HomeMy WebLinkAboutPermit Land Drainage Alteration 1999-6-29 (2)
~ . /' ..: : '. --.: City of Springfield
This Side To Be Filled Ou'tbyApplicant
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;0.:0...:" ~ This permit is required for any site activity in the flo~d phiin and everYwhere sit: alteration consists of
....... ~ fifty (50) cubic yards of material or more and/or if a .drainageway is affe,cted, within City limits and
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By signature, I state and agree, that I have carefully 8X8rTdned.the ~ompleted application and do hereby cenify 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 contl'8ctors and employees who are in
compliance with QRS 701.055 will be use.d on this p~oject..' .'
The City may inspect the work site described in this perrnlt at 'any time.during a one.yesr period following the receipt by
the_ City of notice of completion of the described work and specify, at the City!s sole desecration, any additional restoration
work required to return the site to a standard acceptable to the City. .The perminee Will be notified in writing of any work
required and will have thirty (30) days from the date of the, noticeJo complete the work. Work not completed at the end of
. th~ thirty days will be performed by the ~ity and the costs will be b~lIed to the pe.rmlttee.
I funher agree to ensure that all required inspections are.rflquested.at the proper tlm8~.ttlat project address is readable from
t~e street, and the app~ved se~ plans will remain ~~ t~'e site 8~ all times during ~o,n~~ruct,ion.
Signature 0 .L-- ~~, ,', ,,: Date , ,7 -15'~9 {
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Date of Application &., I;: 1 I '1 '1
Permit Expiration Date:
Property Owner 9R\,.I.&>=r~.1.i':> lA..'\O\LlTY 7,oAi?"t>
Address : I 00 \ t--\ J. ."'\ ~t<JLIT:r
Phone: 71/-'-/ - '<(7Z-'=>
, CitY SIl"''"> Stata:ok.. Zip~
Site Address: 1001 1'-'1.1\,,..,\ <.,-m.-'?..6_1
,Springfield, Oregon
. ~ 7~O}~ (3~5-:4f/~_
UGB Tax Map N,r.\l- /, ~,lr' -:-:>K.L.. ....,'::)
Journal number applicable, Land Use Application'
Ta~ lot: doo
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Fill, Quantity GPoO C~ ,Sourcll,location '=;?lZ..'Nb.1"',I!.>'"':"
Supplier <.!.,p{/.., rJ/~I""'[.I, r-.. /.)" kP P ':]; Material ?J/J.J. -
GRADING, Quantity 0 '
. '1:rT.i:J 5> 0'-'
EXCAVATION, Quantity~~ <::!_,
Supplier: ' ,
Address
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Destination: ,
Project Supervisor' A..:r: .:rA~P,$,or-l
, . Phone "1 if '-f - -;:-, I:::J
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SITE PLAN Required Data:Quantity of material" Property lines and descriptions, Tax map and
lot number, Site address, Existing contour lines, Proposed contqur lines, Existing drainage
ways, Proposed drainage ways, Signific8(lt trees and foliage, Ground cover, Soil types,
Buildings, Septic systems, Sewers, Areas'subject to flooding, l)tilities, Areas subject to land
slides, Proposed site improvements. ' " ,... , ..
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, PHONE
COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
CITY
STATE
, , PHONE
CITY
STATE
cONs-n2,().L.TI Dr.!.
PHONE '. ",4,-Q 2-1<'
, Expiratio~ Date: t-I .. Z -, _ O{)
,CITY: $(>f2-/NbFl17U"'"
OFFICE PHONE ,<-17, qZ~< FAX 74"7.'0,0'1
, EMERGENCY PHONE:/ /.. 77/"" I"
CONTRACTOR NAME: <2.. ;::.,..l.'\O;;E, I ~I N ~
PROJECT SUPERVISOR: ~j (<Yf?-A.~An^,,'
Registration Number: ~ ?l,'\ '" \ ' ,
ADDRESS: ' g D f) <;''' I 0..':'.-\
STATE: n 1Z. . ZIP: C~?'-{77
MOBilE PHONE: or J '2..' I , I. "1
I understand that I or my successurs may have future plana formy property which may be anticipated or unanticipated at
this time. I understand that such future plans may require p~rmits and developement,approvals from the City of Springfield.
I understand that notwithstanding any approval of this Land and Drainage Alteration Permit (LOAP), that at the time 01
application of future permits or approvals the City may review and reconsider all actions which I or my successors have
undenaken persuant to this LDA? I understand that the City may a8 a condition .of any.future approval, require the
u~doing. changing, o(modificatioll of any actions wh.lch I he.ve undenaken as a result o! the City's approval of this LOAP,
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1/6/1998
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DRMNAGE. 0 Storm, 0 Diich,D Culvert. 0 Natural
WETLANDS, Description
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FLOOD PLAIN, Zone:
, FEMA COllltllunity Panel No.:
FLOODWAY, FEMA Commuriity'PilIlOl No.:
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PLAN CHECK FEES:
UP TO 100 CUBIC YARDS
101 TO 1.000 CUBIC YARDS
1.001 TO 10.0qO'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 t .000 CUBIC YARDS
1.001 TO 10.000 CUBIC YARDS
10,000 TQ 100,000 CUBIC Y ARCS
100.001. TO 200,000
Estimated Volume:
r;;~oc..-i,'
t3t',oo
Plan Check Fee:
Received 8y: ' ~~ 0,,-\~
Grading Permit fee: .,(. ~ ~~. 0.0
, Date:
\
$20.00
, $30.00
$40,OQ
$40.00 For 1he firsl 10,000 cubic yards, plus
$20.00 tor each ;ulditional 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.
, $30.00
$30.00 For the first 100 cubic yards. plus
$14.00 for ~8ch 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 thereat.
$264.00 For the first 10,000 cubic yards, plus
$54.00 for each mirlitionall0,000 cubic yards or fraction thereof,
$750.00 For the li':-;l 100,001 cubic yards, plus
$:10.00 for o,il..h addiliollnl 10,000 ..uhie ynrrls or frnetion thereof.
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Receipt No: 6~Y '1\2-
11 \"1 1'1"'1
Date:.2I \'1 (Cft
Dilte:
Receipt No: 15~i'll2-
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Date: :rj \1/"1.1
Received hy:
[v_ ' S\.'^ ^ ,". ~' .
-~'lv-"--:
Dille:
J::.N(""! J.k&/iI&.
'SE.F-' ,;4--:/'kJ:;II?iJ rJoHPO/t).<../>
o Plannin~
~Engineering ~ c.6 V.-r,,/
o Buiiding:
o Maintenance:
Permit Number
.B,:'lnllirprl_Fin~lln~nFH~tion~.. '
Planning:' '
Engineering:
Building:
Maintenance:
Date:
Date: '7 -;:)..7-4'1
Date:
Date
Issued by:
Date:
Date
Date
Date
Date:
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Land' and Drainage activilY 8soutlined in this permit has been completed in accordance with
the proviSions of this permit.. , .
Land' an'd DrajnaQe ac.tivitv' as outlined in this permit has not been completed in accordance
wtth, the proVISIOl1S ot thiS permit.
land'and Drainage activity was performed prior to application for this permit.
Accepted by: '
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Date:
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