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MANUFACTURED DWELLING PLACEMENT PERMIT SUBMITTAL COVER LETTER This packet is an effort to expedite the plan review process. Please review and complete the documents in this packet to complete the permit submittal process. CONTRACTORS: Please submit for permit through the State of Oregon E-Permitting system. With your submittal, include the following: o Construction documents/plans o Site plan o Engineering calculations o Completed Manufactured Dwelling Placement packet HOME OWNERS: Please submit for permit through the State of Oregon E-Permitting system. With your submittal, include the following: o Construction documents/plans o Site plan o Engineering calculations o Completed Manufactured Dwelling Placement packet o 1 signed copy of Owners Responsibility Acknowledgement Thank you for helping us provide timely plan reviews. Sincerely, The City of Woodburn Building Division CITY OF WOODBURN Building Department 270 Montgomery St Woodburn, Oregon 97071 (503) 982-5250 www.woodburn-or.gov ---PAGE BREAK--- The applicant shall abide by all standards, rules, regulations, ordinances, and policies of the City of Woodburn relating to public improvements as now exist and as hereafter change or are amended. The applicant shall comply with attached Generals Conditions for this application and permit. TOTAL FEE AMOUNT: $ Permit Number Date APPLICATION & PERMIT TO CONSTRUCT A PUBLIC IMPROVEMENT SEWER STREET WATER OTHER DATES DURING WHICH IMPROVEMENT IS TO BE CONSTRUCTED: (FEE CALCULATED AS PER ORDINANCE #1795) SIGNATURE OF APPLICANT: ADDRESS: Date Receipt No. PERMIT APPROVED BY: ADDITIONAL CONDITIONS: (FOR CITY USE ONLY) The undersigned hereby makes application to construct the following additions, alterations, or extensions to public facilities (separate applications are required for each type of improvement): IMPROVEMENT (Plans must be submitted): LOCATION: CONTRACTOR(S) NAME: CONTRACTOR(S) CCB LICENSE: CONTACT PERSON NAME AND PHONE NUMBER: ESTIMATED VALUE OF IMPROVEMENTS: TYPE OF IMPROVEMENT: (FOR CITY USE ONLY) STORM DRIVEWAY APPROACH SIDEWALK ---PAGE BREAK--- CITY OF WOODBURN PUBLIC WORKS DEPARTMENT GENERAL CONDITIONS FOR APPLICATION & PERMIT TO CONSTRUCT A PUBLIC IMPROVEMENT Division 1. Generals 1. All work under this permit shall comply with the approved plans & special provisions, City of Woodburn Standard Specifications & Drawings, and the General Conditions for Franchise Utility Permits. 2. Plans are approved in general only and do not relieve the applicant from completing the construction improvements to the City's standards and specifications. 3. This permit is being issued ONLY for work performed in the Public Right- of-Way under the jurisdiction of the City of Woodburn and in Public Utility Easements under the jurisdiction of the City of Woodburn. All work performed on private property and/or other jurisdictions will require the applicant to obtain the appropriate permits and/or approvals required. 4. Only Contractors with a current Construction Contractor’s Board (CCB) license in the State of Oregon shall perform work within the Public Right- of-Way and/or Utility Easements. 5. Notify the City of Woodburn Public Works Department 48-hours prior to beginning construction, [PHONE REDACTED]. Any work done without the proper inspection will be subject to rejection. 6. All underground utilities shall be installed with a minimum vertical separation of at least 1-ft. from existing water, sewer and storm pipes. 7. Applicant shall install a ‘tracer wire” or other similar conductive marking tape or device, if installing any non-conductive, un-locatable underground facility, to comply with the Oregon Utility Notification Center, one call system (per OAR 952-01-00700). 8. The the responsibility of the permit holder to understand the limitation of the UL markings, and to undertake all necessary precautions and diligence to avoid damage and impairment to any private or privately-maintained underground facilities. 9. The Applicant holder or Applicant’s authorized representative shall be responsible for all damages related to work done under this permit, including, but not limited to damage to “unlocatable” underground facilities. All construction sites are to be restored to their original or better condition where affected by construction. ---PAGE BREAK--- CITY OF WOODBURN PUBLIC WORKS DEPARTMENT 10. Provide a traffic control plan and install traffic control devices in accordance with the current the guidelines set forth in the current edition of the Manual on Uniform Traffic Control Devices (M.U.T.C.D.) and the Oregon Temporary Traffic Control Handbook, as it applies to the project. Use as many traffic control devices as necessary to make a safe work site for the Public and construction crews at all times. 11. Leave work area in a clean condition, free from litter and debris, at the end of each workday, or more frequently if directed by the City Inspector. 12. Any changes to the approved plans shall be approved by Project Engineer and City Engineer prior to making the changes in the field. 13. All residents shall have uninterrupted access to their properties and to public roads. All streets, driveways, and sidewalks shall be open to the public at the end of each work day. 14. Construction work and activity shall be limited to Monday through Friday from 7:00 am to7:00 pm, excluding legal holidays. Division 2. Materials 1. The use of materials different from the approved plans, permit specifications, or the City Standard Drawings & Specifications is not allowed, unless they are submitted and approved by the City Engineer prior to their installation/construction. Division 3. Site work 1. All concrete and asphalt to be removed for installation of replacement structure shall be saw cut vertically to ensure neat vertical face to adjoin new. All damaged concrete sections shall be saw cut to the next joint and the panel replaced in its entirety. 2. Do not trim, cut or in any way disturb any trees, shrubbery, and other vegetation without the approval of the City Engineer. 3. Remove and dispose all waste materials of debris in an approved and “Permitted” landfill. 4. All underground work in the Public Right-of-Way shall be properly covered and/or surrounded with caution tape to protect the Public. 5. The permit holder shall comply with the approved erosion and sediment control plan at all times. 6. All damaged or removed street signs shall be replaced by the applicant. Installation shall be according to the current MUTCD standards and shall be completed no later than the end of the work shift. ---PAGE BREAK--- CITY OF WOODBURN PUBLIC WORKS DEPARTMENT 7. Street Closures are issued through the Woodburn Public Works Department, [PHONE REDACTED]. 8. Existing property pins and survey monuments shall be preserved. When disturbed by construction activities, they shall be replaced/reinstalled by a Licensed Professional Land Surveyor. 9. “Sidewalk Closed” signs shall be placed at all intersections leading to the sidewalk where work is being performed. Division 4. Streets 1. Pavement cutting is allowed only in areas specifically approved by the City Engineer or Field Representative. 2. Open cutting of pavement will be allowed in areas approved by the City, under the following conditions: a) Trench backfill shall be 1”-minus gravel or crushed rock compacted in 8” lifts to 95% AASHTO T-180. b) The asphaltic concrete replacement shall be full depth thickness, as per existing level 3, ½” Dense graded asphaltic concrete mix in accordance with the 2015 Oregon Standard Specifications for Construction. The edges must be saw cut, properly prepared, and sealed upon completion. The trench shall be temporarily patched with cold patch material if the surface repair is not to be immediately completed. Surface restoration shall be done in accordance with the City of Woodburn “Trench Cap” detail No. 3800-5. c) Width of trenches in which pipe is to be laid shall be twenty-four- inches (24”) greater than the diameter of the pipe, unless permission is obtained from the City Engineer. d) Open trenching length shall not exceed one-half of the street width. e) Before paving, proof of passing compaction tests on the compacted rock must be provided to the City Inspector. f) No trench shall be left in an open condition overnight. When approved, underground work in the area of paved surfaces shall be covered by steel plates that are capable of supporting traffic loads, with hot or cold mix along all edges, and pinned to prevent displacement of the steel plates. Steel plates shall be daily inspected, any necessary repairs completed on a timely basis, and shall not remain for over 48-hours without written permission from the City. A “SLOW” and “BUMP” sign shall be placed at each side of the steel plating. 3. The staging of materials on the Streets is not allowed. This includes but is not limited to, rock, backfill materials, spoils, construction supplies, etc. ---PAGE BREAK--- CITY OF WOODBURN PUBLIC WORKS DEPARTMENT 4. Existing roadway traffic markings are to be replaced to original or better condition where damaged by construction. Division 5. Water 1. Only City staff can operate live water valves and Fire Hydrants. Notify the City of Woodburn prior to the need for the operation of live water valves. 2. The minimum vertical separation between the water line and any conduit shall be at least one-foot. Division 6. Sanitary Sewer 1. The minimum vertical separation between the Sanitary Sewer line and any conduit shall be at least one-foot. Division 7. Storm Sewers 1. The minimum vertical separation between the Storm Sewer line and any conduit shall be at least one-foot. ---PAGE BREAK--- Form updated 9/2019 Page 1 City of Woodburn Application for Water/Sewer Service SERVICE ADDRESS: Apt/Unit/Suite SERVICE REQUESTED: ☐ STANDARD WATER/SEWER ☐ CONSTRUCTION – WATER ONLY SERVICE START DATE REQUESTED: Applications submitted and approved after 3 pm will be connected the next business day. APPLICANT’S INFORMATION Legal Name: Mailing Address if different than service address: Authorized contact, if account is under a business Previous Service in Woodburn: ☐ Y ☐ N If yes, what address: Phone Number: E‐mail: ☐ CO‐APPLICANT’S INFORMATION ☐ AUTHORIZED TO RECEIVE ACCOUNT INFORMATION Legal Name: Previously Lived in Woodburn: ☐ Y ☐N If yes, what address: Phone Number: E‐mail: If applicant is not the owner, please complete the following owner’s information: PROPERTY OWNER’S INFORMATION Name: Mailing Address: Phone Number: E‐mail: PROPERTY MANAGEMENT COMPANY INFORMATION (if applicable) Name: Mailing Address: Phone Number: E‐mail: I hereby agree to pay all bills for such service when due, and abide by all Ordinances regulating the use of City water and sewer service and any other rules and regulations which may be adopted by the City Council concerning said services. A deposit is required of owner and renters. If service is disconnected for non‐payment of the bill, there will be an added charge before reconnection can be made. All delinquent charges must be paid prior to any new applicant receiving water service. Copies of delinquency notices and shut‐off notices sent to renter are provided to property owner. Customer and/or property owner are required to maintain valid contact information and notify the City to schedule termination of service. Applicant’s Signature Date Co‐Applicant’s Signature Date SIGN SIGN ---PAGE BREAK--- White Copy – File Yellow Copy – Water Department Pink Copy – Finance Department C:\Users\peggyki\Desktop\New Service Forms\WATER SERVICE FORM 4-2019REV.doc CITY OF WOODBURN PUBLIC WATER SERVICE APPLICATION Building Permit Number Receipt Number Meter Deposit Number Date ADDRESS WHERE STRUCTURE AND / OR SERVICES ARE TO BE LOCATED Applicant / Owner Phone Number Service Type Single-Family Commercial Industrial Multi-Family (Number of Units) Other MFD (In Park) Type and Size of Water Service Requested Domestic Size Irrigation Size Fire Sprinkler Size Signature of Applicant Sequence # Account # Meter Reading Week Route Date Water Meter Installed Domestic Meter # ID # Irrigation Meter # ID # Fire Sprinkler Meter # ID # ---PAGE BREAK--- CITY OF WOODBURN PUBLIC UTILITY SERVICE APPLICATION Building Permit Number Receipt Number Meter Deposit Number Date ADDRESS WHERE STRUCTURE AND / OR SERVICES ARE TO BE LOCATED Applicant/Owner Phone Number Service Type ☐ Single-Family ☐ Commercial ☐ Industrial ☐Multi-Family (Number of Units) ☐Other ☐MFD (In Park) Type and Size of Water Service Requested ☐Domestic Size ☐Irrigation Size ☐ Fire Sprinkler Size The applicant agrees to abide by all rules, regulations, ordinances, policies and specifications of the city relating to sewers, traffic, storm, water and parks as now exist and as hereafter are changed or amended. Signature of Applicant OFFICE USE ONLY Accepted and Approved by Date ☐Water Service Fee SDC Based on Meter Size Date Water Meter Installed Meter Deposit Domestic Meter # ID # SDC Charge Irrigation Meter # ID # Water Main Tap Fire Sprinkler Meter # ID # Installation Fee $ Sequence # Account # Meter Reading Manufacture Code ☐Sanitary Sewer Service Fee Residential Type ☐ per Dwelling Unit ☐ per Unit ☐per Bed SDC Charge SDC Based on Gallons Per Day (Peak Load) ☐Storm Sewer Service Fee Roof Area (sq. ft.) SDC Charge Concrete / Asphalt (sq. ft.) Tap Fee Total Impervious Surface (sq. ft.) ☐Traffic Impact Fee $ per unit, room, or other, multiplied by = Number of Units ☐Parks Fee Residential (All Housing Type) per unit, multiplied by units = Non-Residential per employee, multiplied by _________employees = 0