HomeMy WebLinkAboutPermit Curb Cut 1997-4-4
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (503) 726.3753
~
ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER: 9 711~ 9/ .
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
APPLlGATION DATE: ?:> ~ I L/,1(J
...
DATE ISSUED:
q/qA7
. ,LOCATION OF WORK
APPLICANT -:!()U-..J Lc~
SITE ADDRESS: qq() ()( /) t'JP&'t/4liJ IN
CITY: ~ STATE: (SA-
SUBDIVISION: _1?.IlJ~ ~
OWNER: -:lDI.-I iJ I L' ~
ADDRESS: I I CITY:
CONTRACTOR? /BCd(', -rI/EJf'ff"s 'i::'O/VJ(~:
:'CONTRACTOR REGISTRATION NO:;rrR rDlq~~
, PROJECT SUPERVISO~: prp= TV/!"Il.ff5
.PHONE 7(/h - U 75
TAX MAP: / 7-o?- 2:; -q ~
ZIP: Q7'f77 TAX LOT: '2000
PHONE:
tf
STATE:
,--
ZIP: ,. /
7(,.1{~ ~~t<LJ PHONE:
EXPIRATION DATE: ''i?{ rb/~
, ,- PHONE: /' c;</d:J.-,;?76f
REQUESTED PERMITS:
o ENCROACHMENT PERMIT NO: ........................,...... n
VALID FOR SIXTY (601 DAYS FROM DATE OF ISSUANCE
o CUT STREET 0 BORE 0 OTHER n
o OUST CONTROL (TYPE OF CONTROLI
o CONSTRUCTION. STORAGE. STAGING 'l
o OTHER n
o ASPHALT DEPOSiT........ ..................... ....,............................................ ..........,........... .......
!VD!: n!: .~I=~IIRITV n!:pn~rT:'
yaLANKET SURETY BONO 0 SURIITY BOND 0 CASH 1 CHECK
a:rCURB CUT PERMIT NO: ....,.....,......... FT.--.k ' 0
IN~PFCTlnN. CURB' APPROACH AFTER FORMS ARE ERECTED BUT PRIOR TO POURING CONCRETE.
VALID FOR 180 DAYS FROM DATE OF ISSUANCE.
o SECON'O DRIVEWAY (SEE SEPARATE APPLlCA TIONI
o SIDEWALK PERMIT NO:.................... FT. n
VALlO FOR 180 DAYS FROM DATE OF ISSUANCE.
o NEW 0 REMOVE / REPAIR 0 PAVE PLANT STRIP
o SETBACK 0 CURBSIDE 0 LENGTH
INC:PI=I"'TION. SIDEWALK J DRIVEWAY FOR ALL CONCRETE PAVING WITHIN THE STREET RIGHT OF WAY, TO BE
MADE AFTER ALL EXCAVATING IS COMPlETE, AND FORM WORK AND SUB.BASE MATERIAL IS IN PLACE.
o SANITARY SEWER CONNECTION PERMIT: .....,.......... n
VALlO FQR SIXTY 1601 DAYS FROM DATE OF ISSUANCE
o TO STUB 0 MAIN LINE (EASEMENT .R/WI 0 OTHER
o STORM SEWER CONNECTION PERMIT: ....................n
VALlO FOR SIXTY 1801 DAYS FROM DATE OF ISSUANCE
o CATCH BASIN I BUBBLER 0 STUB 0 MAINLINE
PROOF OF INSURANCE' $500,000 MINIMUM
o ATTACHED 0 REQUIRED AMOUNT
INSPECTIONS REOUIRED: APPlICATION FEE' DEPOSIT
ACCOUNT NO:
o $20,00 /
0$
0$
0$
0$
0$
o $10.00+$.15/FT/tl ,~O
o $lD.00+$.15/FT.
o $5.60/.
, ,
o $5.00/
TOTAL DUE: $
TOTAL DUE WITH PERMIT $
/0. t,0
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:
o PLANS (TWO SETS) 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 OUST CONTROL TO BE UTI~IZED:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
FROM DATE:
TO DATE:
DEPTH:
TIME:
TIME:
HEIGHT:
BORE:
BACKFILL MATERIAL:
WARNING OEVICES TO BE UTILIZED:
DESCRIPTION: '^ II [)l!/J ~~:~ work 1J..;:;;;::;n to be;.;;;;;;nc8 w~t78 ~~ o~3n;or", Traffic Control Devices (MUTeD).
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD .
REVISIONS 8124195
FORM'116
PLAN REVIEW COMMENTS I SPE~ INSTRUCTIONS:
RESTORATION WORK SHALL BE IN CON_MANCE WITH EXISTING CITY CODES ANAoMPLlANCE WITH CURRENT
STANDARD SPECIFICATIONS, EXCEPT AS NOTED BELOW.
