APPLICATION FOR FY Dumpster Program RETURN AT LEAST SIX WEEKS PRIOR TO REQUESTED DATE OF DELIVERY

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1 Application for Dumpster Program January 2014 Page 1 of 3 APPLICATION FOR FY Dumpster Program RETURN AT LEAST SIX WEEKS PRIOR TO REQUESTED DATE OF DELIVERY IN AN EFFORT TO INCREASE COMMUNITY PARTICIPATION IN PUBLIC SAFETY AND DISASTER PLANNING, NEIGHBORHOODS THAT REGULARLY COLLABORATE THROUGH ESTABLISHED PROGRAMS ARE ELIGIBLE TO RESERVE A DUMPSTER WITHOUT A FEE Name of Neighborhood Group, Apartment Building, or Association(s): Neighborhood, Apartment Building or Association Coordinator(s) Name: (Address) (Zip) (Phone) ( Address) Addresses covered: Number of Households: QUALIFYING CRITERIA Within the last 12 months have two meetings in the neighborhood. At least one must be with the Fire Department. Qualifying meetings include: REQUIRED-Five Critical Steps Presentation (Fire Department) AND Public Health Presentation OR Neighborhood Watch (Scheduled through BPD Community Services Bureau) ~OR~ Within the last 12 months have a total of five neighborhood members complete either CERT training defined below: Full CERT Academy OR Two Single-Session CERT trainings/person (i.e. CERT FRS Radio Communications) Neighborhood group must be in a residential area. Commercial organizations do not qualify for this program. Dumpsters are provided to qualifying groups once every twelve months, for the duration of the program. No Parking permit must also be completed and submitted with application. Upon approval of application, No Parking signs will be available for pickup at the City s Permit Center. Pick up and proper display of signs is the responsibility of the neighborhood coordinator.

2 Application for Dumpster Program January 2014 Page 2 of 3 CRITERIA: CERT Training Please fill in the names of people trained and date(s) of training. CERT Academy If completed, individual does not need to list other courses Fire Safety Names of Participants Date(s) of Training Verification (Staff Use) Light Search and Rescue CERT Organization Disaster Preparedness Disaster Mental Health Shelter Operations Pandemic Influenza Command Post Set-Up FRS Radio Communications Ham Radio Message Passing Expedient Flood Training Animal Response Other (Please Name)

3 Application for Dumpster Program January 2014 Page 3 of 3 CRITERIA: Community Meeting Please fill in the dates and presentation type represented at meetings. At least one meeting must involve disaster preparedness. Type of Preparedness Meeting Date of Meeting Presentation Type Verification (Staff Use) Fire Department Neighborhood Watch Meeting Public Health Qualifications Met for Dumpster? (Staff Use Only) Dumpster Information Drop-Off Address for Requested Dumpster Drop Off Date (Friday) Pick Up Date (Monday) DUMPSTER RULES All dumpsters are delivered on Friday between 7am and 2pm, and picked up on Monday between 7am and 2pm. Location for drop off must be blocked off, allowing for at least two car spaces. No dumpster deliveries are available on holiday weekends. Dumpster size is 16 cubic yards. The representative of the neighborhood reserving the dumpster is responsible for the management of the dumpster; no overflowing spillage or unwanted materials are allowed in the bin. The driver will not take away the dumpster if it presents any of the problems listed below. The following items listed below may NOT be placed inside the dumpster: NO PESTICIDES NO HAZARDOUS MATERIALS NO FLAMMABLES (SPRAY PAINT CANS) NO PAINT, CHEMICALS, OR SOLVENTS NO MOTOR OIL OR BATTERIES NO REFRIGERATORS NO TV SETS NOTHING WITH FREON NO ROCKS, DIRT, OR CONCRETE NO MEDICATIONS OR DRUGS Signed Date Return to: c/o OES/Dumpster Program 2100 Martin Luther King, Jr. Way, 2 nd Floor, Berkeley, CA OES@CityofBerkeley.info ( PREFERRED)

4 CITY OF BERKELEY PERMIT SERVICE CENTER APPLICATION AND SITE PLAN FOR NO PARKING PERMIT APPLICANT NAME: PHONE# SITE ADDRESS: TOTAL PARKING SPACES* : 2 * 20 Linear Feet = 1 parking space (for unmarked spaces) NUMBER OF METERED SPACES: NUMBER OF STANDARD SPACES: NUMBER OF SPACES IN RESTRICTED ZONES (Colored Curbs): 0 PURPOSE OF PERMIT: Debris Box DATES AND TIMES OF RESTRICTIONS: Fri (7am) through Mon (2pm ) Meter Nos. For Office Use Only: Bldg. Permit No.

5 APPLICATION # Permit Service Center 2120 Milvia Street, Berkeley, CA Main Tel: TDD: Fax: Scheduling Inspections: Eng. Inspector: Planning@ci.berkeley.ca.us STREET ADDRESS/ UNIT # (if applicable) Engineering Permit Application SHADED AREAS FOR STAFF USE ONLY TENANT NAME TOTAL PROJECT SQUARE FEET VALUATION ($) APPLICATION GROUP:! DEMO>DEM! REMODEL>REM! REPAIR>REP Address City, ST Address City, ST Address City, ST Contractor Name Property Owner Name Applicant/Contact Person State Lic# Bus Lic# ZIP Code ZIP Code FAX# ZIP Code Phone# Phone# Phone# Misc. Comments (Brief Job Description) Attach Dimensioned Site Plan BFD/OES Dumpster Program Fees For Engineering Permit (Mark Quantities) + 5% Technology Fee Qty Fee Description Fee/Units Base Permit Fee for each permit type except Const. Park $ Filing Fee $22.00 Refundable Deposit As required by Engineering Inspector $1, SEWER, SANITARY X *Sidewalk Inspection (up to curb) **Trench Inspection (roadway) CONCRETE AREA Flatwork per 100sf $28.00 Curb Gutter per 10 Lin Ft $28.00 CONSTRUCTION PARKING Base Permit Fee $34.00 No Parking Sign $12.00 Time Zone/ Metered Area (weekly) Time Zone/ Metered Area (daily) MISCELLANEOUS Miscellaneous Permit Inspection Electrical Inspection Fee SEWER, STORM (Must be lic. sewer contractor) Sidewalk Inspection Trench Inspection Storm Water BMP Monthly Fee TEMPORARY RIGHT OF WAY USE R/W Inspection Fee $7.50 x Curb LF. x mo. Debris Box/ Moving Containers/PODS (Property Owners ONLY) $79.00/wk $15.75/day $221.00/mo $ ea * - Must be a Licensed Sewer contractor: C36 and/or C42 or a General Class A. ** - Must be a Class A contractor q Single Family Residential q Multi-Family Residential q Commercial NOTE: If this is a fax-in permit, complete the Permit Application Information on the reverse side of this form. Rev. 03/25/2013

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