HomeMy WebLinkAboutPermit Miscellaneous 1999-3-11
22i'l-FIFTH STREET
-.SPRINGFIELD. OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726.3753
.~
ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER: 9 9 03~ 2;.: , ..
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE '
APPLICA TION DATE:
. ,LOCATION OF WORK
'.
DATE ISSUED:
M A-/U!.JI I ( . I <39 9
APPLICANT (fit. c:,/') v)?('...,' .f1c/m 6, r .............
U
SITE ADDRESS: /7t;q C ft-1?/,,_
CITY: J/JP-r'Tf-?/.,L STATE: ,nt?
SUBDIVISION~ .
OWNER: ---:]/f)d_ ~,.-q..I<:Cfr'.- PHONE:
ADDRESS:..1/I/) t,/' P1e;.A.. CITY: ~#""(Z.. t:;rt/ STATE:[)f(
CONTRACTOR:C'p'Gp~<A ,f7//o( __ ADDRESS: :f.'o... t./ Co. ~ ~~
CONTRACTOR REGI{TRATION NO: 0 4...,. <"'S-,. exPIRATION.DATE:
PROJECT SUPERVISOR: /J2../r:-.- t:--I-/V_~
PHONE
q r;xI- t::)..J, 1-.
ZIP:
.TAX MAP:
TAX LOT:
':~;* D
ZIP: r'?</.)... Y
,PHONE: 'i...y'l'~>!):J...j2 _
PHONE: 1f"~.("'12~
REQUESTED PERMITS: .....CTlCN...OUIlWl' AI'I'UCATlONFU,DUOSIT
..d-NCROACHMENT PERMIT NO: ............................:.. n e>K ~'80 oiil
-:;IjlIir C VAL" FOR SIXTY roOl DAY. FROM DATI OF ".UANCE ". \;::&II?" .
o CUT STREET 0 BORE Q OTHER 0 0 $
o DUST CONTROllTYPE OF CONTROU
ACCOUNT NO:
o CONSTRUCTION, STORAGE. STAGING n
o OTHER ,n
o ASPHALT DEPOSIT ......................,.........................,..........................................................
rleEJl" !':"r.VRITV O~POSIT
o BlANKET SURETY BONO Q SURIITY BOND 0 CASH 1 CHECK
0$
0$
0$
o CURB CUT PERMIT NO: .................... FT._ 0
INO'MlI'lN. CURD I APPROACH AFTER FORMS ARe: ERECTED BUT PRK)RfO POURlNQ CONCRETE.
. VALl) FOR 110 DAV. FROM OATI 0' ISSUANCE.
o SECOND DRIVEWAY ISEE SEPARATEAPPUCAnONI
~ SIDEWALK PERMIT NO: ...........~...... FT. )<, Z. n
VALl) 'OR taO DAVS FROM DATI 0' 1S8UANCL
o NEW 0 REMOVE I REPAIR 0 PAVE PLANT STRIP
O'SETBACK 0 CURBSIDE, 0 LENGTH
INC:PIf"Tln~, ';:IDEWALK I,DRr./EWAY FOR AU. CONCRm P",VINQ WITHIN THE STREET RIGHT 0' WAY, TO BE
MADE AfTER ALL E.l(C~VATING 18 COMPUTE '. AND fORM WORK AND SUB-BAS! MATERlAL IS IN f't..ACe:.
o
0$
o $10.00H.16/FT.
1if $10.00H.16/FT,
2-{SO
,
. ,
a $6.0"0 I .
o $5.00 1
TOTAL DUe;-.
TOTAL DUE WITH PERMIT $
2.. I. 5"Q
z. , . S"O
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:
o PLANS (TWO SETS) ATTACHED
AREA: LENGTH:
TYPE OF WORK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEM'eNT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UTlPZED:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
WARNING DEVICES TO BE UTILIZED:
Advanc. .lgnIn; Ind wOlk zono protection to b.ln campll.nc. w;m th, Manual on Uniform TraUlo Control D.v1clI (MUTeDI.
CoNTIt!.ACTote- C!./I AP. tbtFO '/)oUI!J~€ 01/= "Te7 UlO!<.-k:
JIfM:/N~ i:;L?N~ Wl7fffiOT jOG""~{T
FROM DATE:
TO DATE:
WIDTH:
DEPTH:
TIME:
TIME:
HEIGHT:
BORE:
. BACKFILL MATER~AL:
DESCRIPTION:
WORK SHALL COI~PLY WITH CHAPTER X ARTICLE 6 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD ,
REVISIONS 8/24185 FORM , ltI '
.
1:('007/'"
,PLAN REVIEW COMMENTS I SPECIAL INSTRUCTIONS: - ., ,
REit~~~O~~OR~ ~M B~~.ANCE m EXISTING CITY CODES AN.MPUANCE WITH CURRENT -
001 BtckfllllNlth." mlnut rock. ~ 019 Mlnumum 4' clllranc..t .ny point, ewlng..w.y,
~TA 002 cc:p.ctl~~':18'IOO:' d.pth. OTED BEL. 020 Concrat. minimum 4" d.pth, 3,OOOP~I, '-.., :...
. 003 R.qulre. oomp.etlon with. 11111 rolll." 021 Trench to b. "T" C\lt. .
