HomeMy WebLinkAboutPermit Encroachment 2000-6-12
'225 FIFTh'STREET BPRINO.,au>
SPRINGFIELD, OREGON 97477 ~
' ENGINEERING DIVISION A!.
,\ OFFICE TELEPHONE (503) 726-3'{53 ~ I
APPLICATION DATE: i, -- /;2-00
-'
ENCROACHMENT PERMIT
NUMBER:
DATE ISSUED:
LOCATION OF WORK ( /
APPLICANT (ljV1n:l..l':IP_,- ~ /.~-
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SITE ADDRESS: // J .J
CITY: ~p STAW
SUBDIVISION: .c;...-e~_J(
OWNER: @/1. ",~oe-- d../1/>'1'f ('
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p,HONE ] 'I S- - ''7.J' 9..s-
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TAX MAP:
ZIP:
TAX LOT:
,l7VC-r
PHONE:
J 'fC- '9./ 7-->'
ADDRESS: / CITY:
CONTRACTOR: (D It 6'ri!'t"':1u/ ~ ADDRESS:
CONTRACTOR REGISTRATIO~: 97.2 y i
PROJECT SUPERVISOR: PZ-7'''~ (.lv-,,;. t-...,-
STATE:
ZIP:
PHONE:
EXPIRATION DATE:
PHONE:?Y s- 'l'..J9->
REQUESTED PERMITS:
INSPECTIONS REQUIRED: APPLICATION FEE I DEPOSIT
ACCOUNT NO:
o ENCROACHMENT PERMIT NO: ..........................:.....It"
$80.00 I
VALID FOR SIXTY leOI DAYS FROM DATE OF ISSUANCE
o CUT STREET 0 BORE 0 OTHER
n
o DUST CONTROL (TYPE OF CONTROLI
o CONSTRUCTION. STORAGE, STAGING
n
d OTHER
n
o ASPHALT DEPOSiT...... ..............,.............,.......,.............. .................................................. $
o TVP~ o~ !':~r:URITV nWsrr For:
o BLANKET SURETY BONO 0 SURIITY BONO 0 CASH I CHECK $
! SANITARY SEWER CONNECTION: ...... 0 MAIN LINE IEASEMENT.R/w1 0 TO STUB 0 OTHER
STORM SEWER CONNECTION: 0 CATCH BASIN I BUBBLER 0 STUB 0 MAINLINE
,PROm' 01' IN~URANCE' $500,000 MINIMUM 0 ATTACHEO 0 AODITIONAL REOU'RED AMOUNT
,
go"" _ 60
TOTAL DUE WITH PERMIT $
~.Ob
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:
BORE:
DEPTH:
t=: lC'l' f rNvG
TIME:
TIME:
HEIGHT:
z..fJtr .'{'7'o"u... DIUtHAJ
FROM CATE:
TO DATE:
BACKFILL MATERIAL:
-
. SURFACE REPLACEMENT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UTILIZED:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
WARNING DEVICES TO BE UTILIZED:
Ad....ance signing and work zone prutection to be in compliance with the Manual on Uniform Traffic Control Devices (MUTeD:
DESCRIPTION: 7A~ tf jj'D^~ L4-" ~r<!J~ ~~......::~ p",,=. ,c.ft,. h h r<,,'huEc. 7-,......;.
C'A;A~I"'t'?"'~....J TO ~';::I?,~ ~/~ 1?~/..v.. ......... 2. PA~HA~C.r5 I!L)?<;
or.; r"",,($ FA,;" -r
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD.
REVISIONS 3/29/99
FORM "16
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PLAN REVIEW COMMENTS I
IAL INSTRUCTIONS:
RESTORATION WORK SHALL BE IN CONFORMANCE WITH EXISTING CITY CODES AND IN COMPLIANCE WITH CURRENT
STANDARD SPECIFICATIONS, EXCEPT AS NOTED BELOW.
o 001 Back.fill with ,,- minus rock.
o 002 Compact every 18- loose depth.
o 003 Requires compaction with 8 steel roilier.
o 004 A.C. to match the greater of existing depth or 4",
o 005 All cuts sealed for final inspection.
o 006 Temporary patch may be used lit the end of the day.
o 007 Signing and Zone protection to comply with MUTeD
o 008 Cut concrete only on score lines or cold joints.
D 009 Sidewalks and driveways min. 3.000psi.
o 010 Curbing min 3,500psi f No patchwork less than 3',
o 011 Meet min. requirements on curb cuts, Spfd. code.
D 012 Restore planted areas, Spfd. code 206.3.05
o 013 Spec. to Bore I Jack I No A.C. cuts.
o 014 Mechanical compacting required.
o 015 No patchwork allowed,
o 016 Lateral cuts to have control density fill.
o 017 Cuts to be polymerized crack sealed for final inspection.
o 018 Mininum 2" crushed rock o/i" minus.
,
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Comments: -::t:..~f:c+t.v
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o 019 Minumum 4' clesrence at sny point, swing-sway.
o 020 Concrete minimum 4" depth, 3,OOOpsi.
o 021 Trench to be "T" cut.
o 022 Needs State f County permit.
o 023 No above ground en closings in sidewalk or handicap ramps.
o 024 Diamond cut A.C./Concrete vslue boxes to grade.
D 025 Fresh Oil signs f Graded.
D 026 Comply with Americans with Disabilities Act.
o 027 Concrete slabs, 72hrs. curing time, 4500;:ls1.
D 028 Concrate slabs require joint seal material.
o 029 Driveway requires dowels every 18".
o 030 Submit traffic control plan prior to excavation.
D 031 Notify Traffic Division before excavation.
o 032 Core drill main line, insert tee, 2% min. grade.
D 033 Must comply with the provisions of ORS 757.541 to
757.571.
o 343 6" Circular hote/H20-Vac.
o
1). We.: t,;r1A+ If -It. - 00
YOU ARE REOUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
INSPECTIONS:
o CURB CUT AND SIDEWALK INSPECTIONS CALL 726.3769 (RECORDER) STATE YOUR DESIGINA TED, CITY JOB
NUMBER/PERMIT NUMBER, JOB ADDRESS, TYPE OF INSPECTION REQUESTED, AND WHEN YOU WILL BE READY FOR
INSPECTION, CONTRACTOR'S DR 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. / /
SIGNATURE: ill ~
AMOUNT RECEIVED: +iJ
~ ;::~ /1. /
.;Ii- (~- 'A7~
DATE PAID:
RECEIPT NO:
RECEIVED BY:
By signature, I state and agreej that I have carefully examined t:le 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 Springtield, appliceble City Standard specificat,ons and Orawlngshand the laws of the State of Orejlon pertaining to the work
des.cribed herein. I further certify that only contractors and employees w 0 are in compliance with ORS 7lJl.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 receipt 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 (301 from the date of the notice to complete the work. Wcrk 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 tlmez during construction.
Signature
VALIDATION:
D TRAFFIC REVIEWED BY:
D ENGINEERING REVIEWED BY:
D MAINTENANCE:
D PERMIT ISSUED BY:
Date
DATE:
DATE:
DATE:
DATE:
FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED/IN PERMIT DRA WER.
INSPECTION: DATE:
INSPECTION: DATE:
WORK IN PROGRESS
AT TIME OF COMPLETION:
ELEVENTH MONTH:
,DATE:
DATE:
DATE: