HomeMy WebLinkAboutPermit Land Drainage Alteration 1998-6-22
o .... " Lity of Springfield
This Side To 8e Filled Out by Applicant'
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This permit is required for any site activity in the flood plain and everywhere site alteration consists of
~ fifty (50) cubic yards of material or more andlor if a drainageway is affected, within City limits and
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Date of Application
t.-J.2-q~
Permit Expiration Date:
Property Owner c'1lt-trT ,,,)... < /r",.J
Address: <:"2> ;;t '" "" ~ .. I
Phone: .22~ - J 12/
City 5pr--~ State:~Zip.zmA'
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Site Address: .5"''') J
~.1::h ST
,Springfield, Oregon
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UGB Tax Map No: J 70 3 3 -{,"3 V
Journal number applicable Land Use Application
Tax Lot: 0 t ;;:t.o l)
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FILL, QuantiN ?tl1l C, Yo , Source Location (7,1, . >4/lI{ Y
Supplier ~IJR ih Q..,-,~y ,Material I'lL AItNV~
GRADING,Quantity ,';lOI) C."'.
EXCAVATION, Quantity o/fr Destination: Aw A- Y ~
Supplier: , Project Supervisor J ~
Address , Phone ......~
SITE PLAN Required Data:Quantity of material, Property lines and desct;ions, Tax map and
lot number, Site address, Existing contour lines, Proposed contour lines, Existing drainage
ways, Proposed drainage ways, Significant trees and folialle, Ground cover, Soil 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,
COMPANY NAME: r-.1C7J-'H1 A-\c
PROJECT SUPERVISOR: ~
ADDRESS: fro ~ C; t!t <:T
COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
,PHONE' qrZ - () IL L..
CITY (;iI~JM> (,/HJue STATE CW
, PHONE
CITY STATE
CONTRACTOR NAME:
PROJECT SUPERVISOR:
GRf--p,...r-
R.c;y
...,2(~ -~II 7
W~ ,~~,.. A.l
PHONE
,Registration Number:
ADDRESS: ~N.. \I M1l::.L.AJ
STATE: p~ ,Zlp:q7~7 rr
MOBILE PHONE:~- FiO '"
, Expiration Date:
<, .,. , CITY: S? R F /)
OFFICE PHONE 72b - ~17 J FAX ., u; - <?'~ '7
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, EMERGENCY PHONE:
I understand that I. or my successors may have future plans for my property which may be anticipated or unanticipated at
this time. I understand that 6uch future plans may require permits and developement approvals from the City of Springfield.
I understand that notwithstanding any approval of this Land and Drainage Alteration Permit (LDAPI, that at the time of
application of future permits or approvals the City may review and reconsidar all actions which I or my successors have
undertaken persuant to this LDAP. I understand that the City may as a condition of any future approval, require the
undoing, changing. or modification of any actions which I have undertaken as a result of the City's approval of this LDAP.
. .
By signature, I state and agree, 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 Drawings. and the laws of the
State of Oregon pertaining to the work described herein. I further certify that only cOI'Jtractors and employees who are in
compliance with ORS 701.055 will be used on this project. .
The City may inspect the work site described in this permit 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 .ole deleeration. any addltionel reatoratlon
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 1301 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 enstZt at all required i pections are requeste,t the proper time, that project address is readable from
the street, and the a pr ed set of plans ' ill remain on the site at II times during construction. . _./
Signature ~ ~ " .....- /7 _ . Date t -;? '2 ...c:; V
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1/6/1998
[J DRAINAGE, 0 Stann, 0 Ditch, 0 Culvert, 0 Natural
[J WETLANDS, Description
[J FLOOD PLAIN, Zone: , FEMA Community Panel No.:
[J FLOODWAY, FEMA Community Panel No.: , Date:
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PLAN CHECK FEES:
UP TO 100 CUBIC YARDS
101 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
$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 10,000 cubic yards or. fraction thereof.
$340 For the first 200,001 cubic yards, plus
$6.00 for each additional 10,000 cubic yards or fraction thereof.
GRADING PERMIT FEES:
UP TO 100 CUBIC YARDS
101 TO 1,000 CUBIC YARDS
$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 8ach sdditionall,OOO 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 additional 10,000 cubic yards or fraction thereof.
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1,001 TO 10,000 CUBIC YARDS
10,000 TO 100,000 CUBIC YARDS
100,001 TO 200,000
Estimated Volume:
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Receipt No:
Date:
Plan Check Fee:
Received By:
Date:
Grading Permit fee:
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Receipt No:..:;;'."...,O/..:::8 Date:.6 ~~ ~
Received by:
Date:
[J Planninp
[J Engineering - -/"-,,,
cr-- Building:, ~fv/~ -" 2: r ~~...--,
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[J Maintenance:' l ,-
Date:
Date:
Date: ./-2 ~-c:;f'~
Date
Permit Number &:N;Z.A~';2 Issued by:
Date:
RAqllirAn FinAlln~pp.r.tinns'
Planning:
Date
Engineering:
Date
Building:
Date
Maintenaniie:
Date:
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land and Drainage activity as outlined in this permit has been completed in accordance with
the provisions of this permit.
Land and Dralnalle ac.tivitv as outlined in this permit has not been completed in accordance
With the provls,cJ!1S 01 this permit.
Land and Drainage activity was performed prior to application for this permit.
Accepted by:
Date: