HomeMy WebLinkAboutPermit Curb Cut 1996-3-25
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,-Cf'r>v OF SPRINGFr ~D P~ 'M~T APPLICATION
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226 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (603) 726.3763
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ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER: l:f(/lJJ::3f'/ /.-
INSPECTION LINE SEE INSPECTIONl O~ B,CK"IDE
APPLiCATION DATE: . ??pi./90
DATE ISSUED:
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LOCATION OF WORK
APPLICANT ~.;Ji '1/1 ~/<' /J)LJ.Lf/)i<c1r-roI!./Mr~
SITE ADDRESS: 5C?.c/ ~plll (IN I? .H:;.,tL 'Ld
CITY: ::5ri!.(I-(fp4""./J STATE: AL-" ZIP: <7-;477
SUBDIVISION: .
OWNER: .?;TiN Y 01 "I.' I77IrNI/h:Jc:7'L'L/"-'>(_
ADDRESS: ~9'{ o&-L1n~ CITY: q
. CONTRACTOR: '~W^t/t: ~A66RESS: ~o 01:'-74-
CONTRACTOR REGISTRATION NO: - .hf?(gL/ EXPIRATION DATE:
PROJECr SUPERVISOR: ?LJ/~. ~rfl'-rI-lEL-
PHONE e!74/-Wt-s-57qj
TAX MAP:
TAX LOT:
PHONE:
STATE: tT/l-
ZIP: 9---P-ry
PHONE: ?N:? -,,*(0
PHONE:
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REQUESTED PERMITS:
INSPECTIONS REQUIRED:
APPlICATION FEE I DEPOSIT
ACCOUNT NO:
Cl ENCROACHMENT PERMIT NO: ............................... n
VALlO FOR SIXTY 1601 DAYS FROM DATE OF ISSUANCE . \
a CUT STREET a BORE a OTH~R' n
o DUST CONTROL (TYPE OF CONTROLI
a CONSTRUCTION, STOR~GE. STAGING n
o OTHER n
o ASPHALT DEPOSiT.... ............ ........ .........:............... .....:... .................. .................. ........ .....
0 $20.00 /
0 $
0 $
0 $
0 $
0 $
0 $10.00 H.16/FT. :::;t;;2"'C)
JVPF nF"F"'JRITV DEPOSIT ,
~LANKET SURETY BOND 0 SURIITV BOND. 0 CASH I CHECK
~ CURB CUT PERMIT NO: ............:......:.. FT':~ fl ra-'
I.OZURB , APPROACH AmR FORMS ARE ERECTEO BUT PRIOR TO POURINO CONCRETE.
. VALID FOR 180 DAYS FADM DATE OF ISSUANCE.
. SECONO DRIVEWAY (SEE SEPARATE APPUCATlONI
Cl SIDEWALK PERMIT NO: .....................FT. n
VALID FOR 180 DAYS FROM OAT! OF ISSUANCE.
o NEW 0 REMOVE I REPAIR 0 PAVE PLANT STRIp.
o SETBACK 0 CURBSIDE 0 LENGTH
IN~p!:,.TlnN. !':;IDEWALK I DRIVEWAV FOR ALL CONCRETI! PAVING WITHIN THE STREET RIGHT OF WAV, TO BE
MADE AFTEA ALL EXCAVATING IS COMPLETE. AND FOAM WOAK AND SUB-BASE MATERiAl IS IN PLACE.
D SANITARY SEWER CONNECTION PERMIT: ................ n
VAllO FOR SIXTY t601 DAVS FROM DATE OF ISSUANCE
o TO STUB 0 MAIN LINE (EASEMENT.RIWI 0 OTHER
D STORM SEWER CONNECTION PERMIT: ....................n
. VALlO FOR SIXTY 1601 DAVS FROM DATE OF ISSUANCE
o CATCH BASIN / BUBBLER 0 STUB 0 MAINLINE
PROOF OF INSlJRANCF' $600,000 MINIMUM
o ATTACHED 0 REQUIRED AMOUNT
o $10.00+$.16/FT.
o $6.00 I .
o $6.00/
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TOTAL DUE: $
TOTAL DUE WITH PERMIT $
DESCRIPTION OF PROJECT:
PER.!9D OF USE OR TIME OF CONSTRUCTION:
Ia'" PLANS (TWO SETS) ATTACHED
AREA: LENGTH: . WIDTH:
FROM DATE:
TO DATE:
TIME:
TIME:
HEIGHT:
DEPTH:
TVPE 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:
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BORE:
BACKFILL MATERIAL:
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WARNING DEVICES TO BE UTILIZED:
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Ad~ance Igning and work lone pr01ec110n 10 be In compliance with the Manual on UnJform Traffic Control Devices (MUTeD). ~f
DESCRIPTION: ::!7 :JJP1I/.elU4~ '/1fld8 ~ J?S , :
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WORK SHALL COMPLY WITH CtiAPTER X ARTICLE 6 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTeD.
REVISIONS 8/241l1s FORM' 116 .
~1..':~:r~~~~~::~R~~:A~~:: I~ ~:X~~~~:~~:~~~I~G ~I~~C;'D::'~" A. : :.~~~;~:::: ~I~H CURRENf- .~~~
.'STANDARD SPECIFICATIONS. EXCEPT AS NOTED BELOW. ":~" '.",'" .... ."
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001 Backfill with '" minus rock. : '019 Mlnumum 4' clearance at any pOlnt"swing-away.
002 Compact every 18. loose depth. . 020 Concrete 'minimum 4" depth. 3,OOOpsl. .
003 Requires compaction with 8 steel roilier. _ 021 Trench to be "T" cut.
004 A.C. to match the grsater of existing depth or 4". _ 022 Needs Stste I County permit. .4 ~
005 All cuts sealed for final inspection. _ 023 No above ground enclosings In sidewalk or handicap lamps,
, 006 Temporary patch may be used at the end of the day: . 024. Dismond cut A.C./Concrete value boxes to grade.
. .' ~7 Signing and Zone protection to comply with MUTeD _ 026 Fresh 011 signs I Graded.
I J; 008 Cut concrate only on score lines or cold joints. .... -026 Comply wIth Americans with Disabilities Act.
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" 009 Sidewalks and driveways min. 3,OOOpsl. 027 Concrete slabs,.72hrs. curing time, 4500psi.
.' ,,~ Curbing mln 3,600psll No patchWork less than 3'. _ 028 Concrete slebs require joint 88al msterial.
. t ~ 011 Meet min. requlremfU:lts on curb cuts, Spfd. code. _ 029 Driveway raqulres dowels every 18..
~i_.J _ 012 Restore planted areas, Spf.d. code 206.3.05 _ 030 Submit traffic control plan prior to excavation.
t-l _ 013 Spec. to Bore I Jack I No A.C. cuts. _ 031 Notify Traffic Division before excavatijln.
~~ _ 014 Mechanical compactIng required. _ 032 Core drill msln line, Insert tee, 2% min. grade.
if _ 015 No patchwork allowed. _ 033 Must comply with the provisions of ORS 757.541 to 757.671.
;,t':i _ 016 Lateral cuts to have control density fill. 343 6" Circular holeIH20-Vac.
~..I _ 017 Cuts to bB polymBrlzBd crock SBBIBd for t;nollnspBctlon. .:.
Ii' -- 018 Mlninum 2" crushed rock ~"minus.
~: Comments:
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YOU ARE REQUIRED TO CALL .
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
INSPECTIONS:
!l('CURB CUT AND SIDEWALK INSPECTIONS CALL 726-3769 (RECORDERI 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 WORK IS IN PLACE BUT PRIOR TO POURING CONCRETE.
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;, 0 SANITARY SEWER. STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
, I 726.3761.
'.: ' SIGNATURE:
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AMOUNT RECEIVED: ::5t2, tJ l)
RECEIPT NO: [7A v74,1
DATE PAID:
RECEIVED BY:
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.1....: By signature, I state and agrea, that I hava carafully examined the comRlated application and do hereby certify that all information
;. : herein is true and correct, and I further certify that eny and ell work performed shall be done in eccordance WIth the Ordinances of the
i.: City of Springfield, applicable City Standard specifications and Drawlngshand the laws of the State of Ore.9on pertaining to the work
.;' described herein. I further certify that only contractors and employees w 0 are in compliance with ORS 7<Y1.055 will be used on this
I~;', project. ,. ;\..".'~.\h..~ . . ,
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'f .' The City may inspect the work site described in this p'ermit 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 des cress ion, any additional restoration work required to
X 'return the site to a standard acceptable to the City. Tne permittee will be notified in writing of any work required and will have thim
.,; 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 remain on the site at all times during construction. . .
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;Signatu;e K Jl ~ ~~~
Date
3-2.2-Q(o
tf'.VALIDATION: ~. rr /
~I.Q"TRAFFIC REVIEWED BY: ../;?~ tfiitfn:
: ~;Id"ENGINEERING REVIEWED BY: Pni3 1::'.p~
i I'b .MAINTENANCE: . ,
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1" Cl PERMIT ISSUED BY:
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i .j . .:~t:bR SIDEWALK AND CURB CUT PERMITS PLACE A COpy (COMPLETED) IN PERM/T DRAWER.
! ~I. j.'lIN'.S.. PECTION: I ' , . DATE:' .
lINSPECTION: . DATE: .
~W'6RK IN PROGRESS DATE: .. .
t ',,:: AT TIME OF COMPLETION: DATE:
Iff: ELEVENTH MONTH: DATE::"
I f ~ ':DEPOSIT RETURNED: DATE: ,':
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DATE:
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DATE:'
DATE:
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PUBLIC IVORKS DEPARTMENT
AOMfNfS7"ATlON
[NGINEE"fNG OIVISI(lN
MAINTEivANCE
225 FIFTH 57/,',
SP/;,NGFlFLD. Of,':?
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APPLICATION FOR A SECOND DRIVEWAY / QVF.RWIDTH DRIVEWAY
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APPUC}~(P OP~RTY OWNER):
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SONY 1) IS( !l\#\NVFA C.TUfLll\6
ADDRESS OF PROPERTY FOR DRIVEWAY PERMIT::39B J)e.ADf'(\ONf::l Ff;;;~i
54{ - ~fj3 -514/
APPLICANTS TELEPHONE NUMBER:
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Please sketch the proposed drive'oJay. Include the following appticable items: house or building. proposed
driveway. existing driveway. and street names. Include dimensions and measurements 10 property lines, road
intersections and bordering driveW3}'s. (See altachment for an example.)
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AU.. APPUCATlONS OUTSIDE THE CITY UMITS OF SPRINGFIELD THAT ARE WITHIN THE URI3AN
G:WWTlI130UNDARY HEQUIRE A U\NE COUNTY PERMIT.
Nole: The City of Springfield will n01 grant a second driveway permit on an ^r1erlaJ or Collcclor Street.
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AOMINISIRAIIONIENGINEEnJNG (503) 726.3753 FAX (503) 7:'6.3W9
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1. Property type: Single Family Residence ----.- Duplex ~ Other (!jy)1p1.eec1/~
2. The proposed drivewav will take access hom which slreet 1ft) 1,(/11filj.t~7/0r.64.L_';;P If"
3. Tho distance ham the edge 01 the driveway 10 tho nc:ucst COIner (mcasu',cd to tha curb return) is
feet.
.... The second driveway will give access to: garagc_ carport_ side. yard_ Other dO..(/&:7-(
5. The distance from the property ~ne 10 the garage, carport, fence, wall, or other, (where the vehicle"is
10 be parked) is leel.
. 6. VViU the propOsed par_king I storage area create 3. vision obstrudio.n to adjacent proper:1Y driveways Of.
to any vehicular movem~nt on a public street? (See vision clearance attachment)
ApprlC3nt hereby agrees 10 install U>e requested driveway 10 City of Springf,,1d standards. The applicant lurU>er
agrees 10 have 6- of concrete in Ule sidewalk area (adjacent to the drivcW3.y)';and to pave the area behind Ule
back edge or the sidewalk. or driveway apron., with a minim~m depth of 3" asphatl.ic concrete or G" of portl.:lnd
cement concrete. The area behind the sidewall< shaD be paved a minimum of 18 feeL
The apprJC3nt agrees that if helshe does nofpave Ule area behind Ule sidewalk within 30 days of cutting the
curb opening, the City of Springfteki has the authority to close the driveYo-ay access by removal of the curb cut
An incurred costs shall be assumed by Ule applicant and if unpaid, said cost shaU become a fie" 01 Ole property.
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When this app6cation is approved by the City, the applicant must obtain a curbcuVdriveway permit from the dJ I
Pub6c Works Department, Engineering Division. Z 8\ X I (j!2-- = Zo
Curbcull Drivewav Permil Fee tJ,I>;"")(. 0 \~ {~ I
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a. On an imp(oved street (existing curb): 510.00 plus $.15 per lineal foot 01 curb cut.
b. On an unimproved street (no curb): S 12.00
c. On currently unimpro.....ed streets that are under construction: $12.00
PROPERTY OWNER'S SIGNATURE'~ _ _O~ .
DATE:
APPROVED BY: vV'/\.& 'L.9~!m-t.--
, ~ . (TRAFFIC DIVISION
DI<TE3h.?/CfC:,
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BUILDING PERI~IT NO.:
DI<TF'
TRA 9.1
AllACHMENT: Vision Clearance. Example 1:1
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