HomeMy WebLinkAboutApplication APPLICANT 7/1/2010
, GwgorI- .~ .._.4011J____.......... APPLICATION AND PERMIT TO OCC OR {O 5 M 39 8 1 !j
r PERFORM OPERATIONS UPON A STATE HIGHWAY ,I
See Oregon Administrative Rule, Chapter 734, Division 55 CLA~S : I KEY# I
GENERAL LOCATION PURPOSE OF APPLICATION
ITO CONSTRUCT/OPERA TE/MAINT AINI
HIGHWAY NAME AND ROUTE NUMBER DPOLE TYPE I~N.VERT.CLEARANCE
MCKENZIE HIGHWAY (126) LINE N/A
HIGHWAY NUMBER COUNTY c1URIED TYPE
015 20 = LANE I CABLE N/A
BETWEEN OR NEAR LANDMARKS o PIPE TYPE
35TH ST. & 36TH ST. LINE N/A
HWY..REFERENCE MAP I DESIGNATED FREEWAY IIN U.S. FOREST o NON-COMMERCIAL I FEE AMOUNT
AML DYES IZI NO . 0 YES IZI NO SIGN $0.00
. APPLICANT NAME AND ADDRESS IZI MISCELlANEOUS OPERATIONS AND/OR FACILITIES AS
MCKENZIE AUTO SALES DESCRIBED BELOW
ATTN:"Y(10NME.'l-/t<(;, ItE 5 FOR ODOT USE 0 L Y
BOND REQUIRED REFERENCE, AMOUNT OF BOND
122 N. 36TH ST. IZI YES o NO OAR 734-65 $1,000.00
035(2)
SPRINGFIELD, OR. 97477 INSURANCE REQUIRED REFERENCE, SPECIFIED COMP, O"ATE
541-746-4999 IZI YES o NO OAR 734.55 4/01/2011
. 035'11
.
~
PERMIT NUMBER
DETAil lOCATION OF FACILlTY(For more space attach additional sheets)
.
MILE MILE ENGINEERS ENGINEERS SIDE Of HWY OR DISTANCE FROM BURIED CABLE OR PIPE SPAN
POINT TO POINT STATION TO STATION ANGLE Of CROSSING CENTER OF PVM R/w LINE DEPTH/VERT. SIZE AND KIND LENGTH
4.03 4.03 151+45 151+65 LEFT VARIES VARIES xxx xxx xxx
...
h __" -. .. ..
DESCRIPTION AND LOCATION OF NON-COMMERCIAL SIGNS O~ MISCELlANEOUS OPERATIONS FACILITIES
PERMIT IS FOR REMOVAL OF UNPERMITTED APPROACH
SPECIAL PROVISIONS (FOR MORE SPACE ATTACH ADDITIONAL SHEETS)
TRAFFIC CONTROL REQUIRED - OPEN CUTTING OF PAVED OR SURFACED AREAS ALLOWED?
. IZI YES [OAR 734-55-025(BII 0 NO . 0 YES IOAR 734-55-100(2) IZI NO (OAR 734-55-100(11
. AT LEAST 4B HOURS BEFORE BEGINNING WORK, THE APPLICANT OR HIB CONTRACTOR SHALL NOTIFY THE DISTRICT REPRESENTATIVE
AT TELEPHONE NUMBER: 541686-7626
OR FAX A COPY OF THIS PAGE TO THE DISTRICT OFFICE AT: N/A 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.
. ATTENTION: Oregon law requireD you to follow rule. a~opted:by the Oregon Utility Notification Center. Those rules are set forth in OAR
962-001-0010 through OAR 962-001-0090. You may obtein copies of the rules by calling the center at (503) 232-1987.
CALL BEFORE YOU DIG 1-800-332-2344
COMMENTS - OOOT USE ONLY
PERMIT & PERMISSION TO REMOVE UNPERMITTED APPROACH AND REPLACE WITH SIDEWALK AND CURB. ALL WORK
TO MEET CITY OF SPRINGFIELD AND ODOT STANDARDS. CITY OF SPRINGFIELD SIGNATURE REQUIRED ON PERMIT.
SIDEWALK AND CURB TO MATCH EXISTING. MANHOLE WILL NEED TO BE RAISED TO BE FLUSH WITH SURFACE OF NEW
SIDEWALK.
