HomeMy WebLinkAboutPermit Miscellaneous 1996-10-14
CITY OF SPRINGFlr'--'.D " PEr-"IT APPLICATION
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225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
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ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER:
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INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
APPLICATION DATE: If) -144~
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DATE ISSUED:
LOCA nON OF WORK
APPLICANT S'~ E_ '. C:.e.(q" Go...,q,t.e'?
SITE ADDRESS: I:' /0 ~cr .$,-
CITy:.SPA.I^,ch~ STATE: 0.(&,,10
PHONE (S<f/) 7'1? - -;/.{<,I(.
TAX MAP: /1-o-,.u;:.''2,?,
ZIP: "J7't77 TAX LOT: ""'~cit>
SUBDIVISION:
OWNER: &..w.r E. "Co.tlk'f' GC><<A........ PHONE:
ADDRESS: 1'3/0 ~ oS, CITY: S;>~I/VC/7E>.D STATE: a-e
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CONTRACTOR: I he. w......"c); ~ -Ab~RESS: 37cC ~ ~ r/.(~k,?"" Q
CONTRACTOR REGISTRATION NO: DS' B ~ 3'1 EXPIRATION DATE: 12..6./.,L
PROJECT SUP~RVISOR: S~ e. "~4.," (.;o"'~ k7 PHONE: 7'17 --;/<>?</"
7'f7-cf.W~
ZIP: , 7'(7 7
.el-iONE: 7~fo -1or<3
REQUESTED PERMITS:
INSPECTIONS REQUIRED: APPUCATION FEE I DEPOSIT
ACCOUNT NO:
D ENCROACHMENT PERMIT NO: ............................... n
VALID FOR SIXTY (60l DAYS FROM DATE OF ISSUANCE
o CUT STREET 0 BORE 0 OTHER
o DUST CONTROL )TYPE OF CONTROLI
o CONSTRUCTION, STORAGE. STAGING
o OTHER
o ASPHALT DEPOSIT. ..................
o
o $20.00/ .~.
O' ~
0$
0$
0$
n
n
illF OF SFr.IIRITV nFPO.srr
o BLANKET SURETY BOND 0 SURIITY BOND 0 CASH I CHECK
~RB CUT PERMIT NO: .................... FT. Zg 0
~ INSPFr.TION' CURB I APPROACH AFTER FORMS ARE ERECTED BUT PRIOR TO POURING CONCRETE.
, VALID FOR 180 DAYS FROM DATE OF ISSUANCE.
o SECON'D DRIVEWAY (SEE SEPARATE APPLICATION)
o SIDEWALK PERMIT NO:.................... FT. 0
VAllO FOR lao DAYS FROM DATE OF ISSUANCE.
o NEW 0 REMOVE / REPAIR 0 PAVE PLANT STRIP
o SETBACK 0 CURBSIDE 0 LENGTH
1~!e~".r.,.,!'''J:...SlDEWALK I DRIVEWAY FOR ALL CONCRETE PAVING WITHIN THE STREET RIGHT OF WAY. TO BE
MADE AFTER ALL EXCAVATING IS COMPLETE. AND FORM WORK AND sua. BASE MATERIAL IS IN PLACE.
D SANITARY SEWER CONNECTION PERMIT: ................ n
VALID FOR SIXTY l601 DAYS FROM DATE OF ISSUA.NCE
o TO STUB 0 MAIN LINE (EASEMENT-R/WI 0 OTHER
D STORM SEWER CONNECT/ON PERMIT: ....................n
VALID FOR SIXTY (60) DAYS FROM DATE OF ISSUANCE
o CATCH BAS'N I BUBBLER 0 STUB 0 MAINLINE
PROOF nF IN<"JRANCE' $500,000 MINIMUM
o ATTACHED 0 REQUIRED AMOUNT
0$
o $10.00+$.15/FT. /4 ;;2.or
o $10.00+$.15/FT.
