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Home My WebLink AboutMiscellaneous APPLICANT 7/2/2009 v ) . CO?~ . PERMIT NUMBER 0reg0nC1 4 &.....,018___......1 APPLICATION AND PERMIT TO OCCUpy OR r PERFORM OPERATIONS UPON A STATE HIGHWAY See Oregon Administrative Rule. Chapter 134, Division 55 CLASS: I KEY# I GENERAL LOCATION PURPOSE OF APPLICATION ~ ITO CONSTRUciiOPERATE/MAINTAINI HIGHWAY NAME ANO ROUTE NUMBER CJ POLE TYPE I MN. VERT. ClEARANCE McKENZIE HWY (126) LINE N/A N1A - HIGHWAY NUMBER I ~OUNTY cfcURIEO TYPE 015 20 = LANE I CABLE N/A BETWEEN OR NEAR LANOMARKS o PIPE TYPE 6th AND 7th STREETS LINE N1A HWY. REFERENCe-MAP1 DESiGNATEO FREEWAY I iN u.s. FOREST o NON-COMMERCIAl I FEE AMOUNT AMl 0 YES IZJ NO 0 YES IX] NO - SIGN $0.00 APPLICANT NAME ANO AOORESS !:ZJ MiSCELLANEOUS OPERATtoNS AfIVIOR FACILITIES AS SPRINGFIELD SCHOOL DIST. #19 Dl:SCRlBED BELOW FOR OooT USE 0 LY ATTN: JOHN SARACENO BONO REQUIREO REFERENCE: AMOUNT OF BOND 525 Mill ST. o S IZI NO OAR 734.55 $0.00 YE 035121 SPRINGFIELD, OR 97477 INSURANCE REOUIRED REFERENCE: SPECIFIED COMPo DATE 541n47-3331 IZJ YES 0 NO ~;;',~3455 06/10/2010 DETAIL LOCATION OF FACILlTYIFor more space attach additional sheets) - - - SIDE OF KWY OR DISTANCE FROM BURIED CABLE OR PIPE SPAN MILE MILE ENGINEERS ENGINEERS POINT TO POINT STATION TO STATION AHOlE OFCAOSSING ENTER OF PVM R/W LINE DEPTHNERT. SIZE ANO KIND LENGTH 1.B7 41+77.5 LEFT VARIES VARIES xxx xxx XXX - .-- ~ - - I j DESCRIPTION AND lOCATION Of NON-COMMERCIAL SIONS OR MISCELLANEOUS OPERATIONS FACILITIES REMOVE 1 REPLACE ACCESS WITH SIDEWALK SPECIAL PROVISIONS (FOR MORE SPACE ATTACH AOOITlONAL SHEETS) TRAFFIC CONTROL REQUIREO - OPEN CUTTING OF PAVED OR SURFACED AREAS ALLOWED? . IZJ YES 10AR 734-55-0251611 0 NO . 0 YES IOAR 734-55-100121 IZJ NO 10AR 734-55-100(1) . AT LEAST 46 HOURS BEFORE BEGINNING WORK, THE APPLICANT OR HIS CONTRACTOR SHALL NOTIFY THE DISTRICT REPRESENTATIVE AT TELEPHONE NUMBER: 541/686-7626 OR fAX A COpy OF THIS PAGE TO THE DISTRICT OFACE-AT:-WA SPECIFY TIME AND DATE IN THE SPACE BELOW. . A COPY OF THIS PERMIT AND ALL ATTACHMENTS SHALL BE AVAILABLE AT THE WORK AREA DURING CONSTRUCTION. . AnENTION: Oregon Low requites you 10 follow rules odopted by the Oregon Utility Notlticatton Center. Tho_ rules ore eot forth to OAR 962-001-0010 through OAR 952-001-0090. You may obtain copies of the rules bV calling the centef at (503) 232-1967. CALL BEFORE YOU DIG 7-800-332-2344 COMMENTS - ODOT USE ONLY PERMIT AND PERMISSION TO REMOVE ACCESS DRIVEWAY WITHIN ODOT RIGHT OF WAY AT ABOVE LOCATION. WORK TO INCLUDE REPLACEMENT OF ACCESS WITH SIDEWALK AS PER CITY OF SPRINGFIELD SPECIFICATIONS. LOCAL GOVERNMENT (CITY OF SPRINGFIELD) SIGNATURE REQUIRED ON PERMIT. SEE PAGE 2 OF THIS PERMIT FOR GENERAL & SPECIAL PROVISIONS IF THE PROPOSED APPLICATION WILL AFFECT THE LOCAL GOVERNMENT, THE APPLICANT SHALL ACQUIRE THE LOCAL GOVERNMENT OFFICIAL'S SIGNATURE BEFORE ACQUIRING THE DISTRICT MANAGER'S SIGNATURE. LOCAL GOVERNMENT OFAC L SIGNATURE TITLE X .5t 1'1<\"1\ e r It... APPLICANT SIGNATUR APPLICATION DATE TITLE DATE 7-Z-CJCj TELEPHONE NO. X 'h'hen t....s.~t1on lupproved by the OepenmeflC, lhllllppfioBm ~ -.bjec1 to,lIlX:aptl and appr_ DISTRICT MANAGER OR REPRESENTATIVE the terlTl8 .nd proy~ contllined iIIld .ttached: iIIld the term. of OrflQOn Admn.r.ti.... R..... Chapter 734, Divi8iGn55. which i.by th.refe<~ mMte. pert of tt..petrrit. APPROVAL DATE m34s7(7-:ti6) X PAGE-LOF ..2.... Recei\je '~1 1/ 6 - oa\e . sr\ 1)1/ IV ' p\annef. . . . SPECIAL & GENERAL PROVISIONS SPRINGFIELD SCHOOL DlST. #19 MCKENZIE HIGHWAY (015), MP 1.87 "APPLICANT/PERMITTEE SHALL BE RESPONSIBLE ANO LIABLE FOR (1) INVESTIGATING PRESENCE/ABSENCE OF ANY LEGALLY PROTECTED OR REGULA TED ENVIRONMENTAL RESOURCE(S) IN THE ACTION AREA; (2) DETERMINING ANY AND ALL RESTRICTIONS OR REQUIREMENTS THAT RELATE TO THE PROPOSED ACTIONS, AND COMPLYING WITH SUCH, INCLUDING BUT NOT LIMITED TO THOSE RELA TING TO HAZARDOUS MA TERIAL(S}, WA TER QUALITY CONSTRAINTS, WETLAND, ARCHEOLOGICAL OR HISTORIC RESOURCE(S}, STATE AND FEDERAL THREATENEO OR ENOANGERED SPECIES, ETC.; (3) COMPLYING WITH ALL FEDERAL, STATE, AND LOCAL LAWS, REGULATIONS, RULES AND ORDINANCES, WHETHER ENVIRONMENTAL IN NATURE OR OTHER, PERTAINING TO THE PROPOSEO ACTION, AND OBTAINING ALL REQUIRED AND NECESSARY PERMITS ANO APPROVALS. IF APPLlCANTIPERMITTEE IMPACTS A LEGALLY PROTECTEOI REGULATED RESOURCE, APPLICANT/PERMITTEE SHALL BE RESPONSIBLE FOR ALL COSTS ASSOCIATED WITH SUCH IMPACT, INCLUOING, BUT NOT LIMITED TO ALL COSTS OF MITIGATION AND REHABILITATION, AND SHALL INDEMNIFY, DEFEND AND HOLO HARMLESS ODOT FOR SUCH IMPACTS AND BE RESPONSIBLE AND LIABLE TOODOTFOR ANY COSTS OR CLAIMS THAT OOOT MAY HAVE." NOTHING IN THIS PERMIT IS INTENDED TO GRANT RIGHTS OR IMPLY APPROVAL NOT FALLING WITHIN THE AUTHORITY ANO JURISOICTION OF ODOT. IT IS THE RESPONSIBILITY OF THE APPLICANT TO OETERMINE THE NEED FOR AND TO OBTAIN SUCH LICENSES, PERMITS OR OTHER FORM OF APPROVAL WHICH MAY BE REQUIRED BY OTHER STATE AGENCIES, FEDERAL AGENCIES, CinES AND/OR COUNTIES OF OREGON, UTILITY OR RAILROADS. OAR 734-055.055. GENERAL PROVISIONS ALL WORK SHALL BE ACCORDING TO YOUR PLANS & MEET ODOT AND CITY OF SPRINGFIELD STANDARDS AND SPECIFICATIONS FOR ROAD CONSTRUCTION 2008. TRAFFIC CONTROL SHALL BE ACCORDING TO THE CURRENT 'MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES FOR STREETS AND HIGHWAYS, 'USDOT & ODOT MANUAL," OREGON TEMPORARY TRAFFIC CONTROL HANDBOOK, MAY 2006. ODOT REPRESENTATIVE SHALL BE NOTIFIED 48 HOURS PRIOR TO START OF WORK SEE PAGE 1 OF 2 (OF THIS PERMIT) FOR CONTACT INFORMATION. A COPY OF THIS PERMIT AND ALL ATTACHMENTS SHALL BE ON SITE DURING WORK HOURS. ANY DAMAGE TO ODOT RIGHT-OF-WAY SHALL BE RESTORED TO THAT CONDITION PRIOR TO CONSTRUCTION AND TO SATISFACTION OF ODOT REPRESENTATIVE. SPECIAL PROVISIONS GUTTER BAR CUTS SHALL BE FULL DEPTH CUTS. JOINTS SHALL BE PINNED TO NEW SIDEWALK AND CURB PER ODOT STANDARDS. ALL JOINTS/CUTS TO BE SEALED WITH AN APPROVED, (ODOT QUALIFIED PRODUCTS LIST), MODIFIED POLYMER ASHPAL T SEALANT. (CRACK SEALANT). ' RAMPS AND SIDEWALKS TO BE CONSTRUCTEDIREPAIRED IN FULL PANEL SECTIONS (SEAM TO SEAM) AND MEET ODOT AND CITY OF SPRINGFIELD STANDARDS. IF PANEL IS PARTIALLY REMOVED, CRACKED OR DAMAGED IN ANY WAY, PANEL IS TO BE COMPLETELY REMOVED PRIOR TO REPLACEMENT. SIDEWALK TO BE CONSTRUCTlEDlREPAIRED AS PER OREGON STANDARD DRAWING RD720. 4 INCH MINIMUM AGGREGATIE BASE REQUIRED. RAMP TO BE CONSTRUCTEDIREPAIRED AS PER OREGON STANDARD DRAWING RD725. 4 INCH MINIMUM AGGREGATE BASE REQUIRED. IF CONSTRUCTION DOES NOT ADHERE OREGON STANDARD DRAWINGS, DRAWINGS MUST BE SUBMITTED FOR ODOT APPROVAL. APPROVED PLANS WILL BE SIGNED BY AN ODOT REPRESENTATIVE. ANY CHANGES TO PLANS ARE TO BE SUBMITTED PRIOR TO CONSTRUCTION. PAGE-.S..OF L. ~ ReCei\Jed'. oa\e . Sr\ fl\annef.