HomeMy WebLinkAboutPermit Sidewalk 1997-7-21
226 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726-3753
~
U:"LEASl::.-- (Iti}CL.
ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER:
13u lLPt ~b
DATE ISSUED:
I
,LOCATION OF WORK
APPLICANT /11" tLf>"" .ue
-..c.-- ,
SITE ADDRESS: v....;; loV. , ./
CITY: /J'..v(0Ii-~ STATE:
(' /J'Varo<< .,...,..c,~
, (.I>
91/0~t'
~
"
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
APPLIPATlON DATE:
7-zr-,n
"
/00/
I)/L
,PHONE L;'Cf/ - 3'1"; 71c::j::;
llilll-N57. rc,r..d3 ) TAX MAP: r1-u<?:' - 2,~-4/
ZIP: TAX LOT: 530cJ
SUBDIVISION:
OWNER:{lCo~ fA.). Z At->
ADDRESS: CITY: P U('::::> STATE:
CONTRACTOR: .l.tJc.Lek(2(~/?~ ADDRESS': V~ CJ ;;J/V//
CONTRACTOR REGISTRATION NO: <,L5":55Q EXPIRATION,DATE:
PROJECT SUPERVISOR:
PHONE: ::5q 1 .. 7/,/,'5
tf ,(~ ZIP:
PHONE: >~r~ -716f!
REQUESTED PFRMITS: INSPECTIONS REnUlRED,
I!rEN~ROAC~~'~NT PERMIT NO: ............................... n
VALlO FOR SIXTY (801 DAYS FADM OAT! OF ISSUANCE
Q CUT STREET Q BORE Q OTHER n
Q OUST CONTROLITYPE OF CONTROU
Q CONSTRUCTION. STORAGE, STAGING n
Q OTHER , fl
Q ASPHAL T DEPOSiT...........................................................................................................
TYPE OF SECIJRITY DEPOSIT
Q BLANKET SURETY BONO Q SURIITY BOND Q CASH / CHECK
a CURB CUT PERMIT NO: ................;... FT, 0
rNltHMJnN. CURS I APPROACH AFTER FOAMS AR! ERE'CTm NT t"fUOR TO POURINQ CONCRETE.
. VAll) FOA '80 DAVS FROM DAT! OF tSSUANCE.
/tI SECOND 'ORIVEWAY (SEE SEPARATE APPllCATION!
[f SIDEWALK PERMIT NO:.................... FT.-L:fO ( 0
VALl) FOR HIO DAYS FADM OAT! OF ISSUANt!. .
a NEW a REMOVE I REPAIR a PAVE PlANT STRIP
Q SETBACK a CURBSIDE a lENGTH
1N!It~"Tlnt.l. tlIOEWAU.1 DRIV!WAY FOR AU CONCRm PAVINO WITHIN THE STREET RIGHT OF WA'f, TO BE
MADE. AFTER AU. EXCAV:ATlNO IS COMPLm. AND FOAM WORK AND SUB-BASE MATERIAL IS IN PlACE.
a SANITARY SewER CONNECTION PERMIT: ................ fl
VALO FDA SIXTY ISOl DAYS FADM OAT! OF ISSUANC!
a TO STUB Q MAIN liNE IEASEMENT,R/W) a OTHER
a STORM SewER CONNECTION PERMIT: ....................n
VALID 'OR SIXTY 1801 DAVI FADM OAT! 011 ISSUANCI
a CATCH BASIN I. BUBBLER a STUB Q MAINLINE
fBC\n" n" ''''SlJRANCI'' $600,000 MINIMUM
Q ATTACHED Q REOUIRED AMOUNT
o $5.60 / '
o $5.00/
DESCRIPTION OF PROJECT:
TOTAL DUE: $
TOTAL DUE WITH PERMIT $
57 dj r)
PERI,9J>-OF USE OR TIME OF CO~STRUCTION:
!B""'PLANS (TWO SETS) ATTACHED '
AREA: LENGTH: WIDTH:
TYPE OF WORK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFilL MA TERIAl TO BE UTILlZ~D:
SURFACE REPLACEMeNT MATERIALS TO BE UTiliZED:
TYPE OF DUST CONTROL TO BE UTI~IZED:
NAME OF OTHER UTiliTIES IF THIS IS A JOINT PROJECT:
WARNING DEVICES TO BE UTILIZED: .. ...
Advanee signing and work zone prOlaellon 10 be In eompllanea Wlm lhe Manual on Uniform TraUle Control Oavlces {MUTeOI.
DESCRIPTION: (I t./ 128 /lo-r RJZI(/-(",Ll/iJ.IL. &MUI/,.<f/.- 'f .:5(j)&:LvA,,-~ eK/c:.,.:Jcc/'f./;'v/
DeL tI Ii'. /I/M l:e/L.fJt;Vk~7,
FROM DATE:
TO DATE:
7 - ;Z~,- 9'7
DEPTH:
TIME:
TIME:
HEIGHT:
BORE:
BACKFILL MATERIAL:
. .
WORK SHALL COMPLY WITH CHAp-rER X ARTICLE 5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD .
REVISIONS B/24/95 FORM '11 B
J
PLAN REVIEW COMMENTS I SPECI_Sl'RUCTIONS: ' I '
RESTORATION WORK SHALL BE IN CONFO.NCE WITH EXISTING CITY CODES AND IN MPUANCE WITH CURRENT
STANDARD SPECIFICATIONS, EXCEPT AS NOTED BELOW.
- 001 SackfUl 'with ". minus rock. ~ 019 Minumum 4' clearance at any point. swing-away.
. .
. 002 Compect every 18'loo.e depth. . 020 ConClete minimum 4' depth. 3.000pli.
;. 003 Require. compaction with 8 Iteel roilier. . 021 Trench to be""- cut.
004 A.C. to match the greater of existing depth or 4-, 022 Needa St.t, , County permit.
:: 005 All cutI.8alod for f1n.llnspectlon. -~ 023 No above ground encJollngaln sidewalk or handicap ramps.
: _ 006 Temporary patch may be und at the end 01 the d8Y~ 024 Diamond cut A.C./Concrete value bOlt" to grade.
: _ 007 S]gnlng and Zone protection to comply with MUTeD. 025 Fruh 011 algnl' Graded.
.. 008 Cut concrete only on score lines or. cold joint.. 026 Comply with Americans with Disabilities Act.
009 SIdewalks and drlvewaYI min. 3.000pll. 027 COoelate Ilabl. 72.hr1. curing t1me. 4500psi.
.
. 010 Curbing mln 3.500psll No patchwork less than 3'. 028 Concrete &lab. requllllolnt 18al material.
. 011 Meet min. requirements on curb cuts. Spfd. code. _ 029 Driveway requlrel dowell every 18-.
. 012 Restore planted.areas. Spfd. code 206.3.05 _ 030 Submit traffic conuol plan prior to excavation.
. 013 Spec. to Bore I Jack I No A.C. cutl. 031 Notify Traffic Dlvllion before excavatipn.
. 014 Mechanical compacting required. _ 032 Core drill main Un..lnlert tee. 2% min. grade.
_ 015 No petchwork ellowed. 033 Must comply with the provlslone 01 OAS 757.541 to 757.571.
. 016 Lateral cutl to have control density fill. j 343 6. Circular holeIH20.vac.
. 017 Cute to be polymerized crack sealed for final Inspection. ...J
018 Minlnum 2. crushed rock~" minus.
Comments:
YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
INSPECTIONS:
'0
CURB CUT AND SIDEWALK INSPECTIONS CALL 726-3769 (RECORDER) STATE YOUR DESIGINATED CITY JOB
NUMBER/PERMIT 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 WOfjK IS IN PLACE BUT PRIOR TO POURING CONCRETE.
o SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726-3761.
J
SIGNATURE:
AMOUNT RECEIVED:
RECEIPT NO:
0ir 0 ()
2Cn 7(",/
, DATE PAID:
RECEIVED BY:
7 --ZI- cf/
hoP. &f/d(/
'/
By signature, I stete 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 ell work performed shall be done In eccordance With the Ordinances of the
City of Springfield, applicable City Standard specifications and Drawlngshand the laws of the Slate of Ore~on pertaining to the work
described herein. I 'further certify that only contractors and employees w 0 are in compliance WIth ORS 7<Y1.05 5 will be used on this
, project.
The City may inspect the work site described In this p'ermlt 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 sole descreaalon, any additional restoration work reAuired to
, return the site to e standard ecceptable to the City. Tne permittee will be notified in writing of any work required and will have thirty
" daYS (30) from the date 0 the notice to cOlJlplete the work. Work not completed at the end of the thirty days'will be performed by the
, City and the costs will be b lied to the permittee. ,
, I furthor agree to ensure that all required Inspections are requested et the proper time. that project address Is readable from the street,
:~:n the approv d set of Ple_(J;:;;:~te at all tImes during construction. Date 7- 2/- 9 7
!
VALIDATiON:
0 TRAFFIC REVIEWED BY: DATE:
0 ENGINEERING REVIEWED BY: DATE:
0 MAINTENANCE: DATE:
0 PERMIT ISSUED BY: DATE:
: FOR,S/DEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) /N PERM/T DRAWER.
, INSPECTION:
:. INSPECTION:
WORK IN PROGRESS
AT TIME OF COMPLETION:
ELEVENTH MONTH:
DEPOSIT RETURNED:
DATE:
DATE:
DATE:
DAT~:
DATE:
DATE:
.'