HomeMy WebLinkAboutROW Permit Northwood Rd, Butternut Cir to Fremont Ave - � � D �C�C���L�
� AUG 1 4 2006
E « ��
O �0 `� Z�v �P
PERMIT
TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS
AND
APPLICATION FOR INSTALLATION OF UTILITIES
1. Location I�IDRT�IWOCID RoIAD -- 8t�►TCEZNt1.T I..IR. T1D FR.CNI4NT 14VF.
'�D t 1�[T 'C'R�NG N- DtR�C'tloNA L 8D'R.&. LJ 1 T64 IA'1. V.6 � G.
2. Nature of Work ��aVlp.E. SERUtcE FbR KE� I��VBL�P/NENT .
3. indicate below items to be affecred and include a sketch ar plan of work to be done.
Curb & Gutter Street Surface
TraiUSidewalk Trees:
Pond/Wetlands (Publically owned
Traffic Control Devices/Signs or Privately owned _)
Drainage Utilities
StructureBuildings Other $�- �D . "
4. Method of Installation or Construction ����T�'�NA L$flR�. , 'L��pCLZt�1.UE
5. Work to start on or after: and shall be completed by: �� ''y"' �� unless an extension
granted to: by:
, DATE STAFF/DATE
' 6. Will detouring of traffic be necessary? �� 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 writiug at least 72 hours in advance of
any detour being established, changed or discontinued.
NAME OF APPLICANT = N�� C'�R ��L �1_...� ��.. PHONE Q S Z-' `t`�'�"3'7 SE�
PLEASE PRINT FAX q52- 2Z(o - 375f�
ADDRESS '��a ����'� �♦• S�E� P[�10R.. tA1Z'E. MN 553'? Z - A29�1
STREET CITY STATE ZIP
NAME OF PARTY OR ORGANIZATION P�RFORMING WORK
CONTACT PERSON: �N BRRLFtG�. EMERGENCY (24 HR.) PHONE #: � � Z 9 � g ' S a a �
ADDRESS DAY PHONE q 52-' 22l� ' 7�ln4
STREET CITY STATE ZIP _
The unde ' ed herewith accepts the terms and conditions of this permit by the City of Prior Lake as herein
cont and agre to fully comply therewith to the satisfaction of the City of Prior Lake.
Sign Title: �u�+���E� Date: S'Q'��
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� SEP-01-2006 11�56 CITY OF PRIOR LAKE MAINT P.02iO3
' E7tHIBI'I' "C"
CITY pF PRIOR LAKE
REGULATIONS PERTAINII�G TO TFI13 INSTALLATION OR
R�PAIR 4� UNDERGR4UND UTlLTTIES 1N C1'1"Y 3TREETS
• OR IN CITY RiCyHT-OF-WAY/EASTMENTS
The fallow'tx►g regulations and conditions constitute a part of the application made by any ittstaller or conirar.tor for
tho i�stallation of utilities in any City streei right-of-way or Cxty utility easement and tl�e applicant, in m�king his .
appiic�tion to do such work, shaII agree to abide by these r�gulations a�d cor�ditions:
1. The individual obtaining the permit shall, before commr„t�cin� svch work, nai��y+ the City Engitt�.�r when
the wark ac each location is t� commence; and, whea requested by the Engineer, shall submit plans and , •
specifications. '
2. '
final j�g neCCEOri.
3. The �ublic is to bo protected by the individual, at all times, from ihe commencemEnx of the work until the
cornpietion and acceptance by the Ciry. The installer ot contractar shall so canduct his oper�ttions es to
� cause tht minimum inconveniettce ta tiae publio. Ttie Installer or contractor st�all �rrrish, erx�, and
maintain, ia axordanca with the legally acceptcd standards all t�eceasary warnmg mnd traffic control signs,
barrieades, traffie eones, aad flashing lights to direct and contral ti�� maveme.�t of traffic through tha
project in ail directions and at all times.
-• The foregoing provisions shail n4t in any way relior+e the installer or contractor of any of his lagal
responsibilities or liabilities for the safety of ihe public.
4. A!l openinas in biLuminous surfaces shall be cut in a sttalght 1[ne with sides �nooth �d vortical. No ,
ragged edges wiIl be permitted. Cuttiag shatl be done wittz a concreie saw, cuttutA wheei, jack hatnmer,
�pades or similar approved tools.
Backfill materiai shall be suitable for highway eu►bankment No peat, frozen ivmps, broken
asghaii, sod, roots, or other undesirable material shall be perrreitted aa backfili. Rocks larger than six inches
(6") in diameter shall not be used in back�illing af �enches.
The baekfilt material shall be placed in layers not to exceed one foot (1') and meChaniea]Iy compaeted t+�
not less than 95 percent of modified Proctor density.
The upper six u►ches (6") of the bacicfill shall meet Minnesota Highway Depart�nent Specificadons for
Ctass S material and shell be compaeted to not iess than 95 percent of modified Froctor density.
As soon as possib{e after baekfill operations are completed, the cut biht�inaus edges of the treuch she11 be
painted with an asphalt emulsion such as SS-1. Immediately tha�eaf�', the patahi�►S matecta! shall be
ptaced and mecha�lcaliy compacted to not less lhan 95 percant of modified Proctor density. 17te asph�lric
materiai used in patching shall be of the same type as retr►oved from the roadway, excopt, that in no case,
will a plant mixed asphalt o�' less guality than Minnasota Highwsy l�epazlmettt SPeci�ications Z331 be
• used, 3'he ffnished surfaca of the patch shail confo�t�n to the surface of the undisturbed roadwaY•
No permanent asphalt patches shall be on any base whose temperature is 32 degCeess Fahr�nheit or leas.
Cold weather patc}iittg sha11 be of temporary nature, using cotd mixed asphalt, well graded arushed rock or
similar approvcd materials. Temporary patchas shall be true W iine and grade• Tert�laora�Y Patches el��ll be
rcpIaced by permanent patches wh�n weather canditions permit and notiftcation shall bo reqtiired as stated
in 2. .
s�rrs.00c . Pag� 3 af 4
JCf - ✓Jl - GVJYJO 11 • JO l. 1 1 i Ur rR 1 UK LMI'�G I'IH 11Y I f.✓JJ� YJJ
' , t� I �6� /h�T � �� '
EX'EIISIT aC"
5. Other areas may be required to be corap�cted at the direction af the City fingfine�r.
� 6. � Such permittee to be responsible for mauatensnoe and repair of sIl tranchas for a period of ono (I) yoar end
if s�ttlernent occurs or wceavation caves in, the suat shall be promptly indic�ted by adequute w�rning s�gaa
and shall be testored to praper condttion in•accordance with speciIIc�t�ons above provided as sooa as
conaitions permit. ,
7. AII culverts �nd ditchrs a�all be repl�ccod in their o'nginal position aad condition existing prior to
construction and no change shell be made in draiut�ge without approval of the City En�incer.
8. Permittee shall save the City harmless from all third perty claims for iqjury or damage which may ocCUr '
between the tittte the wortc commences and tha t3tne it is fmally accepttec� by the Gity.
9. 1'tie permittee may be �'equind to jack or bora under certain stieet�, as determined by the City �Snglneer.
10. Tl�e applicaut sha11 fum�sh evidence of public liabilhy hz�rance of not less thtu� SlOQ,000/300,Od0 sad
property dama�e of not ]ess than 523,000 essued by an insuranco compnny authorired to do business !n the
� State of Minnesout on which the City is named es � additeonal insared pnrty.
i l. Bxcept Por the naglige»t acts of the City, its agents and its employees, tt►e permitEoo shall assume all
liability for, and save th� City, its agents and its dnployees, l�rmless and defend same at its sate coaE and
exp�se, from any and mU eiain�s for damages, Actions or canses of action arisnng out of the work to be done
�-� haei� and the continuing uses by the permittoe, including bvt not limited to the placing, const�ucting, and �
recanstructing, mslataining, protecting and use of said facility under thls application and permit for
� co�huction.
12. �cisti»g Pacillties • The utility facil�ty and installations shall not interfere with any existing tuility faolllty
on the City's right-of-rvey or easements. It is the responsiblltty of tbe applicant 'to ca11 for necessary
locations of existin� utilities. (Oopher One)
13. Private Property -'Fhe work peimit or permit for constructlon as issuod does not in �ny way imply that the
appropriste �asement exists to allow the spplicent to work on private proporty.
14. Cutting Troes - The parmission herein grantod does not ooafer upon the pear�ittee the :ight ta cen, cemove
or destroy treea os shtubbea�+ w�thin the lagal iimits o£the right-of-way, easemez►�s that are not apeci$c�lly
identi�ed on the ptan attached to this pamit or relieve pamittee frora obtaining any consent otharwise
required from ih� owaer of the properiy �jaoent theroto.
1S. Ctean-Up - Street, tralEways aad affected right-o�=way shatl be aciapad eleaa at tbe end of each worlc dary
as�d swept elean si�t construction is completed and left in a aeat end p�esentablo condition. , .
16. Replacernent of 5od - Whonver top-svil and sod are disturbed, they sha11 be replaced ln kiud and
maii�tained satisfacWri�y► unt�l the turf is establfshed.
The utidersi�ned hereby de�laras ho/she has read �utd will corn Iy with etl the PBRTiIVENT REGULAI�QNS �s
stabad abave an�l relevai�t City Ordinanees.
,
DATE• � ` �_ � � SIG
��,� paga 4 of 4 •
TOTAL P.03