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Home My WebLink About15533 Breezy Point Rd ROW Permit .+ � ��<O �� '._ - z, 'c '�� ° t._ 1 � ►�i � U i �� LL 9� �7 :'�� E S ��P PERMIT TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS AND APPLICATION FOR INSTALLATION OF UTILITIES 1, Location ( S�J� � 3 � �� 'EZ.\/ �'"ti. iti f � t� „ 2. Nature of Work � L� �c1C �Q.q � �'�ep �� . �. Indicate below items to be affec#ed 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 , Utilities StructureBuildings , Other � C9 (� 4, Method of Installation or Construcdon �Lo �,.� �I-� n�°� �� a � ' 5. Work to start on or after:�� shall be completed by: A� 3( _ unless an extension � granted to: b DATE STAFF/DATE 6. Will detouring of traffic be necessary? � v ' If necessary to detour traffic, describe suggested route: � 7. Provide with this applicarion a copy of the contractors Public Liability Insurance. DETOURS: The Director of Public Works sh'all be notified in writin; at least 7� hours in advance of any detour being established, changed or discontinued. NAME OF APPLICANT �; �1� M t1 f�� iM �,ln� �dti„� PHONE • Q 3' 0 � PLEASE PRINT FAX SoZ • 9- 9 (00 �Dx�ss �[_ba- C�oN,,.,� ,.c� p -L�v F ; 5fc . I t� f��r� �ot�e M� • SS 3� � STREET CITY , STATE ZIP NAME OF PARTY OR ORGAIdIZATION PERFORMING WORK C C� . CONTACT P RSON: M� RGENGY (24 i3R,) pHONE #: ( - G$S- � ADDRESS ��.4R� R��S' W� oWY��cl�� Ml� DAYPHONE ( • lo •� � STREET CIT'Y STA'T� ZIP t ;, ��'� . TL.. �___ . . ' . . ii�c uiiuc o ` uGGc�iS ui� i�iuis aciu cunuiiions oi inis permit ny the C;ity o2 rrior Lake as herem a e an ee to'fizl ;, ply therewith ta the satisfaction of the City of Prior Lake. Signed: Title: l"e,n5� �,� Date: J ' c� • C'�� `"- � rc.�{� E�rrc.DOC Page 1 of 4 16200 Eagie Creek Ave. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (b 12) 447-4230 / Fax (612) 447-4245 Aiv EQUAL OPPORTUNIN EMPLOYER ., EXHIBIT "C" TO PRIOR LAKE PUBLIC WORKS DESIGN MANUAL PERMIT TO WORK WtTHIN CITY PROPERTY RIGHT-OF-WAY/EASEMENTS AND APPLICATION FOR INSTAI.LATION OF UTILITtES PAGE 2 FOR CITY USE ONLY AUTHORIZATION OF PERMIT FINANCIAL SECURITY: AMOUNT: NpE; (Cash, Bond, LOC, Etc.) Fee: $ �� C7 Receipt No. Permit No. VP'"0�'�i(D LIABIILITY INSURANCE PROVIDED: �` +� In consideration of agreement to comply in all respects with the regula4ons 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: �i�<� s` � Q.S� __ roa 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: Wdmm\FORMS�EXEIIBIT C APPLIC FOR INSTALL OF UTILTTIHS.doc EXHIBIT "C" TO PRIOR LAKE PUBLlC WORKS DESIGN MANUAL REGULATIONS PERTAINING TO THE INSTALLATION OR REPAIR OF UNDERGROUND UTILITIES IN CITY STREETS OR IN CITY RIGHT-OF-WAY/EASEMENTS The following regulations and conditions constitute a part of the appiication made by any installer or contractor for the installation 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. Upon completion of the proiect, the individual shall' promptiv notifv the Citv Enqineerinq Department for final insoecfion 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 o� contractor shall 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 tra�c through the project in all directions and at all times. . The foregoing provisions shalf not in any way !,relieve the installer or contractor of any of his legal responsibilities or liabilities for the safety of the pu(�lic. 4. All openings in bituminous surtaces shall be cut in a straightline 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 materiai shall be suitable for highway embankrnent construction. No peat, frozen lumps, broken asphalt, sod, roots, or other undesirable materiaf! shall be permitted as backfilL Rocks larger than six inches (6") in diameter shall not be used in backfilling of t�enches. The backfill material shall be placed in layers not �o exceed one foot (1') and mechanically compacted to noi fess than 95 percent of modi�ed Proctor density. The upper six inches (6") of the backfill shall meet fulinnesota 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 operations are cotnpleted, the cut bituminous edges of the trench shall be painted with an asphait emulsion such as SS-1. ;Immediately thereafter, the patching material shall be pfaced and mechanically compacted to not iess thah 95 percent o1 modified Proctor density. The asphaltic material used in patching shall be of the sarne type''as removed from theroadway, except, that in no case, wii! a pfant mixed asp �al# of less quality than iJfinnesota Highway Department Specifications 233 i be used. TL... F:..:..�,.,.� .....1__— r a� _ � � . ��G rn n�i icu aui i o�,a Oi u iG NBiC;i i Si"idii C;UI1fUfR7 IO ifl surtace or ine 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 r�ck or similar approved materials. Terriporary patches shall be true to line and grade. Temporary patches shall G: C APPLIC FOA INSTALL OF UI'ILITfES.doc � � — � � , �� J �'� � � � O ��, � � 3 �� . D�! �D � � � �' � � � _____--.___.._.._._.._._.��, �� `�,� � � �d � ``�, �r� \ �� `,� � � ��" � �; � �� ,�� ti . . . ' •.�,�,�00� k� � � i � � ~= I � � - � . . �..� . . � � .. .. . . �� \ �' � � . . � l�. �� , � rr p - S � l� � - � � � � � � . . �� \ \ � � : . . � . . 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