0$5.00/.
o $5.00 /
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TOTAL DUE: $ "- r /-C/ '2-0
TOTAL DUE WITH PERMIT $
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:
,0 PLANS (TWO SETS) ATTACHED
AREA; LENGTH: 'wIDTH:
TYPE OF WORK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEMeNT 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:
FROM DATE:
TO DATE:
DEPTH:
TIME:
TIME:
HEIGHT:
BORE:
BACKFILL MATERIAL:
DESCRIPTION:
Advance signing and work lone protection to be in compliance with the Manual on Uniform Traffic Control Devices (MUTeD).
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD .
REVISIONS 8/24/95
FORM'116
PLAN REVIEW COMMENTS / SIAL INSTRUCTIONS: . .
RESTORATION WORK SHALL BE IN CO FORMANCE WITH EXISTING CITY CODES AND IN C1:>MPlIANCE WITH CURRENT
STANDARD SPECIFICATIONS, EXCEPT AS NOTED BELOW.
. 001 Backfill with "'. minus rock.
. 002 Compact every 18" loose depth.
. 003 Requires compaction with a steel roilier.
. 004 A.C. to match the greater of existing depth or 4".
. 005 All cuts sealed for final inspection.
006 Temporary patch may be used at the end of the day.
_ 007 Signing and Zone protection to comply with MUTeD
_ 008 Cut coricrete only on score lines or cold joints.
009 Sidewalks and drivews'ys min. 3.000psl.
_ 010 Curbing min 3.500psi I No patchwork less than 3'.
_ 011 Meet min. requirements on curb cuts, Spfd. code.
_ 012 Restore planted arees, Spfd. code 206.3.05
_ 013 Spec. to Bore I Jack I No A.C. cuts.
_ 014 Mechanical compacting required.
_ 015 No patchwork allowed.
_ 016 Lateral cuts to have control density fill.
017 Cuts to be polymerized crack sealad for final inspection.
018 Mininum 2" ~rushed rock %H minus.
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Comments:
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029
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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. 4500psi.
Concrete slabs require joint seal materia!.
Driveway requires dowels every 18".
Submit traffic control plan prior to excavation.
Notify Traffic Division before excavatipn.
Core drill main line, insert tee. 2% min. grade.
Must comply with the provisions of OAS 757.541 to 757.571.
6" Circular hole/H20-Vac.
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YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
I~ECTIONS:
~RB CUT AND SIDEWALK INSPECTIONS ~ALL 726-3769 (RECORDER) STATE YOUR DESIGINATED CITY JOB
NUMBER/PERMIT NUMBER, JOB ADDRESS, I ,,,,,,ue ,,,,,ec:TION REQUESTED. AND WHEN YOU WILL BE READY FOR
INSPECTION, CONTRACTOR'S OR OWNER'S NAME AND PHONE NUMBER. REQUESTS RECEIVED BEFORE 7:00 A.M. WILL BE
MADE THE SAME DAY, REQUESTS AFTER 7:00 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, ·
o SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726-3761.
SIGNATURE:
AMOUNT RECEIVED: JLj, .?-fJ
RECEIPT NO: r.::2 3 qbo/
DATE PAID:
RECEIVED BY:
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By signature, I state and agreej that I have carefully examined the completed application and do hereby certify that all information
herein is true and correct. and further certify that any and all work performed shall be done in accordance with the Ordinances of the
City of Springfield, applicable City Standard specifications and Drawlngshand the laws of the State of Ore.gon pertaining to the work
described herein. I further certify that only contractors and employees w 0 are in compliance with ORS 701.055 will be used on this
project.
The City may insp.ect the work site described in this P.ermit at any time during a one year period following the receipt by the City of
notice of completion of the described work and specify, at the City's sole descression, any additional restoration work required to
return the site to a standard acceptable to the City. The permittee will be notified in writing of any work required and will have thirty
days (30) from the date of the notice to complete the work. Work not completed at the end of the thirty days will be performed by the
City and the costs will be billed to the permittee.
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Signaturl'-- ----d ~'..(
I furthor agree to ensure that all required inspections are requested at the proper time, that project address is readable from the street,
and the approved set of plans will remain on the site at all tImes uring construction. .
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VALIDATION:
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o TRAFFIC REVIEWED BY:
o ENGINEERING REVIEWED BY:
o MAINTENANCE:
o PERMIT ISSUED BY:
Date
/O~0b
DATE:
DATE:
DATE:
DATE:
FOR S/DEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRA WER.
INSPECTION: DA TE:
INSPECTION: DA TE:
WORK IN PROGRESS DATE:
AT TIME OF COMPLETION: DATE:
ELEVENTH MONTH:
DEPOSIT RETURNED:
DATE:
DATE:
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spn'NC~If!LO
f'UULlC lI'O/iKS DEPARTMENT
.rICH.1/(\'IS7/;..'l.11(1lV
[NGIN[[I-;/N(; DIVIS1(1/IJ
M,1INl[NANCE
225 (.lrlH :il
SF/";!NGFI(UJ (If.'
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APPLlCATlor~ FOR A SECOND DnlVFWAY / OVFRWIDTH DRIVEWAY
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ADDRESS OF PROPERTY FOR DRIVEWAY P0RI.1IT: /3/ U /It.VK'. ~ S7""'"
APPlICAI,TS TELEPI~ONE NUMBEI Se.f/ 7"/J -<(,l~("
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OATE: ~ j/9h
APPLICANT (pROPERTY OWNER):
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PICClse sketch the proposed drive\'Jay. Include the following apP~c3ble items: house or building. proposed
driveway. existing dlivew.ay. Clod street names. Include dimensions and measurements 10 property lines. road
intersections and bordering driveW3)'s. (See attachment tor an example.)
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ALL APPUCA nONS OUTSIOE THE CITY UMITS OF SPRINGFIELD THAT AilE WITHIN THE l:JR13AN
GHOWTI1130UNOARV REQUIRE A LANE COUNTY PERMIT. ~ . c/' : .
l.Jale: The City of SplingGeld will nol giant a second driveway per mil on an Ar1cr.ia) Ot Collector Strcet. ..
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I 1. Property type:
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Single family Residence
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Olhe.
2. The proposed drivewaf' will take access hom which stlcet
3. The disl:Hlcc hom the edge of the dlivcway \0 the ne3(CSt COiner (measured to the cUlli rdulO) is:
fecI.
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",C The second driveway will give access to: g313gc_ C3rport_ side- yard~ Other
S. The dislance (rom tl1c,f1'ropcrty line 10 the garage, Cdrport fence. wall. or olher, (where tile vehicle"is
to be parked) is teet. .
. 6. \'\fill the propOsed par.~.ing I slorage <tlea create a. vision obstwctio.n to adjacent P(Opc~y driveways or.
10 any vehicular movem~nt on a puuGe street? (See vision clearance attachment)
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Applicant hereby agrees to install the requested driveway to City of Springfield standards. ~The-3pp(icanl further
agrees to have 6- of concrete in the side\N;31k area (adjacent to the driveway).;and to pave the area behind Ule
hack edge of the sidev.r.llk.,- or drivew:ay apron, with .. minim~m depth of 3" asphaltic concrete or 6" of portland
cement concrete. The area behind the sidevv.iU< shaD be paved a minimum of 18 feet.
The applicant agrees that if he/she does not p3ve the area behind the sidewalk withio-JO days of cutting the
curb opening, the City of Springf.eld has the .authority to close Ute d~ey,."3Y access by removal of the curb cul
An incurred costs shall be assumed by the applicant and it unpaid. said cost shaU become a lien of Ule property.
a. On an imp(oved street (e~isling curb): S10.00 plus $.15 per lineal foot of cUlb cut.
b. On an unimproved street (no curb): $ 12.00
c. On currently unimproved streets thal are under construction: $12.00
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VVhen this appGcation is approved by the City. the applicant must obtain a curbcuUdrivcway permit from the
Pub~c Works Department. Engineering Division.
Curbcut I Drivewav Permit Fe~
PROPERTY OWNER'S SIGNATURE'~_!:.'~cuet..C(.
DATE:
'7//7 / 7~'1
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APPROVED BY:
1Y\~ja t~~~\av;RI\rrIC DIVISION
.DATE:
BUILDING PERr~IT NO.'
.9ATE:
TRI\9-1 .
ATIACHMENT: Vision Clearance. Example 11'1
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