HomeMy WebLinkAboutPermit Sidewalk 1998-08-18V a D I aa Di I O a
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ENCROACHMENT PERMTT ctt3tt t1
NUMBER:
INSPECTION LINE SEE TNSPECTIONS ON BACK SIDE '
APPLtpATtoN DATE:DATE ISSUED:
aPitxoarLD
3bPERMITNUMBER: qK lo
226 STSEET
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ENGINEERING DIV]SION
oFFlcE TELEPHONE (603) 728-3753
.LOCATION OF WORK S
STATE:ZIP:
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PHONE:
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*bPHONE:
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ON.DATE:
OWNER:
ADDRESS:
CONTRACTOR:
APPLICANT
SITE ADDRESS:
CITY:
TAX MAP:
TAX LOT:
ADDRESS
CITY:
PHONE:
STATE:
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CONTRACTOB BEGISTBATION NO:
PROJECT SUPERVISOR:
hBPECTIONE ruOUirDs APPIJCANOfl FEt
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OEPOSIT ACCOUIfI NO:
REOUESTED PERMITS
ROACHMENT PERMIT NO:g &.oo Iv^tp Foi Stxw tlol oAY8 r80M DAT!or tsSuANCt
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TYPE OF SECURTTY NEPOSIT
Q arrnrer sunEry BoNo e sUR[w BoND El cAsH / cHEcK
tr E 010.00+c.16/FT..
k SIDEWALK PERIVIIT NO: ...........r......
VALD roi tlo oAvS FioM oA?! Of EtuANCa
O.rew EnEMovE / REpAtR O pAVE
.. Fr,rl H
/9 Ff t,ts
010.00+ 0.1E/FT.#12. Zg
PLANT STRIP
Qierarcx e cunasroe Q uruorxNreF.Tt6N. StoEwALx / ORIVEWAY FOB ALL coNc8ltl tAvtNO WTH[{ THE STREET RIOIIT OFMAOE AFTER ALL EXCAVATINO 18 COMPLETE . ANO FORM IVOBK ANO 8U&BASE MATERIA! I8 IN
wAY, TO AE
I PLACI.tr SANITARY SEWER CONNECTTON PERMIT:E $6.0'0 /VALD FOB 8|XTY FOt OAY8 FaOM OA?! Of tssuANc!o ro sruB O MA|N L|NE (EASEMENT.B/WI E orHERtrSTORM SEWER CONNECTION PERMIT:r-I 05.oo tv^tD FOR SIXTY toot oAYt FioM o^n Or tssu^llctocATcH BASIN , suBBr"ER 0 sru8 El MAINuNE
PROOF oF |NSTTRANCF: $600,000 MINIMUM. Q arracxeo e neourneo AMoUNT TOTAL DU'i;*i z,z9
TOTAL DUE WTH PERMIT T 2 z9;
DESCRIPTTON OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTTON:tr PrANS (Two sETsIATTAcHED
FROM DATE:
TO DATE:
AREA: LENGTH:WIDTH:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEI\4tNT MATERIALS
TYPE OF DUST CONTROL TO BE UTILIZED:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT
WARNING DEVICES TO BE UTILIZED:
DESCRIPTION:
WORK SHALL COMPLY WITH
TIME:
TIME:
DEPTH:HEIGHTT
TO BE UTILIZED:
Adv.nca tlgnlng rnd work tonr p.otlctlon to bo ln compll.ncc wlth tho Mrnurl on Unlform Tn0lc Control Dcvlco IMUTCDI.
X ARTICLE 6 OF THE CrrY
REVISIONS Et21tg6 roRM , tt!
CODE COITTRACTOB TO COMPLY WTH MUTCD .
F,Qr
Or-
RB/IEW COMMENTS /TNSTRUCTIONS:
EFffi',mB'JEltrBld^lfdlt!]
tBlSdFftE no#B.E[dff.o(IsnNc crrY coDEs AND I WITH CUBRENT
Mlnumrxn 4' chtrrnco !t rny polnt, rwing'lwcy.
Conct.t mlnlmum 4' dcPth. 3,@Opcl.
Tranch to ba 'T'out. t
N.cdt St!t. / iountV Pcrmlt.
