HomeMy WebLinkAboutPermit Sidewalk 1997-03-28SPRINCl TtELD
DATE ISSUED:7 ?
225 FIFTH STREET
PERMIT NUMBER:INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
ENCROACHMENT PERMIT
NUMBER:
APPLTcAnoN DArE : 4 /Zg /f
SPRINGFIELD, OBEGON 97477
ENGINEEBING DIVISION
oFFrcE TELEPHONE (503) 726-3753
'LOCATION OF WORK
OF SPRING LD PIMIT APPLTGAT|ON
APPLICANT
SITE ADDRESS:
CITY:
SUBDIVISION:
OWNER:
ADDRESS
CONTRACTOR:
CONTRACTOR REGISTRATION NO
PROJECT SUPERVISOR:
STATE: a lu
?qo 35 z+CITY: 4
PHONE o
ZIP:
TAX MAP:
TAX LOT:
PHONE:
STATE: OVL ZIP:
l1 o?_ \tbl
()
ADDRESS:PHONE
EXPIRATION DATE:
PHONE:
REOUESTED PERMITS:INSPECTIONS REOU|REDT AppLtCATtON FEE / OEPOS|T ACCOUNT NO:f encnoAcHMENT pERMtr No:
VAIIO FOR SIXTY (60} OAYS FROM OATE OF ISSUANCEI cursrneer Q BoBE E oTHER
Q ousr coNrRoL {TypE oF coNTRoL)
I corusrnucloN, sroRAGE, srAGtNG
I orxen
I asexaur DEposlr.....':"""""""""""
TYPE OF SECURITY DEPOSIT
Q auNxer sunEry BoND I suRttrv aoruo e cASH / cHEcK
E cune cur pERMtr No FT.
INSPECTION. CURB / APPROACH AFTER FORMS ARE ERECTEO BUT PRIOR TO POURING CONCRETE.VALID FOR 180 OAYS FROM OATE OF ISSUANCE.
E $20,00 /
E$
E 910.0o + $.1 s/FT.
geid6o* $.1s/Fr 4/O,t{
E $5.00 /
E $s.oo /
TOTAL OUE:- S /o ,4{
tr
tr
tr
tr
tr
$
$
$
E$
zAsecoio
ffinewatx
DRIVEWAY (SEE SEPARATE APPLICATION)
-
PERMIT NO:..FT
VALIO FOR 180 DAYS FROM OATE OF ISSUANCE.
I r.rew E REMovE / REpAtR E rAVE eLANT srntp
Q sereacx E CURBSTDE E LENGTH
INSPF'TION. SIOEWALK / ORIVEWAY FOR ALL
MADE AFTER ALL EXCAVATING IS COMPLETE . AND FORM WORK AND SUE.BASE MATERIAL IS IN
CONCRETE PAVING WITHIN THE STREET RIGHT OF WAY, TO BE
I PLACE.tr SANITARY SEWER CONNECTTON pERMtT: .,......
VALID FOR SIXTY 160I OAYS FROM OATE OF ISSUANCE
Q ro srue I varN LINE (EASEMENT-B/w) O orHER
f sronrvr SEWER coNNEcnoN pERMtr:
VALIO FOR SIXTY (60I DAYS FROM OATE OF ISSUANCE
Q carcx BASTN / BUBBLEB e srua e varrutrrue
PROOF OF TNSURANCE: SSOO,OOO MIN]MUM
Q arrecHeo E REoutREo AMouNT
DESCRIPTION OF PROJECT
PERIOD OF USE OR TIME OF CONSTRUCTION:
tr PLANS (TWo SETS} ATTACHED
BACKFILL MATERIAL TO BE UTILIZED
SURFACE BEPLACEI\4tNT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UTILIZED:
TOTAL DUE WITH PERMIT $
-Zt
DEPTH;
BACKFILL MATERIAL:
FROM DATE:
TO DATE:
TIMEr
TIME;
AREA: LENGTH:.]WIDTH:
TYPE OF WORK: CUT: -- BORE:
OTHER:
EXISTING SURFACE MATERIAL
HEIGHT:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT
WARNING DEVICES TO BE UTILIZED:
Advanca signing and work zone protBction to be in compliance with ths Manual on Uniform Traffic Conrrol Devices (MUTCDI
DESCRIPTION
REVISTONS 8t24t95 FORM f 116
LE 5 OF THE CITY CODE.CONTBACTOR TO COMPLY WITH MUTCDWORK SHALL COMPLY WITH CHAPTER X ARTIC
PLAN REVIEW COMMENTS / S INSTRUCTIONS:
RESTORATION WORK SHALL BE lN CgltF--
SiAi,r DAR'DSpeclrlOnrtoNS, EXcEPT AS
..MANCE WITH EXISTING CITY
NOTED BELOW.
CODES AND ,bMPLIANCE WITH CURBENT
001
002
003
004
005
006
007
o08
009
010
011
012
013
014
015
016
017
018
Backfill with 7r' minus rock.
Compact every 1 8" loose depth.
Requires compaction with a steol tolllor'
A.C. to match the greater of existing depth or 4"'
All cuts sealed for final {nspection.
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. 3,000psi.
Curbing min 3,SOopsi / No patchwork less than 3"
Meat min. requirements on curb cuts, Spf d. code'
Restore planted areas, Spfd. code 206.3.O5
Spec. to Bore / Jack / No A.C. cuts.
Mechanlcal coinpacting required.
No patcnwiri- allowed.
Lataral cuts to have control density fill.
Cuts to ba polymerized crack sealod for final inspection'
Mininum 2" crushed rock %" minus.
019
020
021
o22
023
024
025
026
o27
o28
029
030
031
032
033
343
Minumum 4' clearance at any point, swing'away'
Concrete minimum 4" depth, 3,OOOpsi.
Trench to be "T" cut. t
Needs Stats / County Permit'
No abov6 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, 4500psi.
Concrete slabs require loint seal material,
Driveway requires dowels avery 18"'
Submit traflic control plan prior to oxcavation'
Notity Traf lic Division before excavatipn.
Core drill main lins, insert tea, 27o min. grade'
Must comply with the provisions of ORS 757'541 to 757'571
6" Circular hole/H2O-Vac.
Comments:
THE LANE UTI
"ONE CA
YOU ARE REOUIRED TO CALL
LITTES COONOINATING COUNCIL'S
LL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
INSPECTIONS:
SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726-3761tr
s'JiBllSL'f f $f #6?,fi frffi 8fi 3
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SIGNATURE:
RL:iH'13\?l? :,il':ffiss,:si,Ti lift'^lf u?,|?i't{![%siHf:fl $3,f "#,"'":,'f,133H[i'[3?.3ii t"elsl?Bh%T'il,liii'e:Aiil""Jx..11"& p"
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project.
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City and the costs will be billed to the permittee.
I furthor aclree to ensure that all required inspections are requested at the proper time, that project address is readable from the street,
;n-d ihe ap'provilO set of plans will r'emain ori the site at all times during constructron.
Signature ,z _3-tr _.o.^Date
/0AMOUNT RECEIVED
RECEIPT NO:RECEIVED BY:
DATE PAID
VAL!DATION:
f runrrureNANcE i
FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.
|NSPECT|ON. DATE
-DATE:
woRK lN PROGRESS_
AT TIME OF COMPLETION: DATE:
ELEVENTH MONTH
I eenrrntr tssUED BY:
I eructrueERtNc REVTEWED BY:
f rnnrrtc REVTEWED BY
INSPECTION
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DEPOSIT RETUBNED: