HomeMy WebLinkAboutPermit Land Drainage Alteration 1999-3-11
',,;' .' j - . - - ..~. . . ,~ity of Spl'ingfield .
This Side To 8e Filled Out by Applicant '" 't'/:,':It1'~~'.1;'~"
=~...':" ~ This per'mit is required for any site activity in the flood p:a~-and everywhere"slte ~~erati~~ consists of
" -... . fifty (60) cubic yards of material or more and/or if a drainage~~y Is effected, within City limits and
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Date of Application '3 . II . qq Permit Expiration Date: .. '/t? II. ' cjl:j
Property Owner ,--;5dhvt f.rnd.7L mrnd Phone: 77.(r 0/17.7'
Address: ----rik; Ed, ~Id. City ')~~~tate:~ZiP_
Site Address: 5 3,CfO /l1a./~ :s.T ' '~'-.Sprlngfield, Oregon
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UGB Tax Map No: /70 Z- -:z., -=s 3/
Journal number applicable Land Use Application
Tax Lot: ~~3
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FILL. Quantity
Supplier
GRADING, Quantity
EXCAVATION, Quantity
Supplier:
, Address
, Source Location
, Material
-:t::Y;f?u
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Destination:
Project Supervisor '
, Phone
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. SITE PLA Requirea ata:Quantity of material, Property lines and descriptions, Tax map and
lot number. Site address, Existing contour lines. Proposed contour"lInes. Existing drelnage
ways, Prollosed drainage ways, Significant trees and follalle, Ground cover. son types..
Buildings. Septic systems, Sewers, Areas subject to flooding, Utilities, Areas subject to land
slides, Proposed site improvements. , .,,'
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CROSS SECTIONS.
SOILS & GEOLOGY PLAN,
DRAINAGE, POLLUTION AND EROSION CONTROL PLAN
REPLANTING PLAN
ADDITIONAL INFORMATION,
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COMPAN-Y NAME: (.J6nn 17 ~S-t ~f(Oc'~/lJfS) . PHONE
PROJECT SUPERVISO~
ADDRESS:
COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
--
CITY
STATE
. PHONE
CITY
STATE
CONTRACTOR NAME: $.+f 1:-/ V W1l(}1fjr UiiiJ? Dv /JfCK F..~r:riVf1 'T/On
PROJECT SUPERVISOR: .-no. P/'-'IM J4't~r' PHONE "7,,1./1 7ZJt.l1 "
, Registration Number: /0/ A .0) ',ExpiratlonOate: '7..:2 ~ . q"'f
ADDRESS: .-S-~ 3~ 'D~/s.. ')p.71-57 ,CITY: ~.P-Ij."
STATE: OIC. ,ZIP: ;if 7t71V OFFICE PHONE 7<14 ~C/) . FAX$i' 3Z.~'r_
MOBILE PHONE: -5'1.0 Z,1A ~ , EMERGENCY PHONE: "74 (p.9;8 z,q
I understand that J. or my succe8sors may have future plans for my property which may be anticipated or unanticipated at
this time. I understsnd that such Mure plans may require permits snd developement approvals ,from the CItY of Springfield.
I understend thst notwithstanding sny approval of this land and Drainage A1terstlon Parmlt"lLDAPlithat at ,the time of
application of future permits or approvals the City may review and reconsider all actions which I or .my IUCce8aors have
undertaken parauent to this LOAP. I understand that the City may 8S 8 condition of any ~_approY81, require the
undoing, changing, or modification of any actions which I have undenaken as a result of the ctty"s approval of thle LDAP.
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By signature, I state end agree, that I have carefully examined the completed application and do hereby certify that all
Information herein is true end correct, and I further certify that any and all work performed shall b8 done In" accordance
with the Ordlnsnces of the City of Springfield, applicable City Standsrd specifications and,O"wfngli; 'and the laws of the
StatB of Orag,?" pertaining to the .work described .h8r8ir~. I further certify that only COr:rtr8ctO~ and em..:., ,.... who are In
compliance wlth ORS 701.055 will be used on thiS proJect. . '..
The City may inspect the work lite described in this permit at any time during a one year 'period foi'owlng the receipt by
the City of notice of completion of the described work and specify. at the City's lole del. _':.:..J# any additional reltoration
work required to return the site to a standard acceptable to the City. The permittee will be nottfied In writing of any work
requlrad and will have thirty (30) days from the date of the notice to complete the wor~ Work not cOmpleted at the end of
the thirty dsys will be performed by the City and the com will be billed to the permittee." '
I further agree to ensure that all required inspections are requested at the proper tlme~ thiit'ptOJect' address. I. readable from
. the atreet, and tha appr~et of plana will remain on the site at all tlm.. during conltrUctlon, . '.' .
Slgnsture ~~['t~_. ' 0, ste '/.:3. / /. ~
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DRAINAGE, rJ Storm, 1:1 Di~c.r' 1:1 Culvert, 1:1 Natural
WETLANDS, Description Nt>M .
FLOOD PLAIN, Zone: (~ , FEMA Community Panel No.: 4/?!i12 OW 2 A
FLOOOWAY, FEMA Community Panel No.: , Date:
PLAN CHECK FEES:
UP TO 100 CUBIC YARDS
10J TO 1.000 CUBIC YARDS
1,001 TO 10,000 CUBIC YARDS
10,000 TO 100,000 CUBIC YARDS
100,001 TO 200,000
200,001 CUBIC YARDS OR MORE
GRADING PERMIT FEES:
UP TO 100 CUBIC YARDS
101 TO 1,000 CUBIC YARDS
1,001 TO 10,000 CUBIC YARDS
10,000 TO 100,060 CUBIC YARDS
100,001 TO 200,000
$20.00
$30.00
$40.00
$40.00 For the first 10,000 cubic yards, plus
$20.00 for each additional 10,000 cubic yards or fraction thereof.
$220.00 For the first 100,001 cubic yards, plus
.20.00 for each eddltlonlll0,OOO cublo v.rdl or f,.otIon ther.ot,
$340 For the first 200,001 cubic yards, plua
$6.00 for Bach additional 10,000 cubic yards or fraction thereof.
$30.00
$30.00 For the first 100 cubic yards, plus
$14.00 for each additional 100 cubic yards or fraction thereof.
$ 156.00 For the first 1,000 cubic yards, plus
$12.00 for each additional 1.000 cubic yards or fraction thereof.
$264.00 For the first 10,000 cubic yards, plus
$54.00 for each additional 10,000 cubic yards or fraction thereof.
$750.00 For the first 100,001 cubic yards, plus
$30.00 for each addittonall0,OOO cubic yards or fraction thereof.
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Estimated Volume: 41"'-''''~'fI#III:~
Plan Check Fee: $:3CJ, c:D
Received By:
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Grading Permit fee: ,17"1 ~r, -
Received by: ~ .'7J! .
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Receipt No:
~J/SI17
Receipt No: 3~451 Date:
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Date:
Date:
Plannin~
Engineering VI C, 1.-:
Building:
Maintenance:
Date:
Date: }\ '<-\.\ \~,
Date:
Date
Permit Number
Issued by:
Date:
.8aQ.u;r~~ !:lnal InSpAl":tinns'
Planning:
1/6/1998
Date
Building:
EnGineering:
Date
DRte
Maintenance:
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Date:
Land and Drainage activity as outlined in this permit has been completed In accordance with
the provisions oTthis permit.
Land and Drainage ac.tivitv as outlined in this permit has not been completed in accordance
With the pr.OVISlonS ot tn,S permit.
Land and Drainage activity was performed prior to application for. this permit.
A!icepted by:
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Date:
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