001 Backfill with Yo" rriinus rock. E 019
. 002 Compact every 18" loose depth. 020
. 003 Requires compactIon with 8 steel roilier. 021
. 004 A.C. to match the greater of existing depth or 4". 022
005 All cuts sealed ,for fln~1 [nspection. 023
006 Temporary patch may be used at the end of the day. _ 024
007 Signing and Zone protection to comply with MUTeD 025
008 Cut concrete only on score lil18S or cold joints. 026
. 009 Sidewalks end driveways min. 3.000psi. 027
. 010 Curbing min 3,500psi I No patchwork less than 3', _ 028
01' Meet min. requirements on curb cuts, Spfd. code. 029
. 012 Restore planted areas, Spfd.. code 206,3.05 030
_ 013 Spec. to Bore I Jack I No A.C. cuts. . 031
_ 014. ~echenlcal co-:npactlng required. 032
. 015 No patch"!'ork allowed. 033
. 016 lateral cuts to have control density fill. 343
. 017 Cuts to be polymerized crack sealed for final inspection.
01a Minlnum 2" crushed rock %" minus.
"
Minumum 4' clearance at any point. swing-away.
Concrete minimum 4 II depth, 3,OOOpsi.
Trench to be "T" cut.
Needs State / County permit.
No ebove ground enclosings in sidewalk or handicap ramps.
Diamond cut A.C./Concrete value boxes to grade.
Fresh Oil signs / Graded.
Comply with Americans with Disabilities Act.
Concrete slabs. 72hrs. curing time. 4500psi.
Concrete slabs require joint seal material.
Driveway requires dowels every 18".
Submit traffic control plan prior to excavation.
Notily Traffic Division before excavatipn,
Core drill main Hne. insert tee, 2% min, grade.
Must comply with the provisions of ORS 757.541 to 757.571.
6" Circular hole/H20.Vac.
Comments:
YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
4B HOURS BEFORE DIGGING
INSPEC1JONS:
~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.
o SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726.3761.
J
SIGNATURE:
AMOUNT RECEIVED:
RECEIPT NO:
/6,60
~~ 17~
DATE PAID:
RECEIVED BY:
4/q/91
bJPr
,-
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 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 Oregon pertaining to the work
described herein. I further certify that only contractors and empioyees w 0 are in compliance with ORS 701,055 will be used on this
project.
The City may insRect 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 130) from the date of the notice to complete the work. Work not completed at the ene of the thirty days will be performed by the
City and the costs will be billed to the permittee.
1 furthor agree to ensure that all required inspections are requested at the proper time, that project address is readable from the street,
~:":~:"":~. ",., \27~" ""oo ""''''':" ..., .,#7
VALIDATION: /7
o TRAFFIC R1fv'IEWED BY: DATE:
0 ENGINEERING REVIEWED BY: DATE:
0 MAINTENANCE: DATE:
0 PERMIT ISSUED BY: DATE:
FOR SIOEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETEDjIN PERMIT DRA WER,
INSPECTION: DATE:
INSPECTION: DATE:
WORK IN PROGRESS OATE:
AT TIME OF COMPLETION: DATE:
ELEVENTH MONTH: OATE:
DEPOSIT RETURNED: DATE: .'
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~ -. .. SP FIELD
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PUBLIC WORKS DEPARTMENT . ~'*
AOMW~mAnDN .
ENGfl'.'EEi1{,\'G Q{:/ISlOiv'
M..;!t.~'TENANCE
225 FIFTH STF'IEEI
SPRINGFIELD D.C? 97"~7
APPLICATION FOR A SECOND DRIVEWAY I OVERWIDTH DRIVEWAY
DATE:
_:/~Fh7
APPLICANT (PROPERTY OWNER)'
JDi-IrJ
LO";<1"J
9'90
OLfJ o.ec~
1.4 - 7'/~-i.).7~
LA/Vc
ADDRESS OF PROPERTY FOR DRIVEWAY PERMIT:
APPLICANTS TELEPHONE NUMBER:
\,V - 9 "I 'If , 3 7..20
Please sketch the proposed driveway, Include the following applicable items: house or building, proposed
driveway, existing driveway. and street names. Include dimensions and measurements to property lines, road
Intersections and bordering driveways, (See attachment for an example.)
S li& /h77fc,fJaJ
S iCfrirl/t:-:S
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ftppr7Tl~cf ft '5 Y du2Jf. UXU; .
/J451.- 3/i2/9?
ALL APPLICATIONS OUTSIDE THE CITY LIMITS OF SPRINGFIELD THAT ARE WITHIN THE URBAN
GROWTH BOUNDARY REQUIRE A LANE COUNTY PERMIT.
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Note: The City of Springfield will not grant a second driveway permit on an Arterial or Collector Slreet.
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.1DMINISmAnON/ENGINEERING (503) 726-3753 F4X (503) ?26'368~]
MAINTENANCE (503) 726,3761 FAX (503) 726,3621
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Proposed Plan
Garage
990 Old Orchard Lane
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Existing Plan
Garage
990 Old Orchard Lane
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