HomeMy WebLinkAbout5485 - 5455 Shore Trail Right of Way Permit , J�n, 2S'. 2007 �:51AM No, 1$O1 P, 2
EXHIBIT "C"
TO
PRIOR LAKE PUBLIC WORKS DESIGN MANUAL
PERMIT TO WORK 1NITHIN CITY PROPERTY RIGHT-OF-WAY/EASEMENTS
AND
APPLICATION FOR INSTALLATION OF U7ILITIES
1. Location .� �lS- S yss ,� ��; s �(e r e.. �/' a r� /V �
2. Nature of Work Rc /e.c e..R ,�/� c�� �0 / � S
3. Indicate below items to be affected autd include a sketch or plan of wock to be done.
G�ub & Gutter S�reet
Trail/Sidewalk:`:'' Trees:
Pond/�1Vetlands: < (Publically owned
Traf�ic Contro�-Devices/Signs Or Privately owned �
Drainage � Utillties
StructureJBuildi�gs Other
4. Method o£' Installation or Const�uction �•'Q e�` �a �r c�C %r u� k
5. 'I�lork to start on ac aRar: v� �� `�� and shall be completed by: a"���`�� � unless an
extension granted to: by:
''�=i DATE STAFF/DA7`E
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6. Wil! detouting of ttaffic be necessary? O If necessary to detotu traffic, describe suggested
route:
7. provide witb this application a copy o#'the cflntractors Public Liability Insucanca.
bETOUELS: The Director of Pubtic VVorks shall be notified in wririna at least 72 houzs �n advance of any
detour being established, changed or discontinued.
NAME OF APPLICANT S�1+r► �So�ee. Pu d/� �� 1'; �; ti e.s PHON� ���2 '`� �/ S 19 �8"
' ` PLEASE PRINT
ADDRESS I��Qer �l)0 �S'+" Sar�x� �Jt .S�ako,�e.Q Mh 1'�.�',�79
ST�I' CiTY STATE ZIP
NAME OF PARTY OR ORCrA1dIZATION PERFOTtMING W�RK S'�i a�tc ,ot e. l� U�,
CONTACT PERSON M e. +� v Al � �, A�, A EMERGLNCY (24 HR.) P 0'N'E#: �-,1 ��` � 8'�
ADDR�SS: .� S5 Sa �! �z � � .f ?, 5.�� ,o �� /'� A SSl1,�AY PHONE 9 S Q- N H 5- 19 8�
STREET CITY STA'IE Zjp
Thc undersigned herewith acoepts tkie• tetms and conditions of this permit by the City of Prior Lake �s herein containcd and agree to
fuqy comply therewith to the sa SEeition oP the City of Prior Lake.
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Signed; Tide: �� Date:
O:Uldmin�pp�$�CFpBTT t APPLIC FOA INSTAL), Of Vilt.! S�E5,4o�
, Ja��.24. 2001 9,51AM No.1801 P, 3
�XHIBIT "C"
TO
PRIOR L:AKE PUBLIC WORKS DESIGN MANUAL
PERMIT TO WORK WI7HIN CITY PROPERTY RIGHT-OF-WAYIEASEMENTS
AND
APPLICATION �OR INSTALLATION OF UTILITIES
PAGE 2
, ,,;
F�R CITY USE ONLY AUTHOR17JaT10N OF PERMIT
FINANCIAL SECURITY: AMOUNT: TYPE:
3, ;
(Cash, Bond,
LOC, EtC.) '`
Fse: $ Receipt No. Permit No. �-� ��� '��
LIABIILITY INSURANCE PROVIDED':
In consideration of agreement to comply:";r'all respects with the regulations of the City of Prior Lake covering such ope�aGons,
and pursuant to authorization duly given,;by said City of Prior Lake; permission is hereby g�anted for the work to be done as
described in the above application, said wo,rk to be done in accordance with special pravisions as hereby stated:
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APPR ED BY: DEPT. OF PUBLIC WORKS
By , —a--� O
IDATE
ALL LEGAL REQUIREMENTS SHOWN 00N PAGE ONE (1) AMD ON AlL "SPECIAL PROVISIONS" SHALL BE COMPLIED
WITH, THE DATE WHEN WORK IS COME�LETED MUST BE REPORTED TO TNE CITY OF PRIOR LAKE CITY ENGINEER.
