HomeMy WebLinkAboutPermit Curb Cut 1998-01-20iffi
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PERMITENCBOACHMENT
N
DATE ISSUED a
APPLIOATION DATE:- 7C -ftr
PERMITINSPECNON LINE SEE INSPECTIONS ON BACK SIDE '
225 FIFTH STREET
sPAMIGFIELD. OREGON g? 477
ENGINEERING DIVISION
oFFtcE TELEPHONE (503! 726.3763
.LOCATION OF WORK
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STATE:
EXPIMTION.DATE:
/ZIP,.o
ZIPz
:?PHONE:
PHONE:
a
7./
CONTMCTOR: D
,A/
do^67 ADDRESS:
PROJECT SUPERVISOR:
SUBDIVISTON:
TAX LOT:
TAX MAP:SITE ADDRESS:
APPUCANT
ADDRESS:
OWNER:
CONTRACTOR REGISTBATTON NO: / / ZI
CITY: 5tr
r{3?ECTp}6 iEotr8lot Aruc^'noil mrorNoStT ACCOI Mf t{or
REOUESTED PERMITS:
I rrucnoAcHMENT pERMtr No:g r'zo.oo IvAtl, Foi SrxTY ttol oAYE tnOM o^rl or atuANClocursrREEr EI BonE Eort{ER EoQ ousr coNTBoL (TypE oF @NTiou
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suaEryloND El suarry BoND El casx / cHEcK Er
[f-*r0.00+ t.r6/FT.
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EI 01o.Oo.+ t.tE/FT.
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PRooF oF INSURANCFT CEOO,OOO MINIMUM, ft errecxeo O REoU|RED AMoUNT TOTAL OUE*Ii TOTAL DUE WIT}I PERMTT I
oDESCRIPTION F PROJECT:
PRING LD MIT APPLICATION
PEHOP OF USE OR nME OF CONSTBUCTTON:Q rr.nrus fiwo sErst ATTAcHED
FROM DATE:
TO DATE:
TIMEr
TIME:
HEIGHT:
the Mrrul on Tn(llc Cont ol Oavlc.r
AREA: LENGTH:
TYPE OF WOBK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SUBFACE REPLACEI4tNT MATERIALS
BORE:
BACKFILL MATERI.AL:
TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE
NAME OF OTHER UT]LITIES IF THIS IS A JOINT
WARNING DEVICES TO BE UTILIZED:
Advlncr
DESCRIPTION:
SHALL COMPLY WITH X ARNCLE
to bo lnworl ronr
woRx
aEustoNS u24r8t toail7 Irt
6 OF THE cnY CODE TO COMPLY wlTH MUTCD
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CURB CUT PERMIT NO:ataaaaaaaiaaataaaraa
g secol'6bnrvEvtly I8EE SEPARAIE
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REI'IEW COMMENTS
B9f,[,g1tBo#JgPr1dhlfd[6,t5{8#?nA'ils#[t5 [6w.E'0snNo ctrY coDEs ANhr{ dttupuancE wrrH cuBRENr
0ot
002
003
004
00r
000
007
008
009
0r0
01r
012
013
01'f
01t
0rc
017
018
Commente:
Eralllll wlth I'mlmr rocl
Comprct rvrry 18'loor drrrtlr.
Rrqulrrr oomprotlon whh r .tml rolllar,
A.C. to mrtdt th. gnil.r ot .dtthe drpth or 4'.
AI out! ulcd lor rlnd lntp.odon.
Trmponry pdsh mry br w.d rt th. tttd ol thl d!y.
Slgnlng rnd Zood proralon lo comDtt wlth MUTCD
Cut ooncr.t. only on rcor lln.3 or oold tolntr.
Sldrwrltr rnd drtvrwryr mln 3,00gPrt
Culblne rnln 3,l00pl I No prtolnrolt hrr ttln 3'.
Mrrt mh. oquhrmrnb on crtrt ot tr, 8Pld. d..
R.rtoo pltllttd.l[r. 8pld. codr 20C.3.06
8p.c. lo Bon / Jrct I No A.G our.
Mrchrnlcrl cott'tptothg nquhrd.
No pdchwott tlowad.
bt.r.l outt to h.Y. oontrol drndw llll.
Crrtt to b. polymcdzrd crmt tlrlcd lor tlnrl lnlpcctlon.
Mlnlnum 2'orurhrd tocl l'mlnua.
THE LANE
"ONE
ot9
o2o
02r
o22
o23
o21
025
026
o27
028
020
030
03t
032
933
3't3
Mnunun 4' cblnncr .t tny polnt. rwlngr.lwlv.
Conerr dntnun 4'dlpth. 3.00Oprl.
Tnnd|to ba 'T. otll. i
N.rdr St ta / Cotnrt9 prrmh.
No rbwr grrand rndorlngt ln.ld.w.lt or h.ndlc.p t.mpt.
OrmorTd ar AC.rtonontl Yrlul borcr to gr!d..
Frorh Oll rlgnr / gndcd.
Comply w[h Arndcrnr wlth Dl.tbllltl.t Act.
Conctrr drbr' 72in outne fiir.. 'l60oprl.Concr.t rlrbr nqdra lolnt rd m.t.rl.l.
Orlvrwry r$lnr dowrlr rvrry t8'.
8ubmh rrltlo conttol Dlm Pdor to crcrvltlon.
Notlly Tnlllo Dlvldm lolor rxcrvrtlgn.
Gota dtll rnrln llnr. ht.tt t!i. 2rh mln. grcdr.
Mu* oanrply wlth tho ,rovblonr ol ORS 767.64'l to 767.671.
C'Charlrr hohlH2OVrc.
t.
NG COUNCIL'S.332-2344
48 HOURS BEFORE DIGGINO
tNs
tr
BE
AND OTHEB INSPECTIONS CALL CIry MAINTENANCE AT
SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT
72A3741,
SIGNATURE:
,"sJi8*od.J]l'J?;llli'llfiftyfi"fJB?fifit|lS3[.Ji$,H*'Jrffir3"B'.'fl:[1rme'
that protect addresa rs readabre from the 8tr80t'
I have
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and
Slgnature
Date /z2r)
<50
oftthla
rnv
thbnot
'I
I furthor
and ths
RECEIVED BY:
AMOUNT RECEIVED:
i
DATE PAID:
RECEIPT NO:
VALIDATION:
E rnernc REVIEWED BY:
E NaetNreNANcE,
E penur lssuED BYi
FoA SDEttUArk ago CURB CUT PEBM41S PtAcE A C1PY (C1MPLETEDI lN PERW7 DRAWE1
. WORK IN PROGRESS
ELETIB{THMONTH: . . , OATES
DA,TF:
DATE:
I eruotHeEBlNG RB/IBI/ED BY:
irnuE oF coMPLETIoN:
OEPOSIT RETURNED:
DATE:
DATE:
DATE:
DATE:
DATE:
'INSPECTION:
,,INSPEC1ON:
CALLED IN AFTER
STATECALt
7:OO
ANO
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