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City of Salem <br />Public Works Department <br />Transportation/Development Management Division <br />555 Liberty Street SE, Room 325 <br />Salem, Oregon 97301-3503 <br />Telephone: (503) 588-6211 <br />TTY: (503) 588-6292 <br />• ~city"of Salenl <br />• ~588•6256 <br />N(pee~r~m't application center) <br />P <br />STREET/LAN E/ALLEY/SI DEWALK <br />CLOSURE PERMIT <br />PID No. 65832.205 <br />Permit Fee $29.50 <br />Processing Fee ~/D,00 --~5@- <br />Total Payment 3~, 50 - ~ <br />48 HOURS NOT/CE REQUIRED-WEEKENDS EXCLUDED Permit No. - ~ <br />APPLICATION FOR: ^ Street Closure ^ Lane Closure ^ Alley Closure ,~ Sidewalk <br />Street: ~1,.~~ ~~cJ ~ll`~ E.u ~'~ `-C1u('~T ~ ~-- N ~~/1 ``1~ ETI~'~~ C- ~~ IJ~C.t-~ ~ }~ ~ C~ f-~ <br />Location: Z..Z.~ ~ j'--~ ~ ~ 1 N~ ~ <br />APPLICANT: <br />Address: <br />Applicant is contractor? ~Yes ^ No <br />CONTRACTOR: ~T A T/Jr / ~D~,i~.cT .-Z~~~ <br />Address: -~ -`'~'3`~Y~l - ,C~ /~~R/~D~T ~ ~d6~'i?/r;' t`,l~ . ~i'7~4z. <br />Contractor's Contact Person: ~/kr" . SlR~`~ ~ Day phone: ~~ ~~77 <br />^ Street Opening Permit No: <br />^ City Project No.: <br />Day Phone: <br />Evening Phone: <br />Day phone: .~5~/- y,S/ "dS~J~ <br />Evening phone: .S~/- YfS~~~977 <br />Evening Phone: YS`~ ~97~ <br />~ Private Contract <br />Request date and time of closure: <br />Description of work to be done: ~°~n.. ~ ~~~ '~~, ~ v~ r"~ `~ ~~- C7C._ ~ ~~ ~ ~~ IU 5! T iM ~ LL <br />1. Permittee shall follow the signing requirements of the City of Salem's "Traffic Control Manual for Maintenance and Construction" and <br />any other traffic control requirements as needed or specified. <br />2. All work shall be done in accordance with all applicable provisions of federal, state and local law, ordinance and administrative rule. <br />3. All work in public right-of-way and all work which is connected, directly or indirectly, to City of Salem water, sanitary sewer, or storm <br />sewer lines shall be constructed in accordance with applicable City of Salem Standard Construction Specifications. <br />4. For extended closures lasting over one day, Contractor shall notify the Emergency Communications Center at 588-6123 each day <br />prior to street closure. <br />5. Permittee shall indemnify, defend and save harmless the Ciry of Salem, its o~cers, employees, and agents from any and all claims <br />arising out of or in connection with any work done under this permit. <br />6. This permit may be revoked at any ti e by the Director of Public Works or his designee. ~ <br />~ Signature of Applicant: ~if .T/~~~ ~ Date: .S ~ ~ 9 <br />The (Street) (Lane) (Alleyk~(Sidewa Closure indicated above is approved subject to the following additional conditions: <br />t F, ;~t u r2 1 <br />-}-Tn~~~ c ~ ~ .. ~'r ~ f ~t n c P ~ ~ta ~s a S ~L.f?w v~ ~, :,, , <br />~ <br />`~C /Yt i'V2 C, ,. . .., ,~+ / <br />Permit Approved By: <br />Check $ Check # Cash $ Billed $ PO # <br />White-Tra~c, Yellow-Applicant, Pink-Inspector; <br />Additional copies: Parking Enforcement, PW Dispatch <br />5 ~ /9~ ' <br />Rec'd by: / I By: <br />PW:PAC03.FOR 06/13/96 <br />Date of Closure: From: J~/ 2--2- To: ~/ Z.Z <br />Time of Closure: From: C~ ~;, n'~ 1 1~t lr^r~.~ To: <br />