HomeMy WebLinkAboutPermit Land Drainage Alteration 1999-3-17
~ ''". " ~.' '. " ('"'ty of Spl'ingfield
This Side To 8e Filled Out by Applicsnt
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=PR.:aPl.:" ~ This permit is required for any site activity in the flood plain and avarywhere site alteration consists of
.a.: &) fifty (50) cubic yards of material or mora andlor if a drainageway Is affected, within City limits and
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Date of Application '8) J"7 ) '1 ~
,
Permit Expiration Date: ..
Property Owner S"oJ~,. ""4/.1"'"-.... ~M
Address: n'SS' \1..':!!... 51[
Phone:
City oS AloCO....
ll'IIf~.:.:::'=' . .... .
!:~..,: ":'-.=-.:.. . _'- .~. Sprlngfhild,
Oregon
State:~ Zip'~'I.1.
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Site Address: ....v
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Tax lot: 'let>
UGB Tax Map No: \1 -01-- '32-oD
Journal number applicable land Use Application
l:3'
13'
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FilL, Quantity '2-.:>00 Tt}/oJ , Source Location si>R.,IVc..F,i::<-1)
Supplier S:;>Q.,"'Ct>f,t...b ~'" l:Wc.... ,Material c.4<~
GRADING, Ouantity I '-ou l-o.{
EXCAVATION,Ouantity 1'51>' e-l(
Supplier:
. Addrass P.do ~. IS 1)0 S,.
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Destination: <;j>IlI,vj&~,{;1oIl ~ ~c..1<
Projact Supervisor ~Ilik> CA4.~~
<;t>a..'Nr.FtCLIl ,Phonll ,41-'11.I.c;"
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)( '''~g~ r.;:gJ!1t;fji'red Jata:ouantity of material, Property lines and descrilltions, Tax map and
lot number, Site address, Existing contour lines, Proposed contour lines, Existing drainage
ways, Proposad drainage ways, Significant trees and follalle, Ground cover, Soil typos,.
Buildings, Septic systems, Sewers, Areas subject to flooding, Utilities, Areas subject to land
.slides, Proposad site improvements. . .
o CROSS SECTIONS,
o SOilS & GEOLOGY PLAN,
lEI DRAINAGE, POLLUTION AND EROSION CONTROL PLAN
o REPLANTING PLAN
o ADDITIONAL INFORMATION,
,~
, PHONE
COMPAN-Y NAME:
PROJECT SUPERVISOR:
ADDRESS:
COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
CITY
STATE
, PHONE
CITY
STATE
(CI1\:WM K. oivLA1 )
PHONE ..1 41 4'-' ~
.. Expiration Date: 4100
. CITY: S:~l rV(,~'''UJ
OFFICE PHONE i4t-'i't 1'$ FAX 14-, -01 04
EMERGENCY PHONE: "7h, -070';
CONTRACTO,R NAME: C$.~lol~ ~~1\"""
PROJECT SUPERVISOR: gll.Af) ~~"-'
Registration Number: "I.~ ('" I
ADDRESS: 80u c. ,'il~ Sl'.
STATE: 011... ,ZIP: q-,q..ll
MOBilE PHONE: (~ -" '? s'>
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I understand that I, or my successors may have future plans for my property which may be anticipated or unanticipated at
this time. 1 understand that luch future plans may require permits and developement approvals from the City of Springfield.
1 understand that notwithstanding any approval of this Land and "Drainage Alteration Permlf(LDAP), that at the time of
application of future permits or approvals the City may review and reconsider all actions which I or ,my successors have
undertaken persuant to this LOAP. I understand tha} the City may as a condition of any future app'roval, require the
undoing, changing, or modification of any actions Which I have undertaken as a result of the Cfty s approval of this LDAP.
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By signature. I state and agre8. that I have carefully" examined the completed application and do hereby certify that all
Information herein is true and correct. and I 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 Orllwlngs, "and the laws of the
State of Oregon pertaining to the work described herein. I further certify that only cOr)tractor!S and employees who are In
compliance with ORS 701.056 will be used on this project. "
The City may Inspect the work site described in this permit at any time during 8 one year 'period foilowlng the receipt by
the City of notice of completion of the described work and specify. at the Clty's lole desecration, 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 (30) days 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.
I further agree to ensure that all required insp'ections are requested at tha proper tlme~ that project address"ls readable from
the street, and the~ppro~ed 8~ of plans Will remain on the site" at 1111 times during construction; " "
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11rh&.~ 3-nAq '~~~.3~le I
t\~f'~ -$400.9
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1/6/1998
o DRAINAGE, Cl Stonn, Cl Ditch. Cl Culvert. Cl Natural
~ WETLANDS, Description---.: Y~"5 - '2>yC Cop'! Ot- }..u:1-P
W FLOOD PLAIN, Zone: (' _ , FEMA Community Panel No.: 41 'S~ 2- OoD34
(0 FlOODWAY, FEMA Community Panel No.: , Date:
PLAN CHECK FEES:
UP TO 100 CUBIC YAROS
101 TO 1.000 CUBIC YAROS
1,001 TO 10.000 CUBIC YAROS
10,000 TO 100.000 CUBIC YAROS
$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 additional 1 0.000 cubic yards or fraction thereof.
$340 For the first 200,001 cubic yards, plus
$6.00 for each additional 10,000 cubic yards or f~~ctionthereof.
100.001 TO 200,000
200,001 CUBIC YAROS OR MORE
GRADING PERMIT FEES:
UP TO 100 CUBIC YAROS
101 TO 1,000 CUBIC YAROS
$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 yerds. 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 additional 10,000 cubic yards or fraction thereof.
~~. "
Estimated Volume:_ 4-1"" V?Q) ~~...
Plan Check Fee: $4-D. DO
h,:3.
Grading Permit fee: $ 2<:)4
r ltlL
1,001 TO 10,000 CUBiC YAROS
10,000 TO 100,000 CUBIC YAROS
100.001 TO 200,000
Received By:
Receipt No: ~\ ~ I
Date:3(n (11
Receipt No:0332<61
Date:3- u~ <t 9
Date:~
Received by:
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Date:
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(tal Planni{lll
~En9ine~ring
o Building:
o Maintenance:
KC7rnI.A-
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Date:
Date:
Date:
Date
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Permit Number
Issued by:
Date:
B.e.nl,irp,rf j:in:::ll Inc::~~~tinn~.
Planning:
Date
Engineering:
Date
Building:
Date
Maintenance:
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Date:
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land and Drainage activity as outlined in this permit has been completed in accordance with
the provisions ofthis permit.
land and DralnllQe ac.tivitv as outlined in this permit has not been completed in accordance
With the prOVISI<1!1S or thiS permit. .
land and Drainage activity was performed prior to application for this permit.
Accepted by:
Date:.
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