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Home My WebLink About3356 Todd Rd ROW Permit . �O� ;� � 4 y F.� �= �, � � <�. � ;� « » v � ,� � �' N E S ��P PERMIT TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS AND APPLICATIUN FOR INSTALLATION OF UTILI'�'IES I. Location 3�s�o I 0E-� �C�4 � 2. Nature of Work I�k�C�C�c �� /�L� 3. Indicate below items to be affected and include a sketch or plan of work to be done. Curb & Gutter Street Surface TraiUSidewalk ' Trees: Pond/Wetlands (Publically owned � Traffic Control Devices/Signs or Privately owned _� Drainage , Utiliries StructureBuildings Other �� 4. Method of Installation or Construction �Cd �+1� �brl° �� nS.(J.p ( q 5. Work to start on or after: hP� f•� �� and shall be completed by: 3 0� unless an extension granted to: by ' DATE STAFF/DATE • . 6. Will detouring of traffic be necessary? _ N� If necessary to detour tr�c, 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 writin T at least 7� hours in advance of any detour being est�blished; changed or discontinued. NAME OF APPLICANT fJ� l KF �\�Y� R� t f.4 Ca lu� Pxorr� G la ^�J 3 " °� 3 ! PLEASE P T FAX `� � � �S ° I S ' �T 8��e � �D�ss �y, ba t�,.�... �,-� ��F_ �� . lad �' r�� l� , Ss3 � a — STREET . CITY STATE ZIP NAME OF PARTY O ORGAI�TIZATION pERF�RMING WORK /!'l �� 5 "- CQNTACT PERSON� s � EMER�. GEN�Y (%4 HR.) PHONE #: 1 c� •�o �-`I S c`�-g ADDRESS 6O o �%�I otJ R�Jer DAY PHONE � C J` ' ` ' 7 �a-�'1 + STREET CITY � STATE ZIP ! MN 55`t 5'S TL. �.. '.� _ � L ____._aL l. _ � . . 1i� uiiuci i� dGGc�is u�c ic�iiis aiiu cuLUiiions oi [nis pernlit by the C:ity oT Yrior l.ake as herem ont ined n ee t co ly therewith to the satisfaciion of the Citv of Prior Laice. Signed: Title: e6y�5 i.�pUt ✓� , Date: �' a• �s � . M E r.�'Y� e�trc.noc Page 1 of 4 16200 Eagle Creek Ave. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (b 12) 447-4230 / Fax (612) 447-4245 AN EQUAL OPPORTUNIlY Eh1PL0`(ER a a . EXHIBIT "C" TO PRIOR LAKE PUBLIC WORKS DESIGN MANUAL �PERMIT TO WORK WITHIN CITY PROPERTY RIGHT-OF-WAY/EASEMENTS AND APPLICATION FOR INSTALLATION OF UTILITIES PAGE 2 FOR CITY USE ONLY AUTHORIZATION OF PERMIT FINANCIAL SECURITY: AMOUNT: TYPE: (Cash, Bond, LOC, Etc.) Fee: $ r�s�•da Receipt No. Permit No. (/D�S'—y� LIABIILITY INSURANCE PROVIDED: I nC. �5/'�''i.3 ��GnGG�,� In consideration of agreement 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; peRnission 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. THE DATE WHEN WORK IS COMPLETED MUST BE REPORTED TO THE CITY OF PRIOR LAKE CITY ENGINEER. r I G:�Admin\FORMS�SXEIIBIT C APPLIC FOR IIJSTALL OF U77I.ITIHS.doc « : EXHIBIT "C" TO PRIOR LAKE PUBLIC WORKS DESIGN MANUAL REGULATIUNS PERTAINING TO THE INSTALLATION OR REPAIR OF UNDERGROUND UTILiTIES IN CITY STREETS OR �N CITY RIGHT-OF-WAY/EASEMENTS The following regulations and conditions constitute a part ofi the application made by any instalier or contractor for the installation of utilities in any City street right-of-way or City uti�ity easement and the appficant, 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. Upon completion of the proiect the individual shall promptiv notifv the Citv Enpineerinq Department for final inspection. 3. The public is to be protected by the individual, at al! 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 shali furnish, 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. Atl 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 toots. ' Backfill material shall be suitable for highway e�nbankment 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 backfi'lling of trenches. The backfill material sha�l 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 compactPd to not less than 95 percent of modified Proctor density. As soon as possible after backfill operations are completed, the cut bituminous edges of the trench shall be paintea with an asphalt emulsion such as SS-1! Immediately thereafter, the patching material shall be placed and mechanical)y compacted to not iess tf�an 95 percenf of modified Proctor density. 7he asphaltic material used in patching shall be of the same type as removed from the roadway, except, that in no case, wi!! a plant r�ixzd asp �ali of fess quality than iJinnesota Hig7way Department Spe�ifications 2331 be used: T�%2 F;;,;��cu Sii�aGc Oi i , ic �aiui �;iidii conForm io'ine surface or ine unaisturbed 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 naiure, using cold mixed asphalt, well graded crushed rock or similar approved materials. Terriporary patches shall be true to linP and grade. Temporary patchQs shal! 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