HomeMy WebLinkAboutPermit Curb Cut 1996-03-27DATE ISSUED:L"7 -
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PERMIT NUMBER: q G O.+Z-{l-
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
-Z'7-9 (e
oFFtcE TELEPHONE (503) 726-3753
APPLTCATTON DATE:
LOCATION OF WORK
ENCROACHMENT PERMIT
NUMBER:
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
SITEADDRESS: B lO ? r.u 'il -7 2(o
ztP:'77 +78
PHONE
'l.u\ t PHoNE: v44-8.'r4a
2Co
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842
STATE:
PHoNE: Z<<Le4
ADDRESS
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CITY:
CITY STATE:
CONTRACTOR:
SUBDIVISION:
PHONE
TAX MAP:
TAX LOT:
EXPTRATIoN DATE; 8'- Z l-
ADDRESS: G3A
OWNER: 3; "^- ^ g-z=-
cONTRAcToR REGISTRATION No: O S [4€d9.
PROJECT SUPERVISOR L-
APPLICANT :. t:-\- 1rt ut- ?-Zf)4lp
ACCOUNT NO:INSPECTIONS REOUIREO: APPLICATION FEE / oEPoStT
fl erucnoAcHMENT pERMtr No: .......E $20,00 /
VALID FOR SIXTY (60I OAYS FROM DATE OF ISSUANCEI cur srnrer I aone E orHEB E$
I ousr coNrBoL (TypE oF coNTRoL)
I corsrnucloN, sroRAGE, srAGtNG tr
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I orxen
I asenllr DEpostr.....
TYPE OF SECURITY DEPOSIT
Q ar-aNxer sunEry BoND E SURUTY BoND E CASH / CHECK E$
El cune cur PERMIT No:FT tr- g-sto.oo+ $.1s/FT
CONCRETE.
/o >a
INSPFCTION: CURB / APPROACH AFTER FORMS ARE ERECTEO BUT PRIOR TO POUBING
VALIO.FOR ,I80 OAYS FROM OATE OF ISSUANCE.
I srcor.rb DRTvEWAy (sEE SEeARATE AppLtcATroN]
fl sroeweLK pERMtr No: .................... FT E $1o.00 + $.1 s/FT
VALID FOR 180 OAYS FBOM DATE OF ISSUANCE.
Q ruew E REMOVE / REpAtB fl PAVE PLANT STRtp
Q seraacr E CURBSTDE fl LENGTH
INSPF'TION. SIDEWALK / ORIVEWAY FOR ALL CONCRETE PAVING WITHIN THE STREET RIGHT OF WAY, TO BEMADE AFTER ALL EXCAVATING IS COMPLETE, ANO FORM WORK ANO SUB.EASE MATERIAL IS IN PLACE.
f, seruraRy sEWER coNNEcnoN pERMtr:E $5.00 /
VALID FOR SIXTY (60} DAYS FROM OATE OF ISSUANCE
fl ro srua fl MA|N L|NE (EASEMENT_R/W)
f, sronnn sEWER coNNEcloN pERMlr:
E oTHER
VALIO FOR SIXTY 160) DAYS FROM DAT€ OF ISSUANCE
I carcH BAstN / BUBBLER E STUB E MAINLINE
PRoOF oF INSURANCE: $500,000 MINIMUM
l--i $5.00 /U
I arracxeo tr REOUIRED AMOUNT la ,.9oTOTAL DUE: $
TOTAL DUE WITH PERMTT $ tC, , ?C)
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION
tr PLANS (TWo sETS) ATTAcHED
AREA: LENGTH .WIDTH
TYPE OF WORK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFITL MATERIAL TO BE UTILIZED:
SURFACE REPLACENNTNT MATERIALS TO BE UTILIZED
TYPE OF DUST CONTROL TO BE UTILIZED
FROM DATE:
TO DATE:
TIME:
TIME:
DEPTH:HEIGHT:
BORE:
BACKFILL MATERIAL
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
WARNING DEVICES TO BE UTILIZED:
DESCRIPTION
Advance signing and work zone prot€ction to be in compliance with the Manual on Uniform Traffic Control Devices (MUTCO)
I
WORK SHALL COMPLY WITH CHAPTER X ABTICLE
REVTSTONS 8t24t95 +oRM ' 116
5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD .
GITY OF SPRING APPLICATION
L sr( 5atr4
r->n3
REOUESTED PERMTTS:
$
$
$
PLAN REVIEW COMMENTS / SP'=^IAL INSTRUCTIONS:
RESToRATIoN WoRK SHALL BE IN CONFoRMANCE WITH EXISTING CITY CODES ANE,IN CTMPLIANCE WITH CURRENT
STANDARD SPECIFTCATIONS, EXCEPT AS NOTED BELOW.
001
002
oo3
o04
005
006
007
oo8
oo9
010
01 1
012
013
014
015
016
017
018
Comments:
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 tho day.
Signing and Zone protection to comply with MUTCD
Cut concrete only on score lines or cold ioints.
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 206.3.05
Spec. to Bore / Jack / No A.C. cuts.
Mechanical compacting raquired.
No patchwork allowed.
Lateral cuts to have control density fill.
Cuts to be polymerized crack sealed for finat inspection.
Mininum 2" crushed rock %" minus.
01 I
o20
021
o22
o23
o24
025
o26
o27
028
o29
030
031
032
033
343
Minumum 4' clearance at any point, swing'away.
Concrete minimum 4" depth, 3,00opsi.
Trench to be "T" cut.
Needs State / County permit. l
No abovs 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 excavatign.
Core drill main line, insert tee, 2olo min. grade.
Must comply with the provisions of ORS 757.541 to 757.571
6" Circular hole/H2O-Vac.
t
rHE LANE urrLdiE6^UbtHbiftThNc couNcrl's"oNE CALL NUMBER" 1-g00-332-2344, 48 HOURS BEFORE DIGGTNG
INSPECTIONS:
tr CURB CUT AND SIDEWALK INSPECTIONS CALL 726.3769 (RECORDER) STATE YOUR DESIGINATED CITY JOB
NUMBER/PERMIT NUMBER, JOB ADDRESS, TYPE OF INSPECTION REOUESTED, AND WHEN YOU WILL BE READY FOR
INSPECTION, CONTRACTOR'S OR OWNER'S NAME AND PHONE NUMBER. REOUESTS RECEIVED BEFORE 7:Oo A.lVl. WILL BE
MADE THE SAME DAY, REOUESTS AFTER 7:OO A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE
CALLED IN AFTER EXCAVATIONS ARE MADE AND FORM WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE.
tr sANtrARy sEwER, sroRM sEwER, ENcRoAcHMENT pERMrr AND orHER tNSpEcloNS cALL ctry MATNTENANCE AT
726-3761
SIGNATURE
AMOUNT RECEIVED:l(>I C)- z_7 -?G
3,-'>2- qb
Date
L DATE PAID
RECEIVED BYRECETPTNo: o2-OA5 <r)
By signature, I state and agree, that I have carefully examined the completed application and do herebv certifv that all informationherein is true and correct, and I further certify that any and all work peiformed'shall be done in accordance with the Ordinances of theCitv of Springfield, applicable Citv Standard Soecifications and Drawinqs, and the laws of the State of Oreoon oertainino to the work
described heiein. I further certify'that only cohtractors and employees-who are in compliance with ORS 7d1 .055 will bd used on thisproject.
The Citv mav inspect the work site described in this oermit at anv time durino a one vear oeriod followino the receiot Uv tne Citv of
notice cif corhpletion of the described work and soecifv, at the Citv's sole deScression. anV additional resioration wbrk ieouired io
return the site to a standard acceotable to the Citv. The permittee'will be notified in writin'o of anv work reouired and will have thirtv
days (30) .from the dqlq of. the noiice to complete'the work. Work not completed at the en? of thi: thirty days will be performed by theCity and the costs will be billed to the permittee.
Signature
VALIDATION:
I furthor
and the
to that
plans a
all inspections are requested at the proper time, that project address is readable from the street,
ori the site at all times during construction.
I rnnrrrc REVTEWED BY
I unrruruNANcE
f erucrrueERrNc REVTEWED BY
DATE:
DATE:
DATE:
DATE:f ernurr TSSUED BY:
FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER
INSPECTION: ' DATE:
INSPECTION:DATE:
WORK IN PROGRESS DATE
AT TIME OF COMPLETION DATE
ELEVENTH MONTH DATE:
DEPOSIT RETURNED:DATE
(