HomeMy WebLinkAbout14215 NE Shady Beach Trl ROW Permit r
y MA� Q9�14 CITY OF PRIOR LAKE MAINT ,;:,P.01iO4
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R�RMIT
PERMtT TO WORK WITHIN ClTY PROP�RtY RIGHTA�•WAYIEASEMENTS '
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APPLICATION FOR 1N57ALLATiON OF UTILiTIES
1. I.ocadon ���/� N� S�i d c.� � GtC.�-. /" !��(����7 �
2. Nature of Work �.��� ��+ 2. � �J(�G�- �
3. indicate below items to be affected and include a skctch or plan af work to be done.
Curb dc Gatter �` Stceet
� TraiUSidewalk _� Trees:
Fond/Wetlands (Publicaily owned .
Traffic Control Deviees/Signs Or Privately owned }
� Utilities
Structure/Build.iags Other ' '
i
4. Method ofinstallatiost or Construction �hQ!-���o��'1e�!` R�+�%
5. Work ta start on or after: ��� l� __ and shall be completed by: S � unless an
extension �rat�ted to: bY�
p,q'�� STAFF/DATE
6. Will detourin� of traffic be neeessary7 I\� If necessary co detour uaffic, describe sugg�sted
rovte:
7. Pmvide with this application a eopy of ttte cantractors Pu61ic Liability Insur�nce.
pETOURS: The Director of Public Works shalt be notified in writin � at least 72 hours in advance of any
detour being established, changed or discontinued.
NAM� OF AT'PLICANT 5� �C�ri ` PHUNE bSI'—�-Ia ��
PLEASE PRINT
avDxESS ��� �. �t�e,h �I�-�Yr � �� SSS��
STREET ' C1TY STATE �p
NAME OF PARTY �R 4RGAN ATtON PERFORMING WO1tK _J�S,� � �1
CONTACF P RSON: ' J�• �a,- �MERGENCY (24 HR.) PHONE#: ' �
ADARESS: Q,,.,�3�C—„ ��— /�lua� SS�'r DAY PHONE /�•C7 --42�e-20Co8�
STREET CI �ATE Z(P
The undersigned herewitlt accepts t}te tecros and co�zdidonS of this permit by the City of Prior Lake a, herein contaiaod and ag�� to
fully co y erewith to e' �chOt1 Of �e City O� PI'1� Lake
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5 � Title: _�^�!�� Date•
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�� ' IhAR-21-2006 09�14 CITY OF PRIOR LAKE MAINT P.02iO4
EXHlBi7 "C"
TO
PRI�R !_AKE PUBL�C WORKS DESIGN MANUA�
PERMIT 70 WORK WITHIN C17Y P�D RTY RIGHT-O� WAYIEASF.MENTS
APP�ICATION FOR 1NSTALL.ATtON OF U7tLITIES
PAGE �
�OR CITY USE ONLY AUTH�RiZATlOIV dF PERMi7
FINANCIAL S�CURITY: AMOUNT: TYPE:
(Cash, Bond,
LOC, EtC.}
Fee: $ U. p Receipt No. ��SG � Permit No. , U�"��'
LIAB!!U'f'Y INSURANCE PROVIDED: r' �` S/ -� G• _ i.
(n Considerd�on of agreemenl to Comply in al) respects with the regulations of 1he City of Pria� LBke covering such operation8,
and pucsuant to authorization duly given by said City of Prior Lake; permission i� h rov s'bn as he f reb stat d tk to be dane as
desciibed in the abuve appiication, said wrork fA be done in accocdance with specia p
APPROV�D BY: DEPT. OF PU6LlC WORKS
� ,�►��,� S �"�.�
BY: i�-=�. /DATE
ALL LEGAL REQU{�tEME�1TORK S COMP ETEp MUST BE TO � CITY OF R OR LAKE CIT`� ENG1N ER.
WtTN. TH� DATE WNEN W
. � G:IPERMISSIROW�U�flity�ROW P�FN{ITS�dx . . . . . � � � . � .
