HomeMy WebLinkAboutPermit Sidewalk 1996-10-04,1 T tr oD1li
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stP'IINGFIELD
DATE ISSUED:
PERMIT NUMBER:
TNSPECTION LINE SEE INSPECTIONS ON BACK SIDE
APPLICATION DATE:
225 FIFTH STREET
SPBINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726.3753
ENCROACHMENT PERMIT
NUMBER:
PHONE
/6
PHONE:
CITY
ZWf b*SilqaADDRESS:
STATE:
PHoNE: ?€?'/SSr'
PHONE:
#
ZIP:
76
€
EXPIRATION DAIE: /O- ZZ
LOCATION OF WORK
CONTRACTOR
STATE
PROJECT SUPERVISOR
SUBDIVISION
CITY
ADDRESS
OWNEB
SITE ADDRESS
APPLICANT
TAX MAP
TAX LOT:
CONTRACToR REGISIRATIoN No: /OZ
REOUESTED PERMITS INSPECTIONS REOUIRED: APPLICATION FEE / DEPOSIT ACCOUNT NO:
fl erucnoacHrvtENT PERMIT No E $20.00 /
VALIO FOR SIXTY (60) OAYS FROM DATE OF ISSUANCE
I cur srnrer E BoRE E orHEn E$
I ousr coNTRoL (TYPE oF coNTRoL)
I corusrnucloN, sroRAGE, srAGtNG tr
tr
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$
$
$
I ornrn
I aseHar-r DEPosrr........,,........
TYPE OF SECURITY DEPOSIT
I elaruxer sunEry BoND E suRlrY BoND Q cnsH / cHEcK E$
I cune cur PERMTT No FT,-E $ 10,00 + $.1 s/FT
IISPECIIOtrL CURE / APPROACH AFTER FORMS ARE ERECTED 8UT PRIOR TO POURING CONCBfiE.
VALIO FOR 180 DAYS FROM DATE OF ISSUANCE.
zfi secor.ro DRTvEWAy (sEE sEeARATE AppLrcATroN)
ffsroeweLK pERMrr No : .....,.............. FT.
VALIO FOR 'I80 DAYS FROM DATE OF ISSUANCE,
H E S 1 O.OO + $.1 5i FT./4,7€
[ ruew D REMovE / REPATR E PAVE PLANT srRtp
I seraacr l] cURBSTDE O LENGTH
NSPECIIOj1:SIDEWALK / oRIVEWAY FOR ALL CONCRETE PAVING WITHIN THE STREET RIGHT OF WAY, TO BE
MADE AfiER ALL EXCAVATING IS COMPIETE, AND FORM WORK AND SUB.BASE MATERIAL IS IN PLACE.
I sarvrraRy sEWER coNNEcroN pERMtr:
VALID FOR SIXIY (60) OAYS FROM DATE OF ISSUANCE
I ro srue E MA|N L|NE (EASEMENT-R/W) D orHER
f sronu sEWER coNNEcroN PEBMTT:
VALID FOR SIXTY (60) OAYS FROM DATE OF ISSUANCE
I carcx BASTN / BUBBLER E sruB E MAINLINE
PRoOF oF INSURANCE: $500,000 MINIMUM
E $5.00 /
E $5.00 /
l-l arracrEo n REOUIRED AMOUNT TOTAL DUE: $/3,7{
TOTAL DUE WITH PERMIT $
DESCRIPT]ON OF PROJECT:
Advance signing and work zone protection to b6 in complianco with the Manual on Uniform Traffic Control Devices (MUTCD)
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH M
BACKFILL MATERIAL
DEPTH
UTCD .
DESCBIPTION
HEIGHT:
TO DATE:
BACKFILL MATERIAL TO BE UTILIZED
EXISTING SURFACE MATERIAL:
BORE:
WIDTH
PERIOD OF USE OR TIME OF CONSTRUCTION FROM DATE TIME:
TIME:tr PLANS (TWo SETS) ATTACHED
AREA: LENGTH:
SURFACE REPLACEN/TtNT MATERIALS TO BE UTILIZED
TYPE OF DUST CONTROL TO BE UTILIZED:
NAME OF OTHEB UTILITIES IF THIS IS A JOINT PROJECT
WABNING DEVICES TO BE UTILIZED:
TYPE OF WORK: CUT:
OTHER:
BEV|S|ONS 8124t95 FORM f 1 16
ITY OF S NG D pilrvur AP CATION
D,(-
ZIP:
PLAN REV!EW co MMENTS S PFA(AL N STRU cTt ONSI
BEqTQRATTON WORK SHALLSTANDARD SPECIFICATIONS,
BE lN col\roRMANcE-wlrH ExtsrtNc crry coDEs AND tN coupularucE wtrH cuRRENTEXcEPT AS NorED erloW.
