HomeMy WebLinkAbout3000 Bobcat Trl ROW Permit Ri: ' �
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WORK ORDER 4� � r l���a�o �
Ml �' N E S ��P PERMIT
TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS
AND
APPLICATION FOR INSTALLATION OF UTILITIES .
1. Location � ��� ��� �'fj" l '��
2. Nature of Work Install new 5/8" Plastic gas service line. . �
3. Indicate below items to be affected and include a sketch or plan of work to be done.
Curb & Gutter Street Surface
TraiUSidewallc Trees:
Pond/Wetlands (Publically owned
Traffic Control Devices/Signs or Privately owned _)
Drainage Urilities
StructureBuildings p�� G�A-� G
4. Method of Installation or Construction ���//�G
5. Work to start on or after: �'oZ � �.�and shall be completed by: l� :�� OS unless an extension
� � �anted to: by;
DATE STAFF/DATE
6. Will detouring of traffic be necessary? ND If necessary to detour traffic, desctibe 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 writin� at least 72 hoLrs in advance of
any detow being established, changed or discontinued.
NANIEOFAPPLICANT CenterPoint Energy PHO 612-321
PLEASE PRINT FAX 612-321-5480
ADDRESS �00 Linden Avenue West, P.O. Box 1165, Minneapolis, MN 55440-1165
STREET CTfY STATE ZIP
NAME OF PARTY OR ORGANIZATION PERFORMING WORK Michels Corp.
. CONTACT PERSON: Steve� Johnson. EMERGENCY (24 HR.) PHONE #: 612-372-5050
ADDRESS DAY PHONE 612-32 L-50.�,6
STREET CITY STATE ZIP
The undersigned herewith accepts the ter:ns and conditions of this permit by the City of Prior Lake as herein
contained and a e to lly, omply therewith to the satisfaction of the City of Prior Lake.
Signed: Title Eng . As s is t. Date: `� �` ���
��� Page 1 of 4
16200 Eagle Creek Ave. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (612) 447-4230 / Fax (612) 447-4245
AN FAt tet nonno�n ivr�v r.•a n..r�
EXHIBIT "C"
FOR CTTY USE ONLY AUTHORIZA'TION OF PERMIT
FINANCIAL SECURITY: AMOLTNT: TYPE: . `
(Cash, bond, LOC etc.)
Fee: S �s0• �� Receipt No. l03 3 i►31 Permit No. — 0 '
LIABII.ITY INSURANCE PROVIDED: Associated Electric & Gas Insurance Services Limited
In consideration of agreement to comply in all respecu with the regulations of the City of Prior Lake covering such
' operations, and pursuant to suthorization duly given by said Ciry of Prior Lake; permission is hereby granted for the
work to be done as described in the above application, said work to be done in accordance with special provisions as
hereby stated:
APPROVED BY: DEPT. OF PUBLIC WORKS
B �� 3 � 7 �
/DATE
r
ALL LEGAL REQUIREMENTS SHOWN ON PAGE ONE (1) AND ON ALL "SPECIAL PROVISIONS" SHALL
BE COMPLIED WITH. Tf� DATE WI�N WORK IS COMPLETED MUST BE REPORTED TO Tf� CITY
OF PRIOR LAKE CITY ENGINEER
�n�.00c Page 2 of 4
� EXHIBIT "C"
CITY OF PRIOR LAKE
REGULATIONS PERTAINING TO THE INSTALLATION OR
REPAIR OF UNDERGROUND UTILITIES IN CITY ST'REETS
� OR IN CITY RIGHT-OF-WAY/EASEMENTS
The following regulations and conditions constitute a part of the application made by any installer or contractor for
the instatlation of utilities in any City street right-of-way or City utility easement and the applicant, in making his
application to do such work, shall agree to abide by these regulations and conditions: '
1. The individual obtaining the permit 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. Unon comnletion of the nroiect the individ�al shall romFti notifv the itv Fn �jn ri � D�parQ►�ent for
final ms en ction•
3. The public is to be protected 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 installer or contractor shall fumish, erect, and
maintain, in accordance with the legally accepted standards, all necessary warning and traffic control signs,
barricades, traffic cones, and flashing 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 for the safety of the public. '
4. All openings in bituminous surfaces shall be cut in a straight line with sides smooth and vertical. No .
ragged edges will be permitted. Cutting shall be done with a concrete saw, cutting wheel, jack hammer,
spades or similar approved tools. �.
Backfill material shall be suitable for highway embankment construction. No peat, frozen lumps, broken
asphalt, sod, roots, or other undesirable material shail 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 Proctor density.
As soon as possible after backfill operarions are completed, the cut bituminous edges of the trench shall be
painted with an asphalt emulsion 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 qua�ity than Minnesota Highway Department Specifications 2331 be
used. The finished surface of the patch shall conform to the surface of the undisturbed roadway.
No permanent asphalt patches shail be on any base whose temperature is 32 degrees Fahrenheit or less.
Cold weather patching shall be of temporary nature, using cold mixed asphalt, well graded crushed rock or
similar approved materials. Temporary patches shall be true to line and grade. Temporary patches shall be
replaced by permanent patches when weather conditions permit and notification shall be required as stated
in 2.
�R�•� Page 3 of 4
EXHIBIT "C"
5. Other areas may be required to be compacted at the direction of the Ciry Engineer.
6. Such permittee to be responsible for maintenance and repair of all trenches for a period of one (1) year and
if settlement occurs or excavation caves in, the same shal( be promptty indicated by adequate warning signs
and shall be restored to proper condition in � accordance with specifications above provided as soon as
conditions permit.
7. All culverts and ditches shall be replaced in their original position and condition existing prior to
construction and no change shall be made in drainage without approval of the City Engineer.
8. Petmittee shalt save the City harmless from all third party claims for injury or damage which may occur
between the tirne the work commences and the time it is fmally accepted by the City.
9. The permittee may be required to jack or bore under certain streets, as determined by the City Engineer.
10. The applicant shall furnish evidence of public liability insurance of not less than $100,000/300,000 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 employees, harmless and defend same at its sole cost and �
expense from any and all claims for damages, actions 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, and
reconstructing, maintaining, protecting and use of said faciliry 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 Ciry's right-of-way or easements. It is tlte responsibility of the applicant to call for necessary
locations of existing udlities. (Gopher One)
13. Ptivate Property - The work permit or permit for construction as issued does not in any way imply that the
appropriate easement exists to allow the applicant to work on private property.
14. Cutting Trees - The permission herein granted does not confer upon the permittee the right to cut, remove
or destroy trees or shrubbery within the legal limits of the right-of-way, easements that are not specifically
identified on the plan attached to this permit or relieve permittee from obtaining any consent otherwise
required from the owner of the property adjacent thereto.
15. Clean-Up - Street, trailways aad affected right-of-way shall be scraped clean at the end of each work day
and swept clean after construction is completed and left in a neat and presentabie condition.
16. Replacement of Sod - Wherever top-soil and sod are disturbed, they shall be replaced in kind and
maintained satisfactorily until the turf is established.
'I'he undersigned hereby declares he/she has read and will comply with a(1 the PERTINENT REGULATIONS as
stated above and relevant City Ordinances.
DATE: � �� SIGNED:
��� Page 4 of 4 `
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