'.M^hF.'--�1-2�E5 09�14 CITY OF PRIOR LAKE MAINT P.03i84
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ExHiBiT �c
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PRIQR I.AKE PUBLIC WbRKS DESIGN MANUAL
REGULATIONS PERTAlNING TO THE INSTAlrLA7'IQN OR �
REPAIR OF UNDERGROUND U711.ITIES 3N CITY STRE�TS "
OR IN CITY RIGHT-OF-WAY/EASEMENTS
The foNowing regulations and conditions constitute a part of the appAcation made by any instaAer or contractor for
#he instailation of utilities in any City street right-af-way or City utility easement and the applicant, in making his
application to do such work, shal{ agree to �bide by these regulations and condf�ons: �t
1. The individuaE obtaining the pe�mit shaEt, befpte commencing such wark, notify the City Engineer when the
work at each lacation is to c�mmence; and, when �equested by the Engineer, sha0 submit plans and
specific.ativns.
2. Unon c�m�letion o# the t�riect. th� individua! �hall oromotiv notfii the Citv Engineerina Deoa�tment for final
' ion.
3. The pubElc is to be pr�tected by the individual, at a11 times, from the commencement of the work unti3 the
completian and acceptance by the City. The installer or contractor shall so conduet his operations as to
cause the minimum incanvenience to the public. The installer or contractor shall fumish, erect, and
maintain, in accadance with the legaliy accepted standards, all necessgry warning and traffic corttmf signs,
barricades, tra�c cones, and flashing lights to direct and control the movement of traffic through the project
in all directians arid at all times.
The foregoing provisians shall not in any way relieve the instailer vr contractor of any of his legai
responsibilities or liabilities for the safety of the public.
4. All openirzgs in bituminous surfaces shatl be cut in a straight line with sides smooth and vertical. Na ragged
edges wiU be permitted. Cutting shall be done with a concrete saw, cutting wheel, jack hammer, spades ar
similar approved tools.
Backfill material shall be suitable 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 ir� backfi{ling of trenches.
The backfiN material shall be p�aced in layers not to exceed one foot (1') and mechanically compacted to
not less than 95 percent of modified F�roctor density.
The upper siz inches (6") of the backfiti shall meet Minnesota Highway Department Specificatioris for Class
5 material and st�alE be compac#ed to nat tess than 85 percent of modified Proctor density.
As saon �s possible after backfili operations are completed, the cut bikuminous edges of the trench shall be
painted with an asphalt emulsion such as SS-1. immediately thereafter, the patching material shaA be
placed and mechanicaliy comp�ated to not less than 95 perc6nt of mod'�'iieti Proctof density. The asphaltic
material used in patching shall b� of the same type as removed from the raadway, except, that in no case,
wit) � pl�nt mixed asphalt of less quality than Minnesdta Highway Department Specif'�catians 2331 be used.
The fin�shed surtace of the patch shall aonform tp the surface of the undisturbed roadway.
Na permanent asphalt patches shatl be on any bass whose temperature is 32 deg�ees Fahrenheit or {ess.
Cald weather p�tChing shalf be of temporary nature, using cold mixed asphalt, well graded crushed rock er
s;milar approved materia�s. Temporary patches shail be true to lin� and grade. 'femporary pat�hes shall
G:1PER.1127'SIROW Utility�ROWPERMITSdwr �
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�� �, M��R-21-2006 09�14 �;iY OF PRIOR LAKE MAINT P.04iO4
be replaced by permanent patches when weather cvnditions permit and notificatian sha(I be required as {
stated in 2.
5, Qther areas may be requ�ed to be compacted at the direction of the City �ngineer• �
,
6. Such permittee to be responsibts for maintenance and repair of a11 trenches fo� a period of one (1) yr�r and
if settlement occ�rs or excavation caves in. the same shalf be prampNy indic.�ted by adequate warning
signs and sha!! be resiored ta proper canditian in accordance with specifications above provided as soan
as conditions permit.
7. All culverts and ditches shatl be �eplaced in their origina! position and condition existing prior to
constructiort and no change shali be made in drainage without approval Qf the City Engineer.
8. Permittee shalf save the City harmless from aEl third party claims for injury or damage which may xcur
between the time the work cammences and the tima it is finaliy accepted by the Ciry.
9. 7'hE permittee may be required to jack ar bore under certain streets, as determined by the City Eng+neer.
10. The applicant shall furnish evidence of pubGc liability insurance of not less than $100,000/300,000 and
property damage of noi less than $25,000 issued by an insarance company authorized to do business in
the State of Mictnesota on which the City is named as an additional insured party.
11. �xcept for the negligent acts of the City, its agents and its employees, the permittee shall assume all
liability for. and save the City, its �gents and its emptoyees, harmless and defend same at its sale cost and
expense from any and al! claim� for damages, actions or causes of action arising dut of the work #o be_
dorte herein and the continuing uses by the permittee, including but not limited to the placing, constructing,
and r�constructing, maintaining, pratecting and use of said facility under this application and permi# for
GOnSE�UCtIOfI.
12. Existing Facilities — The utility facility and instaifations shall not intertere with any existing utility facility on
the City's right-of-way or easements_ !t ls the cesponsibility of the applicant to call for necessary focations
of existing utilities. (Gopher One)
13. Rr�vate Property — The work permit or pe�mit for construction as issued does not in any way imply that the
appropriate easement exists to atlow the applicant to work on private property.
14. Cutting T�ees — The permissian herein granted does not confer upon the permitiee the right to cut, remove
or destroy trees or shrubbery within the lega! limits oE thE right-af-way. Easements tMat are not specif�cally
identif:ed on the plan attached to this perrr3it ar retieve permittee from obtaining any cansent othervvise
required from the owne� of the property adjacent t�ereto.
15. Clean-Up -- Sfreet, trailwayS and affected right-ef-way shall be scraped clean at the end of eaeh work day
and swept ciean after cons#ruction is completed and Eeft in a neat and presentable condition.
16. ReplaCement of Sod — WhereVer top-soi! and sad are diste►rbed, they shall be replaced in kind and
m�intained s�lisfaCtorily until the turF is established.
The undersigned hereby dectares hefshe has read and will comply with a1! the PERTItVENT REGULAT{ONS as
stated above and relevant City Ordinances.
.
DATE: ` � SIGN�D:
G:IPBRMIYffiIROW_U�iit7Y�R�WP[RMtTS.� � � �. .
TOTAL P. %�-.
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;952 9a9�0+.69 sr t/ 2
1.2— 7-05: 6:47PMiS2S0 BUFiV ORIVE
BSIM QRDER FORM� /SKETCH �
Fax to: B12 381-5397 Nectas'# �J'�d �c����
. MP,an�Hx �w�re ce car� > �'� aate sur„+ni�ted,��_��"�_
install�tion , RspairJ Preprouisioning.
(PNas• Ctrcl.One ofJh� Abav�) CUSlOrnB� Ne1?1e
Order � Atldress
T 971'Addtess
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2. Hold - �annol locne ENCAP D Subdhdtlon Ld 1t 81xk`
3. OOS - Can nd lay temp ❑ �� T
4. Held for F1-F2, 8180 need BSW r
s. remP a� _ fNa.d,a�cn b.iow� Name /'�� EC#,;�OR.#
8. Found In�1 - Seme.iab � 3U MSQf
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7. Add` lin6 O/ Q A/ ' Cu�bmet �s canMoled v�rbd Q eand �
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HudsonlKing Yr. �_ Pp, ��� /J '� Tenninal Address
Croes-Streot :Number of Fest Type ot W ire : (3 / 8pr}
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L -iNFO : L�E F.R.S 1Q.� t� 7 W,S�P.Q�9 O,A�,N � 5�,1�t - P.N C
ChaekVYhen Comol�t�
Proposcd Rouk O Na�FiborAddrtues 0 Appmzimeu Property Line i7 Drivervays+e Sid�walks'D Widlh ofDW d� SW (ifietBSW Pslh) O
Utillties [�aaNishts� hydnnts, auj 0 Saeet names � dis� fm cnuline • ped' O Diitanee dotn arcb 10 te�rt� or ped Q Iadiale Not1h direotion O
Disnnoe Prn teem to intusating roAO O SSW length ( in righe of wpy lc pcivarc prop) � 8SW Qistanx itn ewb io bury route D .
Pro-bury Q.O Iki1e: Indudsd crass srrarand coudit�ata O
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Road Push Permit Required ❑ Hand Dig O �Notr liand Dip Mustbe 12"
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