. 004 A.C. to m.tch tho gre.t., ololdlllng d.pth or 4'. 022 Nlldl St.t. 1 CountY p.rmlt. ;
. 005 All C\lt.,...I.d lor fln.ll""p.cilon, . 023 No .bov. ground .nclollng.ln Ild,w.lk or hlndlclp romp.,
. 008. 'T.mpo..;y p.icllmay b. u..d.t tho.nd of tho d.y. . 024 ol.mond C\lt A.C./Concret. valu. boxlI to groda,
. 007 Signing .nd Zond prot.etlon to comply with MUTCO . 025 Frelh 011 Ilgnl 1 Gradad.
. 008 Cut ooncret. only, on Icore IIn.. 0, oold lolntl. 026 Comply with Am.nc.nl with olllblllUII Act,
_ 009 ,.81d.w.lkI,l~d drlylwlYI.mln. 3,OOOplL . 027 Concr.t. "Ibl, 72hra, curing tlm., 4500p.l.
. 010, "Curblng mln 3.500poll No pllchwork '''I thin 3', . 028 Concretoollb. raqulre 10Intl..1 mlt.ri.I,
. 011 MOlt min. requlrem.ntl on curb C\lt., Spld. cod.. 028 Onv.woy requlrl. dow.11 .v.ry 18'.
. 012 Rlltore pl.nt.d,.,.... Spfd. cod. 208,3.05 030 Submlttrofflo control plln prlor'o exc.vaUon.
. 013 Sp.c.to 80re 1 J.ck 1 No A,C, C\lt.. 031 Notify Trafflo olvlllon beforeoxc.v.tlpn,
_ 014 Mechenlc.1 comp.etlng required. 032 Core drill m.ln line, In..rt t... 2% mln, gred..
_ 015 No P.t9hwork .1I0w.d, 033 MUlt comply with tho provlllonl of ORS 757.541 to 767.671.
_ 018 I.Iterel C\ltl '0 hev. control d.nl1ty flll. 343 S' elrcul., ho,.1H20-V.c.
017 Cutl ,ob. polym.nz.d crock 1I.I.d for lInlllnlp.ctlon. '
.:. ' 018 Mlnlnum 2' c","h.d rock .. mlnul,
Comments:
.
.,
. ' , YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
. ~ ..
INSPECTIONS:
'Q
CURB CUT AND SIDEWALK INSPECTIONS CALL 726-376SIRECORDERI STATE YOUR DESIGINATED CITY JOB
NUMBERIPERMIT NUMBER, JOB ADDRESS, TYPE OF INSPECTION 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 WOijK IS IN PLACE BUT PRIOR TO POURING CONCRETE.
o SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726-3781,
SIGNATURE:
.,
AMOUNT RECEIVED:
RECEIPT NO:
S2LS"O
033134
io
DATE PAID:
RECEIVED BY:
M A-/U!.H II I ~q9
B,(....T~
By signature, I state and agree~ that I have carefully examined the completed application and do hereby certify that all information
herein Is trlJe 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 Ity Standard specifications and Drawlngshand the lawI !/f the State of Ore~on pertaining to tha 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
proJact.
The CItY may Insllect the work lite described In this permit at 'any ~Ime during a one year period following the receipt by the City of
notlca 'of.completlon of the delcrlbed work and 8peC1i.fY, at th, City I lole descresslon, aPrY additional restoration workre~uired to
, return the ,ite to a Itandard acceptable to the City. The permlttea will be notified in writ ng of any work required and will have thirty
, daYI (301 from,the dftte of the notice to complete the work. Work not completad at the ena of the thirty days'will be performed by the
CItY and the costs will be billed to the permittee,
I furthor asree to ensure that all required Inspections are requ&ted at the proper time, that project address Is readable from the street,
and the approved set of plans will remain on the lite at all times during construction.
Slg~ature_/l4Y~ Date i-/1~91
VALIDATION:
o TRAFFIC REVIEWED BY:
o ENGINEERING REVIEWED BY:
, 0 MAINTENANCE:
o PERMIT ISSUED BY:
DATE:
DATE:
DATE:
DATE:
. INSPECTION:
. .,...to'
:, INSPECTION:
WORK IN PROGRESS
AT TIME OF COMPLETION:
EI.EVEN:rH MONTH:
DEPOSIT RETURNED:
: FOR S/DEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.
DATE:
,D~TE:
DATE:
OAT!':
DATE:
DATE:
'."
. \' .;,....
to>>, . .
, ~ ,~~
. -
.'
~ .-' .
.-"
.
.
~--
C:L~Y of Spl~ir\gfi~ld
225 F~,fth S1.r'eet
Spri"gfj,eld, OR 3~477
(50:1) ('26-375:3
Tr'ansaction nuo,ber 033i.34
Ma~c~ i1, '1939 1~47 PM
Rec~ived from: CHAPMAN PL;jMBl~I;;
COf~tract;O~n ~ CONTRACTOR
Addl~ess: 242 WEST 6TH STREET
c.; ly: EUGENE
St. OR Z.p' 37401
-FllJild.lng-
Job :;: ~ 3:..J0332
(l1?SCf' .Lp"t, ion
l:el?
Sidp.l.l.l,;,\H:
21.50
To-t;Jl :
AIT.t :,ecf:';, v~d ~
Ch~r..'k :fl:: (~2()/t
Pi ~ ~iO
;:':1." ::jU Ci\r:~!~i.;
Thar\k Y(liJ~ Bob T.