HomeMy WebLinkAboutPermit Sidewalk 1996-05-09225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726.3753
SPFINGlrlELD
INSPECTION LINE SEE INSPECT]ONS ON BACK SIDE
ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER:
DATE ISSUED:
PHONE
s/r/raAPPLICATION DATE:
LOCATION OF WORK
APPLICANT e
SITE ADDBESS: Z3g> N. ZZ*
CITY:STATE:
SUBDIVISION
OWNER: C-b+
ADDRESS
CONTBACTOR:
CONTRACTOR REGISTRATION NO
PROJECT SUPERVISOR, O
D{L ztP
TAX MAP:
TAX LOT:d3€1
PHONE
CITY STATE ztP;
PHONE
7q6
ADDRESS:
" ?7 trA b EXPIRATION DATE:ume> ilat*o>
REOUESTED PERMITS:INSPECTIONS REOUIREO: APPLICATION FEE / DEPOSIT ACCOUNT NO
E rncnoAcHMENT PERMTT No E $20.00 /
VALID FOR SIXTY {60I OAYS FROM OATE OF ISSUANCE
I cur srneer E BORE E OTHER E$
fl ousr coNrRoL (TYPE oF coNTRoL)
I corusrnucroN, sroRAGE, srAGrNG tr_tr
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$
I orxen n $
I aseualr DEPosrr...........
TYPE OF SECURITY DEPOSIT
$
fl elaruxrr suREry BoND E SURUTY BoND I cnsH / CHECK E$
f, cune cur PERMTT No:..FT E $10.00+$.1slFT
lNsPEcrloN: CURB / APPROACH AFTER FORMS ARE ERECTED 8UT PRIOR TO POURING
VALID FOR 1 80 OAYS FROM DATE OF ISSUANCE.
D OHIVEWAY ISEE SEPARATE APPLICATION}/7{aSIDEWALK PERMIT NO:Fr. a E $10.00+$.15/FT
VALID FOR 180 DAYS FROM DATE OF ISSUANCE.
[ ruew E REMovE / REPAIR D PAVE PLANT srBtp
I seraacx E CUBBSTDE E LENGTH
INSEECIIoN|SIDEWALK / DRIVEWAY FOR ALL CONCRETE PAVING wlTHlN THE STREET RIGHr OF WAY, TO BE
MADE AFTER ALL EXCAVATING IS COMPLETE, AND FORM WORK ANO SUB.BASE MATERIAL IS IN PLACE.
f sarurnRY sEWER coNNEcnoN PERMTT:
VALIO FOR SIXTY (60) DAYS FROM DATE OF ISSUANCE
fl ro srua E MAIN LINE (EASEMENT-R/W) E OTHER
E $5.00 /
f sronnn sEWER coNNEcnoN PERMTT:
VALIO FOR SIXTY (60I DAYS FROM DATE OF ISSUANCE
E $5.00 /
I carcH BASTN / BUBBLER E sruB I laatrultrue
PRoOF oF INSURANCE: $500,000 MINIMUM
TOTAL DUE: $/a <- (), /- -_->''' {oTOTAL DUE WITH PERMIT $
DESCRIPTION OF PROJECT
CITY OF SPRINGF D
PERIOD OF USE OR TIME OF CONSTRUCTION:
tr PLANS (TWo sETS) ATTAcHED
AREAI LENGTH:
FROM DATE:
TO DATE
TIME:
TIME:
.WIDTH DEPTH
BORE:
BACKFILL MATERIAL:
HEIGHT:
TYPE OF WORK: CUT:
OTHER:
EXISTING SURFACE 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:
Advance signing and work zon€ protgction to bs in compliancg with the Manual on Uniform Traffic Control Devices (MUTCD)
DESCRIPTION
WOBK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY
BEVTSTONS 8t24195 FORM # 116
CODE. CONTRACTOR TO COMPLY WITH MUTCD.