No abov. ground rnclodngr ln rldcwalk or handicap ramps'
Dlamond cut A.C./Concrctc vllur boxcr to grrdc,
Frcrh Oll rlgnr / Gradcd.
Comply wlth Arn.rlcrns wlth Dlrlbilitilt Act.
Concrlt. dcbr, 72hrr. curlng tlmc, 450opsi.
Concrotr rlabr rrqultc lolnt lc!l mctcrlcl.
Drlvcwry rrqulrr dowtlr rvcry 18'.
Submlt t0lflc control plan prlor to cxcrvation.
Notlly Trrlllo Dlvlrlon bcforc oxcavatign.
Corr drlll mlln llnc, lntlrl tc., 2% min. gradr.
Murt oomply wlth th. provlclons ol ORS 757'541 to 757'671.
6' Clrculrr holrrH2O.Vrc.
001
002
003
OOrf
006
006 .
007
008
009
0r0
01r
012
013
014
olc
or6
017
018
Erckflll wlth I'mlnu rock.
Complct cvory 18'loort drPth.
Rrqulrcr oomptstlon wlth r rtlrl rolllrr.
A.C. to mrtch tht gru.ttr ot uldlng drpth or 4'.
All autt rcolcd tor flnrl lnrpcctlon.
Trmponry prtoh mrY br urcd rl th. tnd ol thr day.
Slgnlng rnd Zond ptol.ctlon to comPlY wlth MUTCo
Cut concrct. only on tcot. llnc. ot aold lolnt..
Sldrwolkr rnd ddvlwayr mln 3,00OPrl.
Curblng mln 3,60Opd / No potchwort lcrl thcn 3'.
Mr.t mh. trqulr.mlnt! on crrb 3rnt. spld. coda.
Rlrtot. pltntld.crcu. Spld. cod. 206.3.05
Sp!c. to Bon / Jrok , No A.C. cut3.
Mcchrnlccl comp.ctlng rcqulrcd.
No prtchwork rllowrd.
btcr.l cutr to hrv. oonttol d.nttty rlll.
Cutt to bt polyrncilrrd crcct ttclcd lor flnat lnrpcctlon.
Mlnlnum 2' crurhcd rock I'mlnur.
0r9
020
02r
o22
023
024
026
020
o27
028
029
030
03r
032
033
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Comments:
l.
TH E LAN E UTIu+iE6^A6THbift.Ah N G- qQ U N qIL,S
"oNE Cnu- NUMBER" 1-800-332-2344
48 HOUBS BEFORE DIGGING
I
INSPECTIONS:
tr ftU[Bg.,I#tP'flP,'##'#$fiBB#".1i]i"3Et'^l33,ffi-3-RTFT,l-iJt'p',[!fli,iE[S-,1fi...i8{3ipv ren --iNsPEcfibt.i, cijrlinAcio*s-on-oWNEn,s naiuE eIID PHoNE NUMBER. REOUESTS RECEIVED BEFORE 7:OO A.M. WILL BE
MADE THE 5AME DAi;iEciulli's AitEii 7:ob a.M. wrr-r- tsE MADE THE NExr woRKtNG DAY. lNSPEcrloNS ARE ro BE
cAr_r-eo tt' erren eiceva:rions Ane uAoe AND FoRM woBK ls tN pLAcE BUT PRIOR To PouRlNG coNcRETE.
I saruraRy sEwER, sroRM sEwER, ENCROACHMENT pEBMrr AND OTHER INSPECTIONS CALL ClrY MAINTENANCE AT
726-3761,
SIGNATURE:
RECEIPT NO: BECEIVED BY:
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AMOUNT RECEIVED:
IZ,Z9ffiP i
DATE PAID:
VALIDATION:
E rnerrtc REVIEWED BY:
I untrureNANcE:
E penrur tssuED BYi
FOR SIDEWALK AND CURB CW PEBMITS PI.ACE A COPY (COMPLETED) IN PERMIT DRAWER,
I DATE:
ir rue oF coMPLETtoN:
DATE:ELB/ENTH MONTH:
WORK IN PROGRESS
DEPOSIT BETURNED:DATE:
DATE:
DATE:
DATE:
DATE:
INSPECTION:
lNSPECTION:
I eruatrueEBtNc REVTEWED BY:
DATE:
DATE:
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