001
002
o03
004
o05
o06
007
oo8
009
010
01 1
012
013
014
015
016
o't7
018
Backfill with %" minus rock.
Compact every 1 8" loose depth.
Requires compaction with a steel rolller.
A.C. to match the greater of existing depth or 4,,.
All cuts sealed for final inspection.
Temporary patch may be used at the end of the day.
Signing and Zone protection to comply with MUTCD
Cut concrete only on score lines or cold joints.
Sidewalks and driveways min. 3,OOOpsi.
Curbing min 3,SOOpsi / No patchwork less than 3,.
Meet min. requirements on curb cuts, Spfd. code.
Restore planted areas, Spfd. code 206.3.O5
Spec. 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
o20
o21
022
o23
024
o25
o26
o27
o28
029
o30
031
032
033
343
Minumum 4' clearance at any point, swing-away.
Concrete minimum 4" depth, 3,OOOpsi.
Trench to be "7" cut. i
Needs State / County permit.
No above ground enclosings in sidewalk or handicap ramps.
Diamond cut A.C./Concrete value boxes to grade.
Fresh Oil signs / Graded.
Comply with Americans with Disabilities Act.
Concrete slabs. 72hrs. curing time, 4SOOpsi.
Concrete slabs require joint seal material.
Driveway requires dowels every 18',.
Submit traffic control plan prior to excavation.
Notify Traffic Division before excavati?n.
Core drill main line, insert tee, 2o/o min, grade.
Must comply with the provisions of ORS 757.S41 to 757.571
6" Circular hole/H2O-Vac.
Comments
rHE LANE unuff#d-ffidHbifrthNc couNctl,s"oNE CALL NUMBER" 1-800_33 2-2i4448 HOURS BEFORE DIGGING
tNs
tr 941ry1yv SEWER, sroRM sEWEB, ENcRoAcHMENT pERMrr AND orHER TNSpECTToNS cALL crry MATNTENANcE AT726-3761.
RBCU ACUT DN DEWSI ALK STCORDER)TEA oY RU eDE tb TENA LD JITY BoITNUMADJOBDNUMBER/PERM BER,R N TSPEC REOtoN STUE DE AN WHD NE o U LL B E ER A FDY RoNPECTIONcooNTRACTRSRoER'SOWN AN ANDME HONP NE MBERU R OUE TSES EIREC ED EFORED A M700 BEILLDEMASAMTHEDEEREOUSTAWIBLLEAFT7RA:00 .M ME EAD TH NE TEX SPECTINWORKNDA o SN EAR oT Eo
CA LL INED FTEBA EXCA TtoA ARENS AM D E NA FOD MR WORK e PLAN BCE PUT roRR POTO RU (jIN N RC TE E
SIGNATURE:
By signature, I state and agree, that I have gare.fully examined the completed application andherern_rs_true and correct, and_l further certify that any and all worti peitormeaiFiit"uJoi"Ji
3::,.fflffillpJisl1,,t?l,itr3l?,fif,,,g,,,lgUtinf;i:1ill"m*,r,;yldsl*Tfi."nn:i!:
project.
The Citv mav insoect the work site described in this permit at anv time during a ong year period following the receipt by the City of
i"",tffir"i#[oi['ll313lJlio%i'"%'r""$yis,f,!ti$"""-l*
;t 'n'"t'tii',igs ffff;tril"[,fli],,*:,jii;*ji.T:ir,i,:t:"8j-iilixrs ,ltr,,davs (30) rrom the date or the noiiCe t-o Coiiiolete'the w6*. W6r[ ;oi Io.iiiri:tJi Ji iilj'.i"'at'riii6 ii.'i"it]'i#'i,,Iriij! pUiiolilEo'tjir'lnuCity and the costs will be billed to me peimit[ee.
all reouired insoections are requested at the proper-time, that project address is readable from the street,will r'emain ori the site at atIilmed du;;g don"struct,on.
that
Date
n accord
State of
with OR
do here
plans
p,"H-
ATE PAID
EIVED BY
AMOUNT RECEIVED:
RECEIPT NO:
VALIDATION:
f, eenrum TSSUED By:
FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER
WORK IN PROGRESS DATE
DATE
f rnnrrrc REVTEWED By:
DEPOSIT RETURNED
DATE
DATE
DATE
DATE
INSPECTION:
INSPECTION:
DATE
DATE
f erucrrueEntNc REVTEWED By:
f nltnrrurrNANCE:
DATE
AT TIME OF COMPLETION
ELEVENTH MONTH:
DATE
I
I furthor
and the
Signature
to
on