New Search
0~~15~2008 12:48 FAX <br />t'« ~ <br />Q~lye~-OMPMnrMal <br />PACIFIC HIGHWAY 1 <br />HfGHWAY NUMBER <br />001 <br />BELTLINE HIGHWAY <br />541 682 5366 CITY EUGENE Pw ENG 3 DELTA CDNSTRUCTI I~j008l009 <br />APPLICATION ANp PERMIT TO OCCUPY pR <br />PERFORM OPERATIONS UPON A STATE HIGHWAY <br />Sea tl-egon Administrative Rula, Chapter 734, Divisor 55 <br />GENERAL LOCATION ._ PUR. <br />COUNTY <br />20 =LANE <br />AND <br />YES <br />CITY OF EUGENE PUBLIC WORKS <br />ATTN' JENFIER WILLER P E <br />SPRAGUE ROAb <br />JYAY IN U.B. FOREST <br />NO ~} YES ~ NO <br />POLE TYPE <br />LINE wA <br />IUHIED TYPE <br />:ABLE WA <br />PIPE I ~~~ TYPE <br />LINE WA <br />PERMIT NUMBER <br />class ~ oS I <br />pF APPLICATION <br />.TlOPERATE/MAINTAINI ___ <br />~1flRT. CLEAFtAWCE <br />sIGNN-COMMERCIAL FEE AMOV O OD <br />® fY~CELLANE0U5 oPERATfONS ANDMOR FACILITIES AS <br />oFrceMREn ~l_Aw <br />' ~ BOND REQUIRED REFERENCE: <br />244 EAST BROADWAY ^ YES ®NO dAq 734-Ei5 <br />095(21 <br />EUGENE, OR. 974(11 INSURANCE REQUIRED REFERENCE: <br />(541) 682-5364 ®YES ~ NO OAA 734-55 <br />035 1 <br />DETAIL LQCATlON OF FACILITY(For more space attach additional sheets) <br />LY <br />AMOUNT OF OOND <br />~~.~ <br />SPECIFIED COMP. DATE <br />1/01/2009 <br />MILE MILE fdNOINEEf15 ENGINEER5 s+ce oF'+t"+~' oR DISTANCE FROM BURIED CABLE OR PIPE SPAN <br />POINT TO POINT STATION TO STATK)N ANGLE OFCROSBtNO ENTER OF PVM R/W LINE DEPTHNERT, SIZE AND KING LENGTH <br />1115,T9 423*60 BOTH SEE ATTAC CQNSTRU TION PLAN <br />DESCRIPTION AND LOCATION OF NON-COMMERCIAL SI~N3 OA MISCELLANEOUS OPERATIONS FACILITIES <br />PERMIT IS FOR CITY QF EUGENE PROJECT WITHIN ODOT RIGHT OF WAY. PROJECT # 4328, FED. AID PROJECT <br />#~ STP•2395-1057), ODOT KEY # 15524 <br />SPECIAL PROVISIONS (FOR MORE SPACE ATTACH ADDITIONAL SHEETS) <br />TRAFf-1C CONTROL REQUIRED -OPEN CUTTING OF PAVED OR 5URFACED AREAS ALLOWED? <br />• ® YES IOAR 73455-025(B)J ~ NO • ~ YES (OAR 734-66-100(2] ® NO (OAR 73455-100(1) <br />• At LEAST 4a HOURS BF>~ORE BBGINNINIa WORK, THE APPLICANT OR HI& CONtpACTOR 8HALL NOTIFY THE DISTRICT RF~tEBENTATNE <br />AT TELEPHONE NuMaER: (5411 686-7828 <br />OR FAX A COPY OF THIS PAGE TO YHE DISTRICT ~~E ATi-" - NIA SPECIFY TIME AND DATE IN THE <br />sPACE BE~ow. -. . <br />• A COPY OF THIS PERMIT AND ALL ATTACHMENYS SHALL 8E AVAILA6LE AT THE WORK AREA DURING CONSTRUCTION. <br />• A7TETITION: Dropon Lew rotµtirse you to fortew rules rdoptad by the Oregon Utilhy Notil-ieatlon linter. Ytwee rules are flttt forth in OAR <br />952-001.0010 throu@h OAR 962-001-0080. You may obteir! copNs o! the nilee by calllrtp the canter at (G03f Z32-1913T. <br />CALL BFI~IEB YOU DIG f-BOQ,?3Z-x344 <br />COMMENTS - O00T USE ONLY ~ - <br />PERMIT 8. PERMISSION TO WORK WITHIN ODOT RIGHT OF WAY AT A90VE LOCATION. PERMITTEES WORK SHALL IN <br />NO WAY INTERFERE WITH THE ODOT BELTLINE & I-5 CONTRACTOR (MOWAT). ANY CHANGES iN CONSTRUCTION <br />PLANS WITHIN ODOT RIGHT OF WAY NEED TO BE APPROVED PRIOR TO CONSTRUCTION BY ODOT. WORK TO BE DONE <br />IS ON NORTH GAME FARM RD. UNDER THE I.5 OV>=RHEAD IN ODOT RIGHT OF WAY. <br />IF THE PROPO5E0 APPLICATION wIl„L AFFECT THE LocAL GOVERNMENT, THE APPLICANT sHAl1 ACQUIRE THE LOCAL GOVERNMENT <br />OFFICIAL'S SIGNATURE BEFORE ACQUIRING THE DISTRICT MANAGER'S SIGNATURE, <br />X ~ C1~n~ ~V[~~f-lE t~iv; 1 -~-~ i~n.~r- <br />APPLICA T SIGN RE ~ ~ ~ APPLICATION L7ATE TITLE ~ ~~ <br />~ 12-- d & ~i''vi 4 ~ v1. (~ 1 v1.PrP~r~ <br />vuhpn tha~p ~b ion as ep d by the Depsrtm«R, mp ~ppti~ant is a,b)aet tee ~ end ~pprorss DISTRICT MANAGER OR REPRESENTATIVE <br />tFN tMfN vlrom meMyy4 end emohtl: Ny tM pNYM of Oropon AtlTtNpfstiva Rulao, <br />GMpeN 79~, Dlvidon S5, whkh ie by 4~ip nihnnpt mttle d pert of this pemw. <br />DA E <br />S I~.~aB' <br />TELEPHONE N0. <br />>~}I-IvKZ-S~a~• <br />794-3457(7.08) _. <br />