Fillable Form 2344: PERMIT - OPENING STREET . Lamb

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Form 2344: PERMIT - OPENING STREET . Lamb

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STREET
OPENING
PERMIT
Permit
No
.
CITY
OF
MiLTON
-
FREEWATER
501
Lamb
,
PO
Box
6
Milton
-
Freewater
,
OR
97862
Phone
:
1
-
541
-
938
-
8274
FAX
#
:
1
-
541
-
938
-
8224
Date
:
CALL
BEFORE
YOU
DIG
:
1
-
800
-
332
-
2344
Location
of
Work
Phone
Phone
Required
Insurance
:
Liability
&
Property
Damage
;
$
100
,
000
/
occurance
;
$
500
,
000
/
aggregate
operations
with
City
of
Milton
-
Freewater
named
as
additional
insured
.
Insured
by
:
Owner
Address
Contractor
Address
Copy
of
policy
must
be
on
file
in
Public
Works
Office
.
Traffic
Control
must
meet
Uniform
Traffic
Control
Codes
.
Inspections
must
be
made
by
City
prior
to
backfill
and
again
prior
to
paving
.
24
hours
notice
of
required
inspection
to
be
given
.
PERMIT
CONDITIONS
:
Contractor
will
contact
the
City
prior
to
starting
work
.
All
trenches
will
be
compacted
with
a
compaction
device
to
City
specifications
.
Pavement
must
be
cleanly
saw
-
cut
on
final
patching
work
.
!
SEWER
/
WATER
CONNECTION
STREET
OPENING
Proposed
construction
Location
of
tap
or
wye
(
compass
direction
)
from
the
manhole
/
water
valve
in
the
intersection
at
ft
.
Method
of
installation
Trench
Safety
Depth
Main
Size
Type
Backfill
/
Patch
Criteria
Contractor
doing
Work
&
Date
of
Work
Service
Size
Type
Depth
Inspected
by
Inspected
by
:
'
Date
Date
:
Street
repairs
must
be
made
within
5
days
after
underground
work
completion
.
SIDEWALK
I
DRIVEWAY
/
CURB
CUT
Method
of
Removal
Inspected
by
Applicant
’
s
Signature
&
Date
Date
Approved
by
City
of
Milton
-
Freewater
FEES
By
$
3.50
/
Ft
.
or
$
100.00
*
Date
Paved
Surfaces
Unpaved
Surfaces
$
1.00
/
Ft
.
or
$
40.00
*
Fee
’
*
Whichever
is
greater
.
Per
Resolution
No
.
1590
Amended
11
/
25
/
96
Copies
:
White
/
Office
;
Yeliow
/
Field
;
Pink
/
Applicant
7
—
«
l i l
:
«
v
-
.
7
-
„
>
.
v
v
.
v
.
v
;
.
v
.
’
:
-
L
..
.
.
V
1
f
J
I
i
i
;
i
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;
i
Completed permits can be emailed to: steven.patten@milton-freewater-or.gov
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Form 2344: PERMIT - OPENING STREET . Lamb

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Completed 20 July 2020

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