HomeMy WebLinkAbout3072 Bobcat Trl ROW Permit , , e�
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WORK ORDER ����I �0 �i �v ��
MJ �' N E S ��P PERNIIT �
TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS
AND
APPLICATION FOR INSTALLATION OF UTILITIES .
1. Location .� � 70� ,(g v,(� �,'� % ��
2. NatureofWork 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 DeviceslSigns or Privately owned _)
Drainage Utilities
StructureBuildings Othe �i�s.5 G/�/4(��[,
4. Method of Installation or Construcrion �6����
5. Work to stazt on or after. ���and shall be completed by: l0 :3/�'�25�unless an extension
• � granted to: by:
DATE ' STAFF/DATE
6. Will detouring of traffic be necessary? NO If necessary to detour traffic, describe suggested
route:
7. Provide with this application a copy of the contractors Public Lia6ility Insurance.
DETOURS: The Director of Public Works shall be notified in wricin� at least 72 hours in advance of
any detour being established, changed or discontinued.
NANIEOFAPPLICANT CenterPoint Energy P HO� 612-321
PLEASE PRINT FAX 612-321-5480
ADDRESS �00 Linden Avenue West, P.O. Box 1165, Minneapolis, MN 55440-1165
STREE'T CITY STATE ZIP
NAME OF PARTY OR ORGAIJIZATION PERFORMING WORK Michels Corp.
CONTACT PERSON: Steve� Jahn�on EMERGENCY (24 HR.) PHONE #: 612-372-5050
ADDRESS DAY PHONE 612-32�-50.�6
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 co ply therewith to the satisfaction of the City of Prior Lake.
Signed:, ��e; Eng.Assist. Date: a '`�"s �c��.
�noc Page 1 of 4
16200 Eagle Creek Ave. S.E., Prior Lake, Minnesota 55372-1714 / Ph. i612) 447-4230 / Fax (612) 447-4245
� CN FA1 IAI ADDAD'R O�tITJ e�m� i+vcn
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EX�IIBIT �°C"
FOR CITY USE ONLY AUTHORIZATION OF PERNIIT
FINANCIAL SECURITY: AMOLJNT; Typg; -
(Cash, bond, LOC etc.)
Fee: S 2SC�D� Receipt Na 0 OD Permit No. -
LIABILITY INSURANCE PROVIDED: Associated Electric & Gas Insurance Services Limited
In consideration of agreemenc to comply in all respects with the regulations of the City of Prior Lake covering such
' operations, and pursuant to authorization duly given by said City 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
By: .��/ ���_�
/DATE
ALL LEGAL REQUIREMENTS SHOWN ON PAGE ONE (1) AND ON ALL "SPECIAL PROVISIONS" SHALL
BE COMPLIED WITH. Tf� DATE WI�N WORK IS COMPLETED NNST BE REPORTED TO THE CITY
OF PRIOR LAKE CITY ENGINEER
�� Page 2 of 4
.� � '�
' EXHIBIT "C"
CITY OF PRIOR LAKE
REGULATIONS PERTAINING TO THE INSTALLATION OR
REPAIR OF UNDERGROUND UTILITTES IN CITY STREETS
� 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 installation of utilities in any Ciry street right-of-way or City utiliry 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 Ciry Engineer when
the work at each location is to commence; and, when requested by the Engineer, shall submit plans and "
specifications. �
2. Uoon comnletion of the oroiect the individ�al shall prompti notifv the itv Fn �ineerin� Dgp$rtment for
final �n ect�on.
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 furnish, erect, and
maintain, in accordance with the legally accepted standards, all necessary warning and traffic con�ol 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 hatnmer,
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 shall 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 densiry.
The upper six inches (6") of the backfill shall meet Minnesota Highway Department Specificarions 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
materiai 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 shall 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 shalt 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
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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 ( i) year and
if settiement occurs or excavation caves in, the same shall be promptly indicated by adequate waming 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. Permittee shall save the City harmless from all third pazty claims for injury or damage which may occur
between the tirne the work commences and the time it is finally accepted by the City.
9. 'fhe 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 parry.
11. Except for the negligent acts of the City, its agenu and iu employees, the permittee shail assume all
liabiliry 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, acrions 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
constiuction.
12. Existing Facilities - The utility facility and installarions shall not interfere with any existing utility facility
on the City's right-of-way or easements. It is tl�e responsibility of the applicant to call for necessary
locations of existing utilities. (Gopher One)
13. Private 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 limiu 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 and 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 presentable 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.
The undersigned hereby deciazes he/she has read and will comply with all the PERTINENT REGULATIONS as
stated above and relevant City Ordinances.
v �`� DATE: o� '0�-5 ' 0 :7 SIGNED:
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GENERAL LOCATION ONLY. DO NOT USE TO LOCATE FOR EXCAVATION. CALL 1-800-252-1166 FOR ONSITE LOCATIONS AND STAKING.
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Plotted by: i213254 CENTERPOINT ENERGY Scale: 1" :100'
Plot Date: 2/9/2005 Field2: �h
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