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G:tAdmin�YOFMS\C7(HIBIT C APPUG FORINSTALL Oy UTTL7;TtE3,doc
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. Jan. 29. 2007 9:51AM �� No. 1801 P, 4
EXHIBIT "C"
TO
PRIOR I:AKE PUBLIC WORK3 DESIGN MANUAL
REGULATIOMS PERTAINING TO THE INSTALLATION OR
REPAIR OF UNDERGROUND UTILITIES IN CITY STREETS
OR 1�1 CITY RIGHT-OF-WAYIEASEMENTS
;;,
The following regulations end conditiohs constitute a part of the application made by any installer or contractor for
the installation of utilities in any City stCeet right-of-way or City utility easement and the app►icant, in making his
application to do such worfc, shall agree to abide by these regulations and conditions:
�.
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1. The individual obtaining the p�rmit shall, before commencing such work, notify the City Engineer when the
work at each location is to commence; and, when requested by the Engineer, shall submit plans and
specifications.
2. U on com letion of th ro' the individual sh II rom tl noti the Cit En ineerin De artment for final
insaection.
3. The public is to be p�otected by the individual, at all times, from the commencement of the work until the
completion and acceptance by the City. The installer or contractor shall so conduct his operations as to
cause the minimum inconvenience to the public, The instaHer or contractor shall furnish, erect, and
maintain, in accordance with'the legally accepted standards, all necessary warning and traffic control signs,
barricades, traffic cones, and #lashing lights to direct and control the movement of traffic through the project
in all directions and at all times;
The foregoing provisions shall not in any way relieve the installer or contractor of any of his legal
responsibilities or liabilities foF�#he safety of the public.
4, All openings in bituminous sutfaces sha11 be cut in a straight line with sides smooth and vertical. No ragged
edges will be permitted. Cu4ting shall be done with a concrete saw, cutting wheel, jack hammer, spades or
similar approved tools.
Backfill material shall be suit�ble for highway embankment construction. No peat, frozen lumps, broken
asphalt, sod, roots, or other`undesirable material shall be permitted as backfill. Rocks larger than six
inches (6") in diameter shall not be used in backfilling of trenches.
The backfill material shall be'placed in layers not to exceed one foot (1') and mechanically compacted to
not less than 95 percent of modified Proctor density.
The upper six inches (6") of the backfill shall meet Minnesota Highway Department Specifications for Class
5 material and shall be compacted to not less than 95 percent of modified P�octor density.
As soon as possible affer baG�ll operations are completed, the cut bituminous edges of the trench shall be
painted with an asphalt emu{sion such as SS-1. Immediately thereafter, the patching material shall be
placed and mechanically compacted to not less than 95 percent of modified Proctor density. The asphaltic
material used in patching shall be of the same type as removed from the roadway, except, that in no case,
will a plant mixed asphalt of less quality than Minnesota Highway Department Specifications 2331 be used.
The finished surface of the patch shall conform to khe surface of the undisturbed roadway.
No permanent asphalt patches shall be on any base whose temperature is 32 degrees Fahrenheit or less.
Cold weather patching shslf be of temporary nature, using cold mixed asphalt, well graded crushed rock or
similar approved materials. Yemporary patches shall be tr�e to line and grade. Temporary patches shall
G'�Adm1eU'QRMS�bXfflBlT C APPI.[C POR iNSTALL 0� US1L1tlE6. doc
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Jan 29, 2007 9:51AM No. 1d01 ?, 5
be replaced by permanent patches when weather conditions permit and notification shall be required as
stated in 2.
5, Other areas may be required to$be compacted at the direction of the Ciry Engineer.
6. Such permittee to be responsibie for maintenance and repair of all trenches for a period of one (1) year and
if settlement occurs or excavation caves in, the same shall be promptly indicated by adequate warning
signs and shall be resto�ed to condition in accordance with specifications above provided as soon
as conditions permit.
7. All culveRs and ditches sha11 be replaced in their original position and condition existing prior to
construction and no change stiall be made in drainage without approval of the City Engineer.
8. Permittee shall save the City fiarmless from all third party claims for injury or damage which may occur
between the time the work commences and the time it is finally accepted by the City.
9. The permittee rnay be requi�ed to jack or bore under certain streets, as determined by the City Engineer,
10. The appficant shall furnish �vidence of public liabiliry insurance of not less than $100,OOO1300,000 and
property damage of not less than $25,000 issued by an insurance company authorized to do business in
the State of Minnesota on which the City is named as an additional insured party.
11. Except for the negligent acts; of the City, its agents and its employees, the permittee shall assume all
liability for, and save the City,' its agents and its employess, harmless and defend same at its sole cost and
expense from any and all claims for damages, actio�s or causes of action arising out of the work to be
done herein and the continuing uses by the permittee, including but not limited to the placing, constructing,
end reconstructing, maintainin�, protecting and use of said facility under this application and permit for
construction.
12. Existing Facilities — The utility;facility and installations shall not interfere with any existing utility facility on
the City's right-of-way or easements. It is the responsibility of the applicant to call tor necessary locations
of existing utilities. (Gopher 4ne)
13. Private Properly — The work permit or permit for construction as issued does not in any way impry that the
appropriate easement exist�!to allow the applicant to work on private propeRy.
14. Cutting Trees — The permissip� herein granted does not confer upon the permittee the right to cut, remove
or destroy trees or sh�ubbery. with�n the legal limits of the right-of-way. Easements that are not specifically
identified on the plan attached to this permit or telieve permitkee from obtaining any consent othenNise
required from the owner of the property adjacent thereto.
15. Clean-Up — Street, trailways and affected right-of-way ahall be scraped clean at the end of each work day
and swept clean after construCtion is completed and left in a neat and presentable condition.
16. Replacernent of Sod — Wherever top-s4il and sod are disturbed, they shall be replaced in kind and
maintained satisfacto�i�y untit#he turf is established.
The undersigned hereby declares helshe has read and will comply with all the PERTfNENT REGULATIONS as
stated above and relevant City Ordinances.
DATE; 2 � od 7 SIGNED: ✓ `
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CT.�AAm�n�PORMS�87CHI8�i C APPLIC P�R tNSTALL OP Vi7Ll�.doc
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; ACORD CERTIFICATE OF LIABILITY INSURANCE DATE�MM/DD/YY)
2/�l0�
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Capesius Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. 0. BOx 97 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
�
Shakopee � MN 55379 INSURERS AFFORDING COVERAGE
INSURED . INSURERA: LEAGUE OF MN CITIES INSU RAP�E TRUST
City of Shakopee and Shakopee Public �NSURERB:
U t 111 t 12 S INSURER C:
129 So. Holmes Street . iNSUReao: �
S INSURER E: �
COVERAGES � -
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO.THE INSURED NAMED ABOVE FOR:THE POLICY.PERIOD INDICATED. NOTWI7HSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONOITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TypE OF INSURANCE POLICY NUMBEfl � POL�CY EFFECTIVE POLICY EXPIRATION ��MITS
LTR DATE M/DD/YY T M Y
. GENERAL LIABILITY � . EACH OCCURRENCE 3 � OOO OOO
COMMERCtAL GENERAL LIABILITY FlAE DAMAGE (Any one fire) $
A X CLAIMS MADE � OCCUR MED EXP (Any one person) S
X Munici�al CMC 27435 7/31/06 7/31/07 PERSONAL&ADVINJURY S
� GENEAALAGGREGATE $
GEN'L AGGREGATE LIMIT APPGES PER: • PRODUGTS - COMP/OP AGG $
POLICY PRO- , LOC .
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
ALL OWNED AUTOS � �
BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILY INJURY g .
NON-OWNED AUTOS (Per accident)
_ • PP.OPERTY DAMAGE �
. . � � � (Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 3
ANY AUTO OTHER THAN � ACC $
AUTO ONLY: AGG $
EXCESS LIABWTY EACH OCCUFiRENCE S
OCCUR � CIAIMS MADE AGGREGATE 3
S
DEDUCTIBLE 3
RETENTION S I $
WOFlKERS COMPENSATION AND � � � ' WC STATU- OTH-
EMPLOYERS' LIABIUTY TO Y LIMIT
E.L EACH ACCIDENT S
E.L. DISEASE - EA EMPLOYE S
E.L DISEASE - POLICY LIMIT S
OTHER
DESCAIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS .
For work in City of Prior Lake right-of-way , ,
CERTIFICATE HOLDER I ADOITIONAL INSURED wsuaea �erTeR: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEPORE THE DCPIRATION
Clty of Prior Lake DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL � 0 DAYS WRRTEN
16 200 E ag 1 e Cre ek Ave . SE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL '
�rior Lake, MN 55372 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE IN URER, ITS AGENTS OH
iiEPRESENTATIVES. �
AUTHOHIZED REPRESENTATIVE
�
Attn: Joe Wiita Sue Sichmeller
ACORD 25-5 (7/97) O ACORD CORPORATION 1988
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