{vr
PHONE;
PEIMTT APPLTGAT|ON
I errecHro E REoU|RED AMoUNT
PLAN REVIEW COMMENTS / SPE;^IAL INSTRUCTIONS:
RESTORATION WORK SHALL BE lN QONLO-RryUUYC-E-WITH EXISTING CITY CODES ANut ifl
Sili{ DARDEpdelrieATtO NS, excepr AS NorED BELow.
ClcwrplterucE wlrH cu RRENT
001
002
003
004
005
006
oo7
oo8
009
010
011
012
013
014
o15
016
017
018
Backfill with %" minus rock.
Compsct every 1 8" loose depth.
Requires compaction with a steel rolller.
A.C. to match the greater of existing depth or 4".
All cuts sealad lor final inspection.
Temporary patch may be used at the end ot the day.
Signing and Zone protection to comply with MUTCD
Cut concrete only on score lines or cold joints,
Sid€walks and driveways min. 3,OOOpsi.
Curbing min 3,SoOpsi / No patchwork less than 3'.
Meat min. requirements on curb cuts, Spld. 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 havo control d€nsity fill.
Cuts to be polymerized crack sealsd for final inspection
Mininum 2" crushed rock %" minus.
019
020
021
o22
023
024
o25
o26
o27
028
o29
030
031
032
033
343
Minumum 4' clearance at any point, swing-away:
Concrete minimum 4" depth, 3,000psi.
Trench to be "T" cut.
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, 450opsi.
Concrete slabs require joint seal material.
Driveway requires dowels every 18".
Submit traffic control plan prior to excavation.
Notify Traffic Division before excavatign.
Core drill main line, insert t€e, 2o/o min, grade.
Must comply with the provisions of ORS 757,541 to 757.571
6" Circular hole/H2O-Vac.
Comments:
I
rHE LANE unu+iE6'ffitHbiflrthNc cou NctL,s"oNE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
INS
CURB CUT AND SIDEWALK TNSPECTIONS CALL 726.3769 (RECORDER) STATE YOUR DESIGINATED CITY JOBNUMBER/PERMIT NUMBER, JOB ADDRESS, TYPE OF INSPECTION REOUESTED, AND WHEN YOU WILL BE BEADY FOBINSPECTION, CONTRACTOR'S OR OWNER'S NAME AND PHONE NUMBER. REbUESTS RECETVED BEFORE 7:00 A.M. WILL 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 PRIOR TO POURING CONCRETE.
tr q4rylI4!,Y SEWER. sroRM sEWER, ENcRoAcHMENT pERMrr AND orHER rNSpEcroNS cALL crry MATNTENANCE AT726-3761.
SIGNATURE:
AMOUNT RECEIVED:a e;o DATE PAID
RECEIPT NO;RECEIVED BY
the eted and
aws
oyees w are n compliance
The Citv mav insoect the work site described in this permit at any time during a one year period following the receipt by the City of
i"",t:,i1"{#[',l3tl;'!,3llliof,",i$if,:fryir,nltr,".'f* ;1,*"#,; lffisi,in:*'x*,.iili,"1+'i'Lv'*i,"iJi:il,i',".t xj Jf;fxr;S,t;r,"davs (3olfrom the date of the noticeto comolete'ihe wdrk. W6i[;ot co,iipttilJii tr'ir',jn"ai'ti'li6 ihl'rty'o"iv".'ir]tiijE pljii"]iiEd'tiir'ir,"City and the costs will be billed to the permitlee.
I furthor
and the
to ensl
set
at all qp_fgguesteg a.t the proper time, that project address is readable from the street,aI all Irmes ounng constructton.ans site
Signatu Date
VALIDATION:
fl rnnrrrc REVTEWED By:DATE:
DATE:
DATE:
DATE:
f erucrrueEntNc REVTEWED By:
tr
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MAINTENANCE:
PERMIT ISSUED BY
FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.
INSPECTION: DATE
INSPECTION: I
DATE
WORK IN PROGRESS DATE:
AT TIME OF COMPLETION: DATE:
ELEVENTH *o*rr, -
-DATE:
DEPOSIT RETURNED: DATE:
I have