HomeMy WebLinkAbout5450 Fairlawn Shores Trl ROW Permit � � - sDL-� ZBZ.L�-Z
EXHIBIT "C"
PERMIT
TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS
AND
APPLICATION FOR INSTALLATION OF UTILITIES
1. Location 545� �AIiCLAW W SNO1tES TRR1L 5,E .
2. Nature of Work QUK-EME�1T 0� BUt,�E� �t�OtJE CAA�.� �OR N�1 NOUSE. S�iZ.V\f�. .
3. Tn3icate below items to be� affec�ed and ir.clude a sketch ar plan of work to be done.
Curb & Gutter Street Surface
TraiUSidewalk Trees:
Pond/Wetlands (Publically owned
Tra�c Control Devices/Signs or Privately owned _)
Drainage Utilities
StructureBuildings Other X 'SLYD `
4. Method of Installation or Constivction CA bL.t. �1..0 W "
5. Work to start on or after: ��`�'�� and shall be completed by: ��A� unless an extension
granted to• by:
, DATE STAFF/DATE
' 6. Will detouring of traffic be necessary? I�t O If necessary to detour traffic, describe suggested
route:
7. Provide with this application a copy of the contractors Public Liability Insurance.
DETOURS: The Director of Public Works shall be notified in writine at least 72 hours in advance of
any detour being established, changed or discontinued.
NAME OF APPLICANT = N��C��R T�L E�.� ���.. PHONE gS
PLEASE PR1NT FAX 952- 22.(0 - 375�
ADDRESS '�� D��R St. S�E. � PRtQR.. 1.AIZ'� rV1 N 5 S37 Z- A Z9�t
STREET CITY STATE ZIP
NAME OF PARTY OR ORGANIZA'fION PERFORMING WORK TSpID�.iZ. +�11GHSiRDl�l
CONTACT PERSON: �N S RRLi�C�l� . EMERGENCY (24 HR.) PHONE #: � � 2' 9 �°� " S H 8'i
ADDRESS DAY PHONE Q52- 22(0 -'7fl(p4
STREET CITY STATE ZIP _
The undersigned herewith accepts the terms and conditions of this permit by the City of Prior Lake as herein
contained and agree to fully comply therewith to the satisfaction of the City of Prior Lake.
Signed: Q��" Title: �-� Date: ��"�" ��
79
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ay� �03 pa�ue��,Cqa�ay si uo�ssruvad :axe-� aoud�o ��� pies rCq uanr� ,(�np uora�zuoq�ne o� �uensand pu¢ `sno��raado
yans 3m�ano� a��Z �oi.�d3o �(ai� ay3,�o suota¢�n�aa aya y��nn s3�adsa� ��e ni �C�dwo� ol auawaal�u3o uo�lgiapisuo� u1
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...,� � .. e�p - ' ��uuad 'ot�( �d�a�a� $ ;aa3
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• . �'
• FXHIBIT'�G"'
CITX O�' PRIOR LAKE
REGULATIONS PERTAIIIING TQ'TFIS INSTALLA'FION OR
REl'AIR OF UNDERGR4UND UTILI'i iES IN CI'tY STREETS
� OR IN CITY' �tiCyHT-OF-WA'Y/EASBMENTS
The fallowtng regulaiions and conditions constitute � part of the applicatIon made by aay ittstaller or conttactor for
the installation of utilities in any City streei ri$ht-of-way or Ciry utility easement and tixe applicaat, in ma�cing his
appiication to do such work, shall a�ee to abide by these �gulations a�d condittons:
I. The individual obtaiauig the parmit sh�il, befare cammet►cing sach work, noiify the City En; ittecr when
the work ac each location is to cominence; and, whcu requested by the Engineer, shall subm�t plans anci . •
apeciticatians. '
2.
f31LZ1'L�
3. The public is to ba protected by the individual, at all times, from tho commencem�nt of t�►e v+`ork usttil the
compietion and acceptance by the Ciry. The installer or contractar sha11 so conduct his opBttttions as to
� ca�ase the minimum inconvenience to ihe public. '!'he instatler ar contractor shall furaish, erxt, and
maitttaia, in accordance with the legally accepted standards, all necessary warnmg and naffic control signs,
barricsdes, traffie cones� and flashing lights to direct and control the movement of traffic throu�h the
project in all directions and at all timas.
•• The foregoing provisions shall not in any way relievc the installer or c�ntractor af any of hia lagal
responsibitities or liabilities for the safety of tha public.
4, A!1 openin�s in bituminous surfaces shali be cut in a straight Ifne witt► sides smooth �nd vertical. No •
r�;ged edges will be permitted. Gutting sha11 be done with a concrete saw, cutEin� wheel, jack hammer,
spades or similar approved tools.
BackfiU materiai shall be suitable fot higl�way emhankmetat oonstruction. No peat, frozen lumps, brokr„n
asphait, sod, roots, or other undesirable material shal! be permftted as backfiiL Rocks larger than:ix inches
{6'� in diameter shail not be used ln backfilling af �enches.
The baekfill material shall be plaeed in layers rtot t� exceed one foot (l') and meehanleally comp�►eted to
not less than 95 percent ef modi�ied Practor donsily.
'1'he upper six inches (6") of the ba�l1 shsll meet Minnesota Highway Department Specificattaa�s for
C1ass 5 materiai and shall be compacted to not ie�s than 95 pen:ent of modifsed P'ractor density.
As soon as pos�ible after baelcctlll operations are eompleted, the cut bituminous edges of tha te�ch aball be
pxinted wish an asphalt emulsion sucts as SS-1. Ymmeci�ate�j► th�', tt'ie p�tching material shnll be
ptaced �nd mechanlcaliy cutnpa�cied to no4less than 95 percent of modifiad Proctor densit7+• The a�ha2ti�
material uised in patching shall bo of tite same type �s tamoved froi'n the r�a.dwaY. �cc�pt, t� u� na case,
witi a plant mixed asphalt o�' less qua9ity than M�nnesata Highway l�epartn°ent SpeciScations Z331 hE
• used, The finished surface of the patch shatl confoxm ta the surf� of the umdisturbed roadwaY•
No permanent asphalt patches shall be on auy base whose temperature ia 32 degrecs Faturaheit or less.
Golct weather pazchittg shall be of temporary natitte nsing cold mixed asPhalt, well graded crushed roek or
siinilar approved »taterials. Temporary patchcs sha�i be ttue to Iine and grade. Temporary patctsos ahall be
rcplaced by permanent paiches when weather eanditlons pecmit and aotiRcation shal! be reqaired �s stated
in 2. .
��,� , �� 3 of 4
, a
� ~ : 4
EXHISIT KC"
S. Other areas may be required to be cotr�pacted at the dir�ction of the Ciry Engineer.
� 6. Such permittee to be responsible for mauttenence and rrpair of aIl trenches for a geriod of one (i) year aad
if settlement occurs or axeavation caves in, the same shatl be prompily indic�ted by adequate wara� si�s
and sha11 be restored to proper condition in • accordanco with sp�iIIcations above providod as soon as
conditions permit. ,
7. Att culverts and ditches ahall be replacod in tlteu o'n�inal positian and condition existiug prior to
construction and no change shall be made i:t dzaittage wititout appmval of tba Ciry Engineer.
8. Permittee shall save the Ciry harntiess finm ali third party clairas for injury or damago which may occur �
between the time the work commences �nd the time it is fmally accepted by the C�ty.
9. The permittee may be requind to jack or bore under certain streets, as detarmitmed by tha Ctty Bnginear.
10. The applicaut shall fumish evidence of public liabi3ity msurance of not leas th� �lOQ,000/304,000 and
property dama�e of ttot tess then $25,000 issued by a�n insurnnco compt�nny authorized to do busfness in ttie
� State of Minnasoi� on which the City is nemed as sr, addition�l inturod party.
11. Except for the aegligent acts of the City, its agents and ib employees, tbe p�rmittoe shall assume all
iiability for, and save the City, ita ogents nnd its emptoyees, harmless and defend sama at its sole cost and
expense from any and all elairns for damages, actions or cavses of action aris�g out of the worlc to be done
�-� herein and the continuin; uses by the p�rmittee, ineluding but not limhed to the placin�, construding, and �
reconstructing, maiata�g, protecting and use of said facitity under this appIIcatlon and permii for
coastructi�n.
12. Exist�r►g Facilities - The utiliry facility and instaliations shall not intecfere with any existing tulliry faoility
on the City's r�ght-of-w�y or easements. It is the responsibllity of the applic�nt to catl for necessary
locations of existing udlities. (Oophea One)
13. Private Properly -'fhe work permit or permit for construction as issuod does not in �ny way imply that the
appropriate easement exists to allaw the applteant to work on privato propeity.
14. G�tting Tress - The permission herein granted does not oonfor npon the permittee ffie right �a cut, zemove
or destroy trees or shrubbery within the legal Iimits o£the right-of-way, easements thei aro not speciSc.�illy
identified on the plan attachea to this permit or relieve permittee frora obtaiatag any consent othawise
rec�uired from ihe owaer of tho proQeriy adjactne theroio.
iS. Ctean-Up - 5treet, trallways and affected right-o�=way shall be sciaped elean at the end of each work day
and swept clean after construction is eompieted and ieft 3n a neat and psesentable condltion. , .
16. R,eplacement of 5od � Wherever top-soil and sad are dtsturbod, they shall be replaced in lcind and
maintai�ced aatisfacWriiy until tha tar� i� atirtablfshed.
The uttdersigned hereby declares he/ahe has read and wili comply with sll the PfiRT1NSN'i' REGULATlQNS as
stabed abave a��i relevaat City;Ordintunaa.
�b �Z S�'� 0 6
DATE• SIGNED: _
�rrc,�oc page 4 of 4 •
TOTf� P.63
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