNG CONCRETE.
E$
1O.O0 + S.1 s/FT.
VATIO FOR 180 OAYS FROM OATE OF ISSUANCE.
. tr sEcoNo DRtvEwAy (sEE SErARATE
f, sroewaLK PERMIT No:...........
VALIO FOR 180 OAYS FROM DATEOF FiSUANCE.
FT.-E $1O.00 + $.1 S/FT.
Q NCW E REMOVE / REPAIR E PAVE PLANT STRIP
I sereacx Q cunasroe E LENGTH
INSPF'TINN. SIOEWALK / ORIVEWAY FOR ALL CONCSETE PAVING WTHIN THE STREET RIGHT OF WAY, TO 8E
MAOE AFTER ALL EXCAVATING IS COMRETE , ANO FORM WORX ANO SUB.BASE MATERIAL IS IN PLACE.
f saruraRY sEWER coNNEcrroN pERMrr:
VALID FOR SIXTY (60I OAYS FROM OATE OF ISSUANCE
Ti s5.00 /U
Q ro srua O MAIN LINE (EASEMENT-RM) E orHER
I sronrvr sEwER coNNEcloN E $5,00 /
VALIO FOR SIXTY (60} OAYS FROM DATE OF ISSUANCE
$ cercH BAstN / BUBBLER E sruB Q laAruurrue
PRooF OF INSURANCE: $500,000 MtNtMUM
IarracHeo tr REOUIREO AMOUNT . TOTAL DUE: $//,9
TOTAL DUE WITH PERMIT $
DESCRIPTION OF PROJECT:
signing and work zono prot6ctlon to be in complianco with the Manual on Uniform Traffic Control Dsvicos {MUTCDI,
DEPTH:
BORE:
BACKFILL MATERIAL:
WORK SHALL COMPLY WITH X ARTICLE 6 OF THE CITY . CONTRACTOR TO COMPLY WITH MUTCD .
Advanco
TYPE OF DUST CONTROL TO BE UTILIZED
WARNING DEVICES TO BE UTILIZED:
DESCRIPTION:
..WIDTH:
EXISTING SURFACE MATERIAL:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:
HEIGHT:
BACKFILL MATERIAL TO BE UTILIZED:
FROM DATE:
TO DATE:
TYPE OF WORK: CUT:
OTHER:
tr PLANS (TWo sETS) ATTAcHED
AREA: LENGTH:
TIME:
TIME:
REVTSToNS 8l24tS5 FORM ' 116
CITY OF S D PrylTAP ICATION:
I coNsrRucloN, sroRAGE, srAGtNG
I orxen
tr_
SURFACE REPLACEI\iItNT MATERIALS TO BE UTILIZED:
PLAN REVIEW COMMENTS / SPEEIAL INSTRUCTIONS:
RESTORATION WORK SHALL BE lN CC.--<TRMANCE WITH EXtSTtNc CITY COOESSTANDARD SPECIFICATIONS, EXCEPT AS NOTED BELOW.
Alrt*t{ cttupuAlcE wtTH CURRENT
001
002
003
004
005
006
007
008
009
010
011
012
013
014
015
016
017
018
Comments:
Backfill with l(" minus rock.
Compact every 18" loose depth.
Requires compaction with a stgsl rolllor,
A.C, to match the greater of existing depth or 4".
All cuts sealod for final inspectlon.
Temporary patch may be used at tho end of the day.
Signing and Zono protection to comply with MUTCD
Cut concrete only on score lines or cold joints,
Sidewalks and driveways mln. 3,0o0psi.
Curbing min 3,SoOpsi / No patchwork less than 3'.
Meet min. requiremerrts on curb cuts, Spfd. code.
Restore planted aroas, Sp(d. code 206.3.05
Spoc. to Bore / Jack / No A.C. cuts.
Mechanical compacting required,
No patchwork allowed.
Lateral cuts to have control density fill.
Cuts to be polymerized crack sealed for final inspection.
Mininum 2' crushed rock %" minus.
019
020
021
o22
023
o24
o25
026
o27
028
029
030
031
032
033
343
Minumum 4' clearance at any polnt, swing.away.
Concrete minimum 4' depth, 3,0O0psi,
Trench to be 'T'cut. x
Noods State / County parmlt. { .
No above ground enclosings ln sldewalk or handicap ramps,
Diamond cut A.C./Concrete valua boxes to grade,
Fresh Oil signa / Graded.
Comply wlth Americans with 0lsabillties Act.
Concrete rlabs, 72hrs. curing timo, 4500psi,
Concrete olabs require joint eeal m8t6rial,
Driveway requlras dowels every 18".
Submit traffic control plan prior to Bxcavation.
Notify Traffic Divlsion before excavatign.
Core drill main llne, insert t€0, 27o min. grade,
Must comply wlth the provisions of ORS 757.541 to 757.671
6" Circular hole/H2O-Vac.
tr
rH E LANE ulu+if6"Ll6"8HbiflrttrNc cou NcIL,s"oNE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
. INSPECTIONS:
I cuna cur AND SIDEwALK tNspEcloNs cALL 726-g169 (REcoRDER] srATE youR DESTGTNATED ctry JoB
NUMBER/PERMIT NUMBER, JOB ADDRESS, TYPE OF INSPECTION REOUESTED, AND WHEN YOU WILL BE READY FORINSPECTION, CONTRACTOR'S OR OWNER'S NAME AND PHONE NUMBER. REOUESTS RECEIVED BEFORE 7:OO A.M. W|LL BEMADE THE SAME DAY, REOUESTS AFTER 7:OO A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIoNS ARE To BECALLED IN AFTER EXCAVATIONS ARE MADE AND FORM WORK IS IN PLACE BUT PBIOR TO POURING CONCRETE.
E g4ryll4nY sEwER, sroRM sEwER, ENcRoAcHMENT pERMrr AND orHER rNSpEcloNS cALL crry MATNTENANcE AT726-3761.
SIGNATURE:
iljti:ii""? Lil::!,?!3!:Ei'd"1liftti3.:?,!?i'3,{![%fii.#[sfl $*t"*,t,;'*gjBfl[",.t8t31jtfl",83!?3x"?T,,}lt,lli:tii'""jt]1{"& ,n"
3*Y.fl[ifit:FJls11",?s,lfi3!?,fii.1n'"'fsf,nl$nfi[tilX";nzH,?ry$i:t*!s llH,flI;lintiF.gsl]t"tibttnrtii:;T1r,.{]i"project.
qp^fpgye-slefl qt the proper.time, that project address is readable from the street,aI aI tlmes ounng constructton.
(
r J DateSignature
/.-/
receiot bv the Citv ofion wbrk r'eouired (o
red and will 'have thirtvwill be performed by the
a ar
at
any
theof
toa
r the
thisct me
costs
I furthor aqree to ensure that all reouired
and the approved set of plans will r'emain on e
,otac
not com
26s-- 7
RECEIVED BY:
DATE PAID:AMOUNT RECEIVED:
RECEIPT NO:
. VALIDATION:
,FOR SIDEWALK AND CTJRB CTTT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.I
.,
I rnarrrc REVTEWED By:
DEPOSIT RETURNED:
w.6nr IN PRoGRESS
DATE:
DATE:
DATE;
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
l] eenurr tsSUED By:
I erucrrurERtNc REVTEWED By:
[ ,varrureNANCE:
*, ' INSPECTIONI
INSPECTION:
AT TIME OF COMPLETION
ELEVENTH MONTH: