HomeMy WebLinkAboutPermit Curb Cut 1996-5-31
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE 1503} 726-3753
~
ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER:
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE
APPLICATION DATE: '. ~A/ ,/Yh
DATE ISSUED:
lOCATION OF WORK
APPLICANT -f'7(<€l. -i'0~ fYl;;~/ p \t!L1t& PHONE
SITE ADDRESS: /<;</K D.6L.eO~
CITY:~,c{} STATE: OJ! ZIP: ?7c:..c7,7
SUBDIVISION:
OWNER: ~flC.O liff Y
ADDRESS: /(;/1'<[ p~~ CITY: 4.
CONTRACTOR: ~il.i/ 4-. ?/Y/71.J ADDRESS:
CONTRACTOR REGISTRATI~N NO: .J:5/<24.<6
PROJECT SUPERVISOR: ~.~ ~ /Tff
9~()73:7
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TAX MAP:
TAX LOT:
17 ~?...t/ ;;'3
"",>t;r;n
PHONE:
STATE: t5~
ZIP: -'?7Cr77
PHONE:
EXPIRATION OATE: .g//,~c..
REQUESTED PERMITS:
INSPECTIONS REQUIRED: APPliCATION FEE / DEPOSIT
ACCOUNT NO:
o EN<;ROACHMENT PERMIT NO: ............................... n
VALID FOR SIXTY [601 DAYS FROM DATE OF ISSUANCE
o CUT STREET 0 BORE 0 OTHER n
o DUST CDNTROLITYPE OF CONTROL!
o CONSTRUCTION, STORAGE. STAGING n
o OTHER n
o ASPHALT DEPOSIT.......... ...................... ............................................ m. ........ .......... '''m...
IYfF nF ~F.c.uB'TV nFeosJI
o BLANKET SURETY BOND 0 SURIITY BOND 0 CASH I CHECK
ra--cURB'CUT PERMIT NO: .................... FT._-n I 0
INSPFl':TlnN. CURB I APPROACH AFTER FORMS ARE ERECTED BUT PRIOR TO POURING CONCRETE.
VALID FOR 180 DAYS FROM DATE OF ISSUANCE.
o SECON'O DRIVEWAY ISEE SEPARATE APPLICATION!
o SIDEWALK PERMIT NO:.................... FT. n
VALID FOR 1BO DAYS FROM DATE OF ISSUANCE.
o NEW 0 REMOVE I REPAIR 0 PAVE PLANT STRIP
o SETBACK 0 CURBSIDE 0 LENGTH
tt'c:~rTlnt',:..sIOEWAlK I 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
VALID FOR SIXTY 1601 DAYS FROM DATE OF ISSUANCE
o TO STUB 0 MAIN LINE (EASEMENT-RIW! 0 OTHER
o STORM SEWER CONNECTION PERMIT: ....................n
VALID FOR SIXTY 160) DAYS FROM DATE OF ISSUANce
o CATCH BASIN / BUBBLER 0 STUB 0 MAINLINE
fRnnF nF IN~I 'R~ $500,000 MINIMUM
o ATTACHED 0 REOUIRED AMOUNT
PHONE: ?/// 1]'142..
1
0 $20.00 I
0 $
0 $
0 $
0 $
0 $
0 $10.00 + $.1 51FT. / /.:2/)
o $10.00+$.15/FT.
o $5.001.
o $5.00 I
TOTAL DUE: $
TOTAL DUE WITH PERMIT $
/ I, z.6
/ I. '2-.D
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:
o PLANS (TWO SETS) ATTACHED.
AREA: LENGTH:
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:
WARNING DEVICES TO BE UTILIZED:
FROM DATE:
TO DATE:
,wIDTH:
DEPTH:
BORE:
BACKFILL MATERIAL:
TIME:
TIME:
HEIGHT:
Advance signing and work zone protection to be in compliance witn the Manual on Uniform Traffic Control Devices (MUTCD).
DESCRIPTION:
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD .
REVISIONS B/24/95 FORM , 11 B
PLAN REVIEW COMMENTS I SPjiAlINSTRUCTIONS:
RESTORATION WORK SHALL BE IN CO"RMANCE WITH EXISTING CITY CODES AA c:t>MPLIANCE WITH CURRENT
STANDARD SPECIFICATIONS, EXCEPT AS NOTED BELOW.
001 Backfill with %" minus rock.
002 Compact every 18" loose depth.
003 Requires compaction with 8 steel rolller.
- 004 A.C. to match the greeter of existing depth or 4".
005 All cuts sealed for final Inspection.
006 Temporary patch may be used at the end of the day.
- 007 Signing and Zone protection to comply with MUTeD
- 008 Cut concrete only on score lines or cold joints.
009 Sidewalks end driveways min. 3.000psi.
- 010 Curbing min 3.500psll No patchwork less than 3'.
- 011 Meet min. requirements on curb cuts, Spfd. code.
012 Restore planted ar8as, Spfd. code 206.3.05
- 013 Spec. to Bore I Jack I No A.C. cuts.
- 014 Mechanical compacting required.
- 015 No patchwork allowed.
- 016 Lateral cuts to have control density fill.
- .017 Cuts to be polymerized crack sealed for linal inspection,
018 Mininum 2" crushed rock %" minus,
J 019
_ 020
021
022
023
024
025
_ 026
_ 027
_ 028
029
030
031
_ 032
033
343
Minumum 4' clearance at any point. swing-away.
Concrete minImum 4" depth, 3.000psi.
Trench to be "T- cut.
Needs State / County permit.
No above ground enclosings in sidewalk 0' 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.
Notify Traffic Division before excavati~n.
Core drill main tine. insert tee, 2% min. grade.
Must comply with the provisions of OAS 757.541 to 757.571.
6" Circular holeIH20.Vac.
u
.. \.
Comments:
~.. ~,
. .
YOU ARE REQUIRED 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 (RECOROER) STATE YOUR DESIGINATED CITY JDB
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.
SIGNATURE:
AMOUNT RECEIVED: / I &0
RECEIPT NO: -ffl'7.; :;;;,~~n~.~
DATE PAID:
RECEIVED BY:
5-13>I/rh
~ ~al9
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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 further certify that any and all work performed shall be done in accordance With the Ordinances of the
City of Springfield, apDlicable City Standard specifications and Drawlngshand the laws of the State of Ore>)on pertaining to the work
des.cribed 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 Hermit 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 130} 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 wili be billed to the permittee.
I furthor agree to e that all required inspections are requested at the proper time. that project address is readable from the street,
and the approve f plans will remain on the site at all times during construction. .
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Signature
Date
1
VALIDATION:
0 TRAFFIC REVIEWED BY: DATE:
0 ENGINEERING REVIEWED BY: DATE:
0 MAINTENANCE: DATE:
'0 PERMIT ISSUED BY: DATE:
FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRA WER.
INSPECTION: . ,
"
INSPECTION:
WORK IN PROGRESS
AT TIME OF COMPLETION:
ELEVENTH MONTH:
DEPOSIT RETURNED:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE: