HomeMy WebLinkAboutPermit Building 1997-11-14 (2)
City of Springfield
225 Fifth Street
Sp~ingfield, OR 97477
(503) 726-3753
Transaction number 028023
November 14, 1397 2:24 PM
Received from: BILL FERGUSON
Contr'ad/Own :
Address: 507b FORSYTHIA
City: SPRINGFIELD St: OR Zip:
-Building-
Job t: 971b33
Descr-ipt ion
Sidewalk
Total:
Anlt Received:
20.00
20.00
Thank you, Lisa H.
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" , CITY OF SPRIf\ FIELD ' " .'>ERMlif A~PLlCATION
226 FIi"fH STREET
~PRINGFIELD. OREGON 97477
ENGINEERING DIVISION
OFFICE TELEPHONE (603) 726.3763
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INSPECTION LINE SEE INSPECTIONS ON BACK SIDE '
ENCROACHMENT PERMIT
NUMBER:
PERMIT NUMBER: 971 t, ~'
APPLICATION DATE: U -/l/~q7
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DATE ISSUED:
//~/t:( --17
,LOCATION OF WORK
APPLICANT 8 I / I
SITE ADDRESS: Cj'O 71n
CITY: 5PFb
R' r:'ERGiJC,OA./
FoRSyTHIA DR.
STATE: t1R
PHONE 7117- 9738
,TAX MAP:
q7tJlf( TAX LOT:
/1-cP - 6Y; ??
/700
ZIP:
SUBDIVISION:
OWNER: FLf)/J!./ G{~-\dAR---r
ADDRESS: c,'r?7(nPORl)YTHIA OR CITY: C;PFf)
CONTRACTOR: ADDRESS:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERVISOR:
,PHONE:
STATE: DR
ZIP: q 7 LJ 7J?
PHONE:
EXPIRATION,DATE: '
REQUESTED PERMITS: INSI'l!CTIONS REClUllWl.
~NCROACHMENT PERMIT NO: ............................... n
VAlD FOA SIXTY 1801 DAYS PROM D~~I
Q CUT STREET Q BORE I,;;] OTHER 1J'l/)-1 L b X n
Q DUST CONTROL ITYPE OF CONTROIJ
PHONE:
APf'UCATlCN FU I DEPOSIT
ACCOUNT NO:
1ZJf20.00 I
0$
Q CONSTRUCTION. STORAGE, STAGING
Q OTHER
n
n
0$
0$
0$
I:) ASPHALT DEPOSIT ......................................................................................................~.....
mE.!lF !:F~IIRITV I1EPOSIT
Q BLANKET SURETY BOND Q SURIITY BOND Q CASH / CHECK
0$
o $10.00H.16/FT.
o CURB CUT PERMIT NO: .................... FT. 0
IN!I:~l'!TIt'HI" CURB I APPROACH ArnR fORMS ARI ER!CTID BUT PRJOR TO POURINQ CONCR!TL
, VALlI POR IIClDAYI FROM DATI Df ISSUANCE.
Q SECON'O DRIVEWAY (SEE SEPARATE APPUCAnONl
Q SIDEWALK PERMIT NO:.................... FT.
VALl) fOR 110 DAYS FROM DATI Oil 1S8UANCI.
Q NEW Q REMOVE / REPAIR Q PAVE PlANT STRIP
Q'SETBACK Q CURBSIOE Q LENGTH
INlt,.t"Tln",. RIDEWAlIC , DRIVEWAY FOR ALL CONCMTI PAVlNQ WITHIN THE STRUT RIGHT Oil WAY. TO BE
MADE A"EA AU. !XCAVAT&NQ IS COMPLlTE. AND FORM WOAK ANO SUB-WE MATIR1AL IS IN PlACI.
D SANITARY SEWER CONNECTION PERNUT: ................ n
VAUD FOR SIXTY 110) DAYS FROM DATI Oil ISSUANCE
Q TO STUB Q MAIN UNE lEASEMENT.R/W) Q OTHER
D STORM SEWER CONNECTION PERMIT: ....................n
VALl) FOR 8DCTY IISOI DAVI fROM DATI OfIISSUANCI
Q CATCH BASIN I BU8IlLER Q STUB Q MAINUNE
PROOF OF IN!:IIRANCF' $600.000 MINIMUM
, Q ATTACHED Q REQUIRED AMOUNT
n
o $10.00,,"$.16/FT.
o $6.00/,
o $6.00/
TOTAL DUE:'-.
TOTAL DUE WITH PERMIT $
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c90 -
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 UTI~IZED:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
WARNING DEVICES TO BE UTILIZED: '" , '.
Advance .lgnIng Ind work lone ,protectfon to be In compll.nco Wfm tne Manual ~ Uniform TraUlc Control Devlc., {MUTeDI.
FROM DATE:
TO DATE:
WIDTH:
. DEPTH:
TIME:
TIME:
HEIGHT:
BORE:
BACKFILL MATERIAL:
DESCRIPTION:
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WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD .
REVISIONS 8/24/85 FORM III e '
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PLAN REVIEW COMMENTS / SPECI3;TRUcnONS: '
RESTORA, ;'nON WORK SHALL BE IN CONFO CE WITH EXlSTlNO CITY CODES AND IN 6UANCE WITH CURRENT
STANDARD SPECIFICAnONS, EXCEPT AS NOT BELOW. ,V'
3 oo~ Backfill with.' mlnUl rock. :' 018 Mlnumum 4' cl..rlncl Itlny point. Iwlng'lwIY.
.. 002 Complct IVlry IS' I.... dlpth. . 020 Coner'lI minimum 4' dlpth. 3.000p.1.
003 Rlqulral comp.ctI.n with I .t..1 rollllr. . 021 Traneh to ba .,.. out.
. 004 A.C.t. m.tch tha gra.tar ollxllllng d.pth or 4'. . 022, N..dl Stltll Count\l plrmlt,
. 005 AU cutl ...lld I.r IInollnapoctl.n. 023 N. IbovI ground oncl.llnglln Ildowolk .r hondlcop rompl.
. OOB, Tlmporlry pitch mlY bl u..d It tho Ind 01 thl doy. L 024 Olom.nd out A.C.te.ncroto vlluo b.... t. grodo,
. 007 Signing .nd 2.nll pr.tactlon to comply with MUTCO a 025 Froo. on olgno I Gradod.
. 008 Cut concrete only on Icor. IIn.. or. COld lolntl. . 028 Comply with Amertcana with DI,abllities Act.
. 008 Sldlwllko Ind drtVlw'YI mln. 3,OOOp.L . 027 Concratl Illbo, 72hr.. curlng tlml, 45oopol.
. 010 Curbing mln 3.8ooplll N. pllchworlt II" thin 3'. 02S C.ncrlto IIlbl raqulra ,.Int ...1 matorlol.
. OIl MI.t min. raqulrlmlnta on CIIrb Cutl, Spld. Codl. 028 Otlvlw,y raqulr.. d.wII. .Vlry IS'.
. 012 R..tora pllntld,lra... Spld. Codl 208.3.08 030 Submit trlfll. coMr.1 pion prl.r to I.clvltl.n,
. 013 SpIC. to S.ra I Jlck I No A.C. outl. 031 N.tlly TraW. Olvlll.n bllora uClvltlpn,
. 014 Mlchonl..1 comPlctlng raqulrad. 032 Corl drlll main IInl.ln..n tll, 2% min. grodl.
. 018 N. pltchw.rk In.wld. 933 MUlt comply with thl provlllonl 01 ORS 757.541 t.757,871-
. 018 Latorll Cutlto hlvl c.ntr.1 dlnaltY 1111. 343 8' Circular horI1H2o.V.c.
017 CutltO ba p.lymlrlZld crIck ,""I.d I.r IInlllnap.ctl.n.
c.. ,018 Mlnlnum 2- CNlhed rock~. minus.
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Cor:nments:
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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:
. ~URB CUT AND SIDEWALK INSPECTIONS CALL 728-3789 (RECORDER) STATE YOUR DESIGINATED CITY JOB
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 WO~K 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:
RECEIPT NO:
/20.()()
r9K02.~
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DATE PAID:
RECEIVEO BY:
II -1'-f~f7
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By signature, I state and agree~ that I have carefully axamlned the completed application and do heraby certify that alllnlormation
herein Is true and correct. and further certify that any and all work parformed shall be dpne In accordance With the Ordinances of the
, City of Springfield, applicable Ity Standard specificatlons and Drawlngshand the laws Qf the Stata of OreJlon pertaining to the work
dascrlbed herein. I further certify that only contractors and employees w 0 are in compliance with ORS 701.056 will be used on this
, project. ,
The City may Inspect the work site described In this permit at:any ~ime during a one year period following the receipt by the City of
notlce of,completlon of the described work end ape~lfv, at the City 8 8ple dascresalon, any addltlonel restoration work re~uired to
, return the alte to e atandard acceptable to the City. TKe permltte, will be notified In writing of any wprk required and will have thirty
" daYS 1301 from the da" of the notice to complete the work. Work not completed at the enll of the thirty daYI' 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 requllstad st the proper time, that project address Is readable Irom the street.
and the approved set of plans will remain on the site at all times during construction.
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Slgnlture
Date
/1- JJj- q?
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VALIDATION:
o TRAFFIC REVIEWED BY:
o ENGINEERING REVIEWED BY:
, 0 MAINTENANCE:
o PERMIT ISSUED BY:
DATE:
DATE:
DATE:
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:
DAT~:
DATE:
DATE:
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ADDENDUM'
City of Springfield
To:
'\ From:
PeTI?iteelUtility InstallerlUti,lity Company
Mike Koivula, City SUlVey Dep't.-
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Date: '
Ajlril9, 1997,
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,Subject:', City Specifications, SUlVeyMonumentation; State Law
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P~GE 1 OF2 \
, .Ail permittees under our "Encroachment Permit" program should be particular,ly aware of their
, responsibilities as noted under th~ section "PLAN REVIEWCOMMENTSISPECIAL '
INSTRUCTION~" on the reverSe side of the permit form which refers to the current city
specifications document.'
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'Besides the full' glll1lut 'of construction s~dards the document also lias specific provisions relating
to the protection and preselVation of sUlVey,monum~nts. (1) In addition, there are Oregon State,
laws that deal with the sanie subject(2) .
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For, a general ovelView of sUlVey monuments, please see the following page,
For general information regarding city specifications and the permit process, please call our office
at' (5~ 1) ,726-3753, For specific assistance with sUlVey monumentation please call me directly at ,
(541) 726-3679.,
(I ),City of Springfield Siandard Specifications, 1993 section '1 O,5~ I 0 "Protection of SUlVey
Monuments" " ,
(2)OREGON REy'ISED STATUTE 209.150 "REMOVAL AND DESTRUCTION OF
, ,MONUMENTS.."
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, ADDENDUM, '
City of Springfield
PAGE 2 OF 2
TYPICAL MONUMENT CONFIGURA nONS CAN INCLUDE:
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'1) Property comers
"Th~se usually area piec,e of steel reinforcing rod (~ebar) of 1/4 to I inch diameter or lengths of
iron pipe with diaineters of 1/2 to 4 inches; They mayor quiy not have tags or caps of brass,
aluminum or plastic with identifying letters,'numbers or combinations of the two. They are
typically found at recognized property occupation limits, fence co~er areas, hedge rows and'
,between utility services like water meters, Along road right-of ways; they can be found 1/2 to eight
, feet behind the back of sidewalk, and may be found at typical "occupation" lines as delineated
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, above arid also at areas where roads make angular changes, curve or change iti width..
2) Roildw~Y'ce~terline marke~s' ' ,', ' ,
. In asphalt or concrete streetS, these are tYpically nails of various types, sometimes with
identifying tags or washers, They can also be "rebars" or iron pipes as delineated above, They can
be found typically at the intersections of roads, on the center of both roads, and on the ,center o(
, one and the right-of-way of the other. They may also be found at ,angles and curves ofroad ,
alignment or at changes in r~adway width, In unimproved dirt or gravel roads, they are typically
"rebars" or pipes set below the driving surface.
3) Road Reference Monuments and Benchmarks
These a~e typicailys!llall naiis,set in concrete curbs in the vicinity of road centerline markers,
They also can be brass caps of 1/2 to'2 inches in diameter, Benchinarks(vertical control
monuments) can also be squares chiseIedin to the curb 'concrete, A system offederally installed
precise ben~hmarks comprises iron rods set into aluminum "valve-type" ~ases at South A st in the'
vicinity, Of 14th st, and along Main St. in the vicinities of 24th st, 33rd st (at hou'se no, 185 -N
33rd), s 41 st st, 59th st. and 64th st. ' ,
, 4) ?over:nment Control'Monuments
,These typically co~prise brass caps set in concrete monuments, railroad spikes set in p~ving ,
and various types of ri1ontimeh~ set in ~'valve~type" cases, Their location varies with the type of
monument and does not follow any typical location pattern. Often'there are warning signs in the
vicini))' or survey stlkes and c610rful ribbon to alert you to these monuments, ' '
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