HomeMy WebLinkAboutPermit Sidewalk 1996-12-13
rlrrvoF,sP'RINGFI(' if"-J,~'~':::" ",'~' ',;, PEr- IT APPLICATION
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225, FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726,3753
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ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER: 7>0 / r;.,c;-'(o
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
APPLI(;A TION DATE:
/z-~ /~- 1'&
'1
DATE ISSUED:
/7-/2.,-C(e-.,
,LOCATION OF WORK
APPLICANT ?, ',Jl,F.L -rOt-! &2t'Jc.
SITE ADDRESS: I (^ \::>, M 1. \ IJ oS-r
-sf) STATE: ()~
PHONE
CITY:
ZIP:
TAX MAP: 17-63 -'5c.,- 5 (
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STATE: oIL ZIP: <.~..,..--
p\::..oe. W(..fi"o'"1>HONE: -4t%c)~<I?
'7/ ;ilY1
TAX LOT:
SUBDIVISION:
OWNER: I) 0 ,W-E.S-r 6'0 (rvlJo.., v /ooI.ILA-r LO~ <.. .
ADDRESS: I \0 12., M A.1N S 1, CITY: 6P
CONTRACTOR: ~ING~l'ON &lcI',. ADDRESS: ?7r;:- ALVA
CONTRACTOR REGISTRATION NO: ::-r~'? ,ffr EXPIRATION,DATE:
PROJECT SUPERVISOR: ;::)( l"'. .:R ,..J/:.,eLfCI;.f
PHONE:
Cl;<-. _sv-~9r
PHONE: L/t1.f9"'7'7
REQU..,ESTED PERMITS: INSPECTIONS REQUIRED: APPLICATION FEE I DEPOSIT
h&f'ENCROACHMENT PERMIT NO: ''',,'',,'''' '" """" '",," n ~OO 1
~ VALID FOR SIXTY (601 DAYS FROM DATE OF ISSUANCE
o CUT STREET 0 BORE 0 OTHER' n 0 $
o DUST CONTROL (TYPE OF CONTROLl
ACCOUNT NO:
o CONSTRUCTION, STORAGE, STAGING
o OTHER
o ASPHAL T DEPOSiT........... ...........................
n
n
0$
0$
0$
LYPF nF SFr.\JRITY nFPnSII
o BLANKET SURETY BOND 0 SURIITY BOND 0 CASH I CHECK
0$
o $10,OO+$,15/FT,
D CURB CUT PERMIT NO: ..'",,,,....,,...., FT, 0
IN~PFr:TlnN. CURB I APPROACH AFTER FORMS ARE ERECTED BUT PRIOR TO POURING CONCRETE. .
VAllO FOR 180 DAYS FROM DATE OF ISSUANCE.
_ ..-O-SECOND DRIVEWAY (SEE SEPARATE APPLICATION)
~ !1YSIDEWALK PERMIT NO:......,..,........., FT, 0
VALID fOR 180 DAVS fROM DATE OF ISSUANCE.
o NEW 0 REMOVE I REPAIR 0 PAVE PLANT STRIP
o SETBACK 0 CURBSIDE 0 LENGTH
J,tJ~~f....TL'1.~I.:...SIOEWALK I DRIVEWAY FOA ALL CONCRETE PAVING WITHIN THE STREET AIGHT OF WAY. TO BE
MADE AFTER ALL EXCAVATING IS COMPLETE. AND FORM WORK AND SUB-BASE MATERIAL IS IN PLACE.
D SANITARY SEWER CONNECTION PERMIT: ....,......".., n
VAllO FOR SIXTY 1601 DAYS FROM DATE OF ISSUANCE
I fi"T6 STUB 0 MAIN LINE IEASEMENT.R/WI 0 OTHER
[y'STORM SEWER CONNECTION PERMIT: ....,..,............ n
VALID FOR SIXTY 1601 DAYS FROM DATE OF ISSUANCE
DCA TCH BASIN / BUBBLER 0 STUB 0 MAINLINE
eJlllnF nF INSIIRliliCE; 5500,000 MINIMUM
o ATTACHED 0 REQUIRED AMOUNT
o $10.00 + $,15/FT,
J2<2~
o $5,001 '
o $5,001
.f~ 0 p
TOTAL DUE: $
TOTAL. DUE WITH PERMIT $
#?/7.2S
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:
o PLANS (TWO SETSI ATTACHED
,AREA: LENGTH: .WIDTH:
TYPE OF WORK, CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEMENT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UTiliZED:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
FROM DATE: l2-r7-4'h
TO DATE:
DEPTH:
TIME:
TIME:
HEIGHT:
BORE:
BACKFILL MATERIAL:
WARNING DEVICES TO BE UTILIZED:
DESCRIPTION: --2Yt.l"',1L
Ih v "~f hL-
Advance signing and work zone protection to be in compliance with the Manual on Uniform Traffic Control Devices (MUTCDI.
"5'?&LM 6W~ (P,2IL1M~) ({) . A03f1!L (("O"-LJlE<:'f -tD
t!,.ti: /J/21t-<-. j2,u~JJt.PL.,. -
WORK SHALL COMPLY WITH CHAPTER X ARTICLE S OF THE CITY CODE, CONTRACTOR TO COMPLY WiTH MUTCD ,
REVISIONS 8/24/95 FORM , 116
PLAN REVIEW COMMENTS /IIAL INSTRUCTIONS: .. -------
RESTORATION WORK SHALL BE IN !JNFORMANCE WITH EXISTING CITY CODES AND IN C'OMPUANCE WITH CURRENT
STANDARD SPECIFICATIONS, EXC ,PT AS NOTED BELOW.
001
002
003
004
005
006
007
006
009
010
011
012
013
014
.J 015
J 016
J 017
..J 018
-
Comments: .
Bacldiil with Yo" minus rock.
Compact every 18" loose depth.
Requires compaction with a steel roilier.
A.C. to match the greater of existing depth or 4",
All cuts sealed for final inspection.
Temporary patch may be used at the end of the day.
Signing and Zone protection to comply with MUTeD
Cut concrete only on score lines or cold joints.
Sidewalks and driveways min. 3.000psi.
Curbing min 3.500psi I No patchwork less than 3',
Meet min. requirements on curb cuts, $pfd. code.
Restore ~lanted areas, Spld. code 206.3.05
Spec. to Bore I Jack. I No A.C. cuts.
Mechanical compacting required.
No patchwor~ allowed.
Lateral cuts to have, control density fill.
Cuts to be polymerized crack sealed for final inspection.
Mininum 2" crushed rock If,'' minus.
:J 019
:J 020
021
022
023
j 024
..J 025
..J 026
..J 027
..J 028
..J 029
..J 030
.J 031
..J 032
..J 033
..J 343
..J
Minumum 4' clearance ot any point, swing-away.
Concrete minimum 4" depth. 3.000psi.
Trench to be Hr cut.
Needs Slate / County permit.
No above ground enclosings in sidewall<. or handicap ramps.
Diamond cut A.C.lConcrete value boxes to grade.
Frestl Oil signs / Graded.
Cornllty with Americans with Disauilities Act.
Concrete slabs, 72hrs. curing time, 4500psi.
Concrete slabs require joint seal material.
Driveway requires dowels every 18".
Submit traffic. control pion plior to excavation.
Notify Ttaflic Division before excavati~n.
Core drill main line, insert tee, 2% min. grade.
MUSI comply with the provisions 01 ORS 757.54110 757.571.
6" Circular hole/H20.Vac.
YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
SIGNATURE:
AMOUNT RECEIVED:
RECEIPT NO:
/72-C;-
rz.-40<:f'Z..
DATE PAID:
RECEIVED BY:
INSPEC.JIONS: !
~RB CUT AND SIDEWALK INSPECTIONS CALL 726-3769 (RECORDER) 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 WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE,
~NITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726-3761,
.
/2 - /3--10
606 ;::::...
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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 Drawlngshand the laws of the State of Ore_90n pertaining to the 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
project.
The City may inspect the work site described in this ,p.ermit at any time during a one year period following the re.ceipt by the City of
notice of completion of the described work and specIfy, at the City's sole descression, 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
days (30) from the date of the notice to complete the work. Work not completed at the ena of the thirty days will be performed by the
City and the costs will be billed to the permittee.
I furthor agree to ensure that all required inspections are requested at the proper time, that project address is readable from the street,
and the approved set of plans will~main 0,.., e site at all times during construction.. .
Signature
,
VALIDATION:
o TRAFFIC REVIEWED BY:
o ENGINEERING REVIEWED BY:
o MAINTENANCE:
o PERMIT ISSUED BY:
Date
/,??-/3- ?-~
DATE:
DATE:
DATE:
DATE:
FOR SIOEWALK ANO CURB CUT PERMITS PLACE A COPY ICOMPLETEOj IN PERMIT ORA WER,
INSPECTION: DA TE:
INSPECTION:
, WORK IN PROGRESS
AT TIME OF COMPLETION:
ELEVENTH MONTH:
DEPOSIT RETURNED:
DATE:
DATE:
DATE:
DATE:
DATE: