HomeMy WebLinkAbout170th St ROW Permit _,
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EXHIBIT "C"
PERMIT
TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS
AND
APPLICATION FOR INSTALLATION OF UTILITIES
I. Location t?Otl�. St'. �i.ECANST1Zla.C.Tt�tV AP."�..ii - HWY �3 T� PN�RSRNT I n1EADDI.�S
2. Nature of Work pR�.1�ARAT1��1 �bR. GOt.��1TY - STArT� - C! T 4 P RbS � LT
YLPeC.E NE1+v C6'E'PER �A1ND F 12�ER BQT1 C, � I�'ES1..E S
3. Tndicate below items to be affecred and include a slcetch or pl�.n 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 8 L V L� . `
4. Method of Installation or Construction D�R�.CT1'�1t�1 AL 'FSaR.�'e. �. 13AC�ti.,kit7E
5. Work to start on or after: �b `°� " ��► and shall be completed by: 3 1.�'EEK-S unless an extension
granted to: by:
, DATE STAFF/DATE
' 6. Will detouring of traffic be necessary? N.O If necessary to detour traffic, describe suggested
route:
7. Provide with this application a copy of the contractors Public Liabiliry Insurance.
DETOURS: The Director of Pttblic~WorksShall l�e rt�tifi fn vVriti at le 2 honrs �in'�dvance of
any detour being established, changed or discontinued.
NAME OF APPLICANT = N TEC��R TE.L ��U ��J�... PHONE QSZ
PLEASE PR1NT FAX q52- 22.l0 - 375b
ADDRESS `�`� D C6LDRl4'�G St. 5�E � PR1UR. l.A{2'E. M N 5 53� Z- A Z9�
STREET CITY STATE ZIP
NAME OF PARTY OR ORGANIZATION PERFORMING WORK TTR�� � �� � Gl'�'� T�� �
CONTACT PERSON: �N $AR�G�- EMERGENCY (24 HR.) PHONE #: �� Z q�q "���
ADDRESS DAY PHONE q52- 22[0 - 7flla4
STREET CITY STATE ZIP _
The undersigned herewith accepts the terms and conditions of this permit by the City of Prior Lake as herein
con ' ed e to fully comply therewith to the satisfaction of the City of Prior Lake.
Signe � Title: �� 81 N EE� Date: 9 Lo —!� te
79
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S�RIOM �IZIIfId 10-'.Lci'3Q �J�$ Q�9A0?Iddt� �� ' � ' �
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se suoisinad �c»ads y�in+ aauep�oo�e ui auop aq oa ��on� p�es `uoiac���ddu anoq� ay� u► paqi��sap se auop aq o� x�onn
ay� �o� pa�ucl� �Cqa�ay si uo�ss�uuad :a��Z aoiad 30 ��� pies �Cq uani� ,(�np uo�aez»oyane o�;uens�nd pa� 'suo��raado
y�ns �uiaano� a�e� ioud3o ,(�i� ai�a,�o suo�aeln9aa aya y�in� s��adsa� ��e ui �C�dwoa oa �vawaa��a3o uo�aeaapisuo� uj
� �Q�41A02Id S�I11�21C1SI�Ii �C.LI'IISt�I']
b �. - • dn 'oH ��uua� •o� ad�a�a� $ ;aa3
(•� �O'I `P uoq `ys��)
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.LIY�I2I�d :IO 1�10I.L`dZI2IOH.Lfl�d 1C'II�IO �Sf11t.LI� 2I03
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• E7tHIBIT •°C"
CITY QF PRIOR LAKE
REGULATIONS PERTAINING TQ TI� INSTALLATtON OR
R�PAiR O� UNDERGROUND U'TILTTIES 11`Y Ct`I`Y 3TnEETS
- OR IN CITY' �2ICrI3T OF-WAY/EASBMgNTS
The f�llawiztg regulations and corditions constitute a part of the application made by aay installcr or contractor for
the installation of utilities in at�y City streat right-of-way or Cfty utillty easement and ti�e applicant, in making his .
application to do such work, shall agree to abIde by these regulations a�d cortditions:
1. The individual obtainitig the permit shail, before comme,ncing snch work, itotify #he C�ty En�ituer W+hen
the work at each location is to commonce; and, when requested by the Enginee�', shall submft plans and �
specsfications. '
2. on com�letion af the ,nroi,,, eet the individLal sh�1_momn� �Qt�gy the '�y.$D, '
IIns�� ��
3. The pubtic i� w ba protected by the individusl, at all tim�s, from ihe commencearent of the work unt�t the
completion �nd accepta»ce by the City. The installer or centra�tar shall so conduct his operations as to
. cause the minimum inconvenience to the pubiic. Tiie installer dr eontractor shall furnish, erect, and
mait�tain, in accotdanca with the legally accepted standards, all ne�es�ery w�rniu$ tusd traffic c.ontrol signs,
barrieades, traffte cones, and itashing lights to direct and control the mavement of traffic through tha
project in �11 directions and at all times. �
•• The foregoing provisions shail not �n any way relieve rha 3�istallei ar contractor of any of bis le�al
responsibilitiea or lisbilitios for tho safaty af the public. .
4. A!l openin;s in bituminous surfac4s shali be cut in a straight liae with $ides smooth �nd vertical. No �
raaged �dges wiil be permitted. Cutting sha21 be done with a concrete saw, cutiin� wheel, jack h�msner,
spades or similar approved toois.
BackfiU matarisl shall be suitable far highway embankme�at,construction. No peet, frozen Inmps, broker►
asphalt, sad, roots, or other nndesirable material shatl be pennitted as backfiil. Rocks larger than six ittches
(6'� in diameter shall not be used ln backfitting af uenches.
Th� backfill material shall be placed in layers not to exceod one foot (1') and meed'►enicaliy compacted to
not less than 95 pereent of modified Proctor density.
'1'he apper six inches (6") of the backfill shsll meat Minnesota Htghway Dopartrnent Spacifications for
Class S material and shall be compacted to not iess thari 95 pet�cent of modl�ied Proctor density
As soon as possible after backfill operations are completed, the cut bituminaus ed,ges of th�� a�ha�1 �
painted with an asphalt emulsion such as SS-1. Ytnmeciiately thereafter, the patehinS
pEaced �nd mechatiicaliy cornpacted to not less than 9S percent of modifiod Proctor density. "l9�e asphaltic
material used in patching shalE bo of the same type �s removed from t�►e rQadv�►aY except, that in no case
will a plant mixed asphalt of less quality than Minnesota Highw�y �eparlment Spec�cat�ons x331 h$
• used, T'he feaished surface of the patch sha11 confa�n to tho surface of the undi�turbed roadwaY-
No permanent asphalt p��tchos shal! be on any base whose temmperattite is 32 de8rtes Fahre�he�t or less.
Cold weather patching shalt be of temporary t►at�ttc, using cold mixed asphalt, well grxded csuahed rock or
similar app�coved tn�terials. Temporary patchcs sha21 be trt�e to Iine and ga'ad�• Teml�ora'Y P�� e�ll be
repIaced by permanent patches when weather eanditions permit And notificatian shall bo required as �tated
in 2. .
��� . Page 3 of 4
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EXHiBIT aC"
5. Other areas may be required to be contpacted at the direction of the Ciry Fsagineer.
� 6. Such permiitee to be responsible for maitttenaaa and repair of a11 trenches for a period of one (I) year sud
if settlement oxurs ot axeavation caves in, tho same shall be promptly indicated by adequate warning signs
�utd shall be restored tn proper condition in•accordanco with speciIIcatioas above providod as aoon as
condidoas permit. ,
7. Atl culverts snd ditches a3iall be repl�ced in their ori�iaal position aad condition existiag priar to
conatruction �nd no chac�e sLall be mada in draina�ge without approval of the City Engineer.
8. Permittee shall save the Ciry 11armless from all third party clairns for ialjury or damago which may occur '
beiween the titne the work ewnmences and the tune it is fmally acc�ptod by the GSty.
9. The permittee may be r'equired to jack or bon under certain streets, as determmiued by the City fingjueer.
10. The applicaat sbali fumisli eYidenee of publio liability �runrance oPnot less than $104,000/300,000 aad
property clamnge of not Iess ihan 523,000 issued by sun insurence comparty authorized to do busfmss in the
� State of MinneffiotA on which the City is named as an additional inaurod party.
11. Except for the na�ligent.acts of the City, its agents and ib employees, tbe permittee shall assumo alI
iiability for, a�d save th� City, fta agents �nd its etnployeea, harntless and defead same at its sola coat and
expense from any and all eiaims for damages, actions er causes of action srisimg out of th� work to be dqne
�-� herei� and the continuin�, usea by the p�rmiitee, inclading bvt not 3imited to the placing, consiruding, and �
reconsiructing, malntaining, protecting and use of said faciiity uncl�' this application and permit for
co�truction.
12. Existi»g Facilities - The utiliry facility and instailations shall not interfere with any existin� utiliry faellity
on the City's right-of-way or easements. It is the responsibility af tbe applicani to caIl for necessary
locations of txisting utilitfes. ((iopher One)
13. Private Property - The work permit or permit for wnstruction as �SSUed dooa not in any way Lnply that the
approprieto easament exists to sllow th� applicant to wark on private property.
14. Cutting'fYees - Tt►e parmission herrrin granted does not oonfer upon tha peratittee the right to cut, removo
or destroy trees os shtubbery wit�in the iegal limids of the right-of-way, easements that are not apeciScally
identi�ied on the plan attached to th�s permit or relieve p�mittee from obiautirtg any consenE otherwise
t'equired from the owaer of the propec�y adjacenc therato.
IS. Clean-Up - 5treet, traitways and afPfected right-of�way shall ba sciapad elean at the end of each work day
and swept elean a8er constrac6on is campleted and left �n a neat and p�esentable c�dition. . .
16. ILeplacement of Sod - Wlaerever top-soil and sod an dIsn�rbod, they sha11 be raplaced in kiod and
maititained :�tisfaoWrFty wstil ttte turf is establiahed.
The tu�derstgnad henby declares hdshe has read attd will comply with atl the PERTII�IENT REGULA'FIONS �s
stabed above an�i relovaat City,Ord'uwnoas.
DATE• 9' Ga - O�c SIGNED:
�rcc.tioc page 4 of 4 •
TOT� P.03
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