HomeMy WebLinkAbout16516 Franklin ROW Permit . �� PRI
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� ��' N E S ��P PERMIT
TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS
AND
APPLICA'I'ION F'OR INSTALLATION OF UTILI']�"IES
1. Location � � s � � ��A�l� L / /l� ST : � E
2. Nature of Work �� L,A�_�q,� (�.�� �
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 (Pubtically owned �
Traffic Control Devices/Signs or Privately owned _�
Drainage Utilities
StructureBuildings ' Other 'f � 2�
4. Method of Installation or Construction �LO T �,2{T��� �5 t� 11 i �
� 5. Work to start on or after: 'S OS and shall be completed by: _N►A�) �6, p� unless an extension
� granted to: �u N� 3O o�by: '
DATE STAFF/DATE
6. WiI1 detouring of traffic be necessary? /" �� If necessary to detour tra�c, describe suggested
route: '
;
7. Provide with this applicarion a copy of the coniractors Public Liability Insurance.
;
DETOURS: The Director of Public Works shall be notified in writing at least 7� houre in advance of
any detour being establishec�, changed or discontinued.
; NAME OF APPLICANT � E MC-� �-2 i'_ M rv� PHONE ��� -�3 - 0�9 �
� PLEAS �'RINT FAX ° IS�-`(`�v • at��D
aDDxESS I Co a— m�w.,�., erc -� oT� � 2 � - M�1J S 3 7�
STREET C;ITY STA ZIP
NAME OF PARTY OR ORGANIZATION PERFC�RMING WORK M �ASKo C-tf t�CC .
CONTACT PERSON: R A� L FiI�RG NCY (24 HIt.) PHONE #: 6Sl -� G 1- I( 9 c7
ADDRESS `�O�P O Q l< �_ . Q�01� � 8� (.tl ��iJ �t�FP�AY PHONE �c� S( - o� �o) � �(9 Zti
! STREET CITY S'fATE ZIP
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i! uiiuciarv iui d�Gc}tiS uic iciiiis aiiu uuuuiiions oi inis permii by ttie C;ity oT Yrior Lake a�, herein
onta ed d a ee :.omply therewith to the satisfaction of the City of Prior Lake.
Signed: Title: �5-1-, �soi � Date: 3 ` Q• a 5�
/�-t , a'� C:'/ C�
exi�trc.DOC Page 1 of 4
16200 Eagle Creek Ave. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (b12) 447-4230 / Fax (612) 447-�245
AN EQUAL OPPORTUNfTY EMPLOYER
EXHIBIT "C
TO
PRIDR LAKE PUBLIC WORKS DESIGN MANUAL
PERMIT TO WORK WITHIN CITY PROPERTY RIGHT-OF-WAY/EASEMENTS
AND �
APPLICATION F�R INSTALLATION OF UTILITIES
PAGE 2
�
FOR CITY USE ONLY AUTHORIZATION OF PERMIT
FINANCIAL SECURITY: AMOUNT: TYPE:
(Cash, Bond,
LOC, Etc.)
Fee:$ �i$�b.0o ReceiptNo. IPg��Z- PermitNo. JD�dS�Zn
LIABIILITY INSURANCE PROVIDED:
In consideration of agreement to comply in all respects with the regulations of the City of Prior Lake covering such operations,
and pursuant ta authorization duly given by said City o# 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: ��lt���---- �� O
/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.
�
G:�.4dmin\FORMS�EXFIIBIT C APPUC FOR INS'fALL OF UTILITIES.doc
EXHIBIT "C"
TO
PRIOR LAKE PUBLlC WORKS DESIGN MANUAL
REGULATiUNS PERTAINING TO THE (NSTALLATION 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 application rnade 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 �hese 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
inspection. '
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 Gity. 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 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 materiai 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 density:
The upper six inches (6") of the backfill shall �neet Minnesota Highway Department Specifications for Class
5 material and shall be compact�d to not less than 95 percent of modified Proctor density:
As soon as possible after backfifl operations �re compteted, the cut biturninous edges of the trench shall be
painted with an asphalt emulsi�n such as �S-1. Immediately thereafter, the patching material shall be
placed and mec�anically compa�ted to not le`ss than 95 perceni of modified Proctor densiry. 7he asphaltic
material used in patching shall be of the sarne�type as removed from the roadway, except, that in no case,
will a pla�t r;ixed asptiafi af less guality than Minnesota Fiighway Department Specifications 2331 be used.
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���c �n „a, �cu Siii ia�c v� u �c Natci � si �dii cor�Fornn io ine.suriace or ihe undisturbed roadway.
No permanent asphalt patches shall be on any base whose temperature is 32 degrees Fahrenhei# or less.
Cold weather patching shall be of temporary naiure, using cold mixed asphal±, well graded crushed roek or
similar approved materials. Terriporary patches shall be true to line and grade. Tempora!;� rafches shall
G:1Admin\FORMS�EXHIBIT C APPLIC FOR INS'fA1.L OF UTILITIES.doc � � �
be replaced by permanent patches when weather conditions permit and notification shall be required as
stated in 2.
5. Other areas may be required to be cornpacted at the direction of the City 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 shall be promptly 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 ofthe City Engineer.
8. Permittee shall save the City harmless from all third party claims for injury or damage which may occur
between the time the work commences and the time it is finally 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 ctaims 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 facility under this application and permit for
construction.
12. Existing Facilities — The utility facility and installations shall not interFere any existing utility facility on
the City's right-of-way or easements. it is the 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 aifow the appiicant io work on privaie property.
14. Cutting Trees.— The permission herein