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~G VERNMENT OFFICIAL SIGNATURE "T\1~ P~f>o ..... '" "",-,,,S TITLE
\"tAli "'~.J. U{\.o-,r '^rplAt::-h"Q\- ~\ '
X ,- -=----> O<<C.UIO-O"'~I-o.. _ ,<"y\y\"-'("_
APPLICANT SIG ATU E APPLICATION DATE ~ITLF
- O,~...
, the applicant il ~ to. occopt. and approve. D!y'; I'I1ICT Mf\N8Gt.H EPRESENTA TIVE
: and tho term. of Oregon Administrative Rule., I
lIIt-rlnea mode 0 part of tm. permit.
x
VYhen this II j ion i. IlIpprov V t
thlllllllfml and provilion. contllinad and
Chapter 734. Divlelon 56, whiCh i. bV
734-3457(7-06)
Date Received'
Planner: DK
-'((Tho
1Jt-,ZJ~/O
. . .~ 5M3 981!i
SPECIAL & GENERAL PROVISIONS
FRED BUSHER
MCKENZIE HIGHWAY (015), MP 4.03
"APPLICANT/PERMITTEE SHALL BE RESPONSIBLE AND 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 THA TRELA TE TO THE PROPOSED ACTIONS. AND COMPL YING WITH SUCH. INCLUDING BUT NOT LIMITED TO THOSE
RELATING TO HAZARDOUS MATERIAL(S), WATER QUALITY CONSTRAINTS. WETLAND. ARCHEOLOGICAL OR HISTORIC RESOURCE(S).
STATE AND FEDERAL THREA TENED OR ENDANGERED SPECIES. ETC.; (3) COMPLYING WITH ALL FEDERAL, STATE, AND LOCAL LAWS,
REGULATIONS, RULES AND ORDINANCES, WHETHER ENVfRONMENTAL IN NATURE OR OTHER, PERTAINING TO THE PROPOSED
ACTION, AND OBTAINING ALL REQUIRED AND NECESSARY PERMITS AND APPROVALS.
IF APPLICANT/PERMITTEE IMPACTS A LEGALL Y PROTECTED/ REGULA TED RESOURCE, APPLICANT/PERMITTEE SHALL BE
RESPONSIBLE FOR ALL COSTS ASSOCIATED WITH SUCH IMPACT, INCLUDING. BUT NOT LIMITED TO ALL COSTS OF MITIGATION AND
REHABILITATION, AND SHALL INDEMNIFY, DEFEND AND HOLD HARMLESS ODOT FOR SUCH IMPACTS AND BE RESPONSIBLE AND
LIABLE TO ODOT FOR ANY COSTS OR CLAIMS THAT ODOT MA Y HA VE."
NOTHING IN THIS PERMIT IS INTENDED TO GRANT RIGHTS OR IMPL Y APPROVAL NOT FALLING WITHIN THE AUTHORITY AND
JURISDICTION OF ODOT. IT IS THE RESPONSIBILITY OF THE APPLICANT TO DETERMINE THE NEED FOR AND TO OBTAIN SUCH
LICENSES, PERMITS OR OTHER FORM OF APPROVAL WHICH MAY BE REQUIRED BY OTHER'STATE AGENCIES, FEDERAL AGENCIES,
CITIES AND/OR COUNTIES OF OREGON, UTILITY OR RAILROADS. OAR 734-055-055.
SPECIAL PROVISIONS
ALL WORK SHALL BE ACCORDING TO YOUR PLANS & MEET ODOT AND CITY OF SPRINGFIELD STANDARDS
AND SPECIFICATIONS FOR ROAD CONSTRUCTION 2008.
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 CONSTRUCTED/REPAIRED 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 CONSTRUCTED/REPAIRED AS PER OREGON STANDARD DRAWING RD720. 4 INCH MINIMUM
AGGREGATE BASE REQUIRED
RAMP TO BE CONSTRUCTED/REPAIRED 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.
11 =-::muon
. .
GENERAL PROVISIONS
FOR POLELlNE, PIPELINE, BURIED CABLE,
AND MISCELLANEOUS PERMITS
Revised May 2003
.0 5 M 3 9 8 1 5
I HIGHWAY: 015 ....
I MP:403
I APPUCANT: FRED BUSHER
All checked (V') provisions apply.
WORKSITE
o 1. Permittee must call for utility locates before digging ("Call Before. You Dig!" 1-800-332-2344)
per Oregon Administrative Rules (Chapter 952, Division 1). You may be held liable for damages.
Pre-marking of excavation areas is required.
o 2. Permittee shall have a copy of this permit and all attachments at the work site. They shall be
available to the District Manager or representative upon request
o 3. Permittee shall acknowledge, in writing, receipt and review of Oregon Administrative Rules
(Chapter 734, Division 55) governing miscellaneous facilities and operations in the highway right
of way as the governing provisions of permit or agreement. Copies f this rule may be obtained
from any district maintenance office.
[{J 4. Permittee shall review the Oregon Administrative Rules (Chapter 734 Division 55) governing
miscellaneous facilities and operations on the highway right of way as the governing provisions
of this permit or agreement. Web site: http://arcweb.sos.state.or.us/rules/OARS_7001
OAR_7341734_055.html.
o 5. Access control fence must be maintained during construction and restored to its original or
better condition after construction is complete.
o 6. The permittee shall not use state highway right of way to display advertising signs or merchandise
of any kind. .
[{J 7. The stopping and parking of vehicles upon state highway right of way for the maintenance of
adjoining property or in furtherance of any business transaction .or commercial establishment is
strictly prohibited.
o 8. All grass and small brush within the work area shall be rotary or flail mowed to ground level prior
to the beginning of work to facilitate clean up. Disturbed areas shall be reseeded with grass
native to the area in an appropriate seeding time.
o 9. The spreading of mud or debris upon any state highway is strictly prohibited and violation shall
be cause for immediate cancellation of the permit. Clean up shall be at the applicant's expense.
The highway shall be cleaned of all dirt and debris at the end of each work day, or more frequently
if so determined by the District Manager or representative.
o 10. Permittee shall replace any landscape vegetation or fences that are destroyed. Any damage
that is not fully recovered within 30 days (weather permitting) shall be replaced by ODOT at
the expense of the permittee. A "plant establishment" shall be understood to be p-art of the
planting work to assure satisfactory growth of planted materials. The plant establishment period
will begin when the original planting and all landscape construction has been completed and
approved. The length of the establishment period will be one calendar year or as defined in the
permit Special Provisions.
734-3457 (7106)
General Provisions Page 1 of 5
.
.
05M39815
D 11. Permittee shall install and maintain landscaped area as shown on the attached drawings. Planting
shall be limited to low-growing shrubs, grass or flowers that do not attain sufficient height to
obstruct clear vision in any direction. The Oregon Department of Transportation (ODOT) shall
have the right to remove said landscaping at any time such removal may appear to be in the
public interest, without liability or loss, injury, of damage or any nature whatsoever.
TRAFFIC
ILl 12. During construction or maintenance, the work area shall be protected in accordance with the
current Manual on Uniform Traffic Control Devices (MUTCD), Federal Highway Administration,
U.S. Department of Transportation, and the Oregon Department of Transportation supplements
thereto. Flaggers must have a card or certificate indicating their completion of an approved
work zone traffic control course. All traffic control devices shall be maintained according to the
American Traffic Safety Services Association (ATSSA), Quality Standards for Work Zone Traffic
Control Devices handbook. .
ILl 13. Permittee shall provide a detailed traffic control plan for each phase of the work, showing signs.
and cones. Plans shall be reviewed and approved by Oregon Department of Transportation in
advance of construction or maintenance.
ILl 14. All damaged or removed highway signs shall be replaced by the pennittee. Installation shall be
according to MUTCD standards or ODOT specifications, and shall be completed as soon as
possible but no later than the end of the work shift.
o 15. No lane restrictions are permitted on the roadway during the hours of darkness, on weekends,
or between 6:00 AM and 9:00 AM, or 3:00 PM and 6:00 PM (Monday through Friday) without
prior approval by ODOT.
ILl 16. Hours of work shall be 9:00AM-3:00PM
DRAINAGE
o 17. On-site storm drainage shall be controlled within the permitted property. No blind connections
to existing state facilities are allowed.
o 18. Excavation shall not be done on ditch slopes. Trench excavation shall either be at ditch bottom
or outside ditch area. (Minimum depth at bottom of ditch shall be 36 inches; minimum depth
outside of ditch shall be 42 inches).
D 19. Only earth or rock shall be used as fill material and shall slope so as not to change or adversely
affect existing drainage. Fine grade and seed the finished fill with native grasses to prevent
erosion.
o 20. A storm drainage study stamped by an Oregon Registered Professional Engineer (PE)
is required. The study must meet standards of the National Pollution Discharge Elimination
Systems (NPDES) when any of the following conditions apply:
. Whenever a four inch pipe is inadequate to serve the developed area,
· development site is one acre or larger in size and directly or indirectly affects state facilities,
o or as directed by the District Manager or representative.
. An advance deposit for OOOT hydrology reviews may be required.
734.3457 (7106)
General Provisions Page 2 of 5
.
.
,0 5 M 3 9 8 1 5
o 21. Permittee shall provide on-site retention for storm water runoff that exceeds that of the
undeveloped site.
o 22. All water discharged to an ODOT drainage system must be treated prior to discharge. All requests
for connection to an ODOT storm system must meet any requirements of the National Pollutant
Discharge Elimination System (NPDES). This may include local jurisdiction approval of on-site
water quality treatment facilities and/or development of an operation and maintenance plan for
anyon-site water quality treatment facility, as determined by local jurisdiction.
EXCAVATION I CONSTRUCTION
o 23. The following ODOT documents and any supplements and subsequent revisions thereto, where
applicable and not otherwise superceded by the permit language herein, but only to the extent
that they provide standards and performance requirements for work to be performed under the
permit, shall be incorporated for use in the permit:
"Oregon Standard Specifications for Construction (2002)" and relevant Metric Standard
Drawings. ODOT shall have authority over acceptance of all materials and workmanship
performed under this permit as stated in Section 00150.00 of the "Oregon Standard
Specifications for Construction (2002)."
For additional Supplemental and Special Provisions please refer to: http://www.odot.state.or.us/
techserv/roadway/specs/home.htm. Standard Specification books is available on this site.
o 24. Open cutting of pavement is allowed in areas specifically approved by District Manager or
representative.
o 25. Trench backfill shall be according to the attached typical drawing, marked as Exhibit A.
o 26. Open cutting of the highway is allowed with construction in accordance with OAR 734-55-0100.
All excavation in paved areas shall be backfilled and the roadway surface patched before the
end of each shift. In special cases where steel plates are allowed, said plates shall be pinned
and a temporary cold patch applied to the edges. The permittee shall be fully responsible for
monitoring and maintenance of temporary patching and steel plating.
o 27. Compaction tests shall be required for each open cut per Oregon Standard Specification for
Construction. Compaction tests shall be conducted once for every 300 lineal feet per lift of
continuous trench according to the Manual of Field Test Procedures (M FTP), published by ODOT.
Percent Compaction shall be 95%. At the discretion of the District Manager or representative,
results of compaction test shall be provided to District Manager or representative at applicants'
expense.
o 28. Control Density Fill (CDF) shall be used as surface backfill material in place of crushed rock in
open trenches that impact the travel portions of the highway. A %"-0, or 1"-0 rock will be used for
the aggregate. The amount of cement used shall not exceed 3.0% of the total mixture's weight.
Maximum compressed strengths must not exceed 250 pounds per square inch (psi).
o 29. Surface restoration shall be a minimum of eight inches of hot asphalt-concrete (AG), compacted
in two inch lifts, or match existing pavement depth, whichever is greater. Sand-seal all edges
and joints.
o 30. All aggregate shall conform to Oregon Standard Specification for Construction, Section 02630
- Base Aggregate.
734-3457 (7/06)
General Provisions Page 3 of 5
.
.
,0 5 M 3 9 8 1 5
o 31. Any area of cut or damaged asphalt shall be restored in accordance with the included attachment
"T-Cut Typical Section" drawing. For a period of two years following the patching of paved
surface, permittee shall be responsible for the condition of permittee's pavement patches, and
during that two year period shall repair to District Manager or representative satisfaction any of
the patches which become settled, cracked, broken, or otherwise faulty.
o 32. An overlay to seal an open-cut area shall be completed priorto the end of the construction season,
or when minimum temperature allows per "Oregon Standard Specification for Construction"
and any subsequent revisions thereto. Typical overlay shall be 1.5 inches deep and cover the
affected area from edge of pavement to edge of pavement, and taper longitudinally at a fifty feet
to one inch (50' : 1") ratio. Taper may be adjusted by the District Manager as required. For a
period of two years following this patching of the surface, the permittee shall be responsible for
the condition of said'pavement patches, and during that time shall repair to the District Manager
or representative's satisfaction any of the patches which become settled, cracked, broken 'or
otherwise faulty.
o 33. Highway crossings shall be bored or jacked. Bore pits shall be located behind ditch line or in
areas satisfactory to the District Manager. Unattended pits shall either be protected by a six-foot
fence, backfilled, or steel plated and pinned.
o 34. Permittee shall install a "tracer wire" or other similar conductive marking tape or device, if
installing any non-conductive, unlocatable underground facility, in order to comply with Oregon
Utilities Coordination Council (OUCC), per OAR 952-01-0070 (6).
o 35. Trench backfill outside of ditch line or in approved areas can be native soil compacted at optimum
moisture in twelve inch layers to 90% or greater of the maximum density.
o 36. Native material that is found to be unsatisfactory for compaction shall be disposed of off the
project and granular backfill used.
o 37. Trench backfill in rock slope or shoulder shall be crushed 1"-0 or %"-0 size rock compacted at
optimum moisture in eight-inch layers. Compaction tests shall be conducted according to the
Manual of Field Test Procedures (MFTP), published by ODOT. Percent compaction shall be
95%. At the discretion of the District Manager or representative, results of compaction tests shall
be provided to District Manager or representative at applicant's expense.
o 38. Where excavation is on fill slope steeper than a two to one (2:1) ratio, slope protection shall be
provided using four-inch size rock laid evenly to a minimum depth of twelve inches.
o 39. No more than 300 feet of trench longitudinally along the highway shall be left open at ariy one
time and no trench shall be left in an open condition overnight.
o 40. Areas of disturbed cut and fill slopes shall be restored to a condition suitable to the District
Manager or representative. Areas of erosion to be inlaid with an acceptable riprap material.
o 41. All underground utilities shall be installed with three-foot or more of horizontal clearance from
existing or contract plans guardrail posts and attachments. All non-metallic water, sanitary and
storm sewer pipe shall have an electrically conductive insulated Number 12-gauge copper tracer
wire the full length of the installed pipe using blue wire for water and green for storm and sanitary
sewer piping.
734-3457 (7/06)
General Provisions Page 4 of 5
. . 105M 3 9 8 1 5
o 42. Any area of cut or damaged concrete shall be restored in accordance with the attached Typical
Section-Pipe Section under sidewalk.
D 43. Utility markers and pedestals shallQe placed as near the highway right-of-way line as practical.
In no case shall pedestals and line markers be located within the highway maintenance area.
D 44 No cable plowing is allowed within the lateral support of the highway asphalt (Le. at six feet lower
than the edge of the asphalt, no plowing within nine feet of the edge of the asphalt).
D 45. Review by ODOT Bridge Engineers ;s required for all proposed bridge and structure attachments
and for utility or any facilities to be installed within sixteen feet of bridge foundations, supports,
walls or related, or within the influence zone of bridge facilities.
MISCELLANEOUS
[{] 46. Permittee shall be responsible and liable for (1) investigating presence/absence of any legally
protected or regulated 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 relating to hazardous material(s), water quality constraints,
wetlands, archeological or historic resources(s) state and federal threatened or endangered
species, etc., (3) complying with all federal, state, and local laws, and obtaining all required and
. necessary permits and approvals.
[{] 47. If the permittee impacts a legally protected/regulated resource, permittee shall be responsible
for all costs associated with such impact, including, but not limited to all costs of mitigation and
rehabilitation, and shall indemnify, ana hold ODOT harmless for such impacts and be responsible
and liable to ODOT for any associated costs or claims that ODOT may have.
[{] 48. Plans are approved by ODOT in general only and do not relieve the permittee from completing
construction improvements in a manner satisfactory to ODOT. The District Manager or
representative may require field changes. When revisions are made in the field, permittee
is responsible to provide "as built" drawings, within 60 days from completion of highway
improvements, and shall submit them to the District Office issuing the permit.
D 49. Permittee shall be responsible for locating and preserving all existing survey monumentation
within the work area in accordance with ORS 209.150 and/or 209.155. If monumentation or its
accessories are inadvertently or otherwise disturbed or destroyed, applicant shall be responsible
for all costs and coordination associated with it's reestablishment by a professional licensed
surveyor.
D 50. An advance deposit of $_________~ is required for project associated costs incurred by ODOT.
Such costs will be identified and estimated by o DOT, and include, but are not limited to review
of studies and calculations involving hydraulics/drainage, geotechnical, traffic and traffic control
plans, signal, roadway design, bridge and other engineering support. Excess funds remaining
in the account upon completion of ~illing will be refunded. If ODOT costs exceed the deposit
amount, permittee shall be billed for the difference.
By this signature applicant accepts all checked (vi') provisions (5 pages).
I Applicant Signature: 1'1) r3Yl/l1)-(J,~) ~
IDate:~ -/<7 ~/O I
,
734-3457 (7106)
General Provisions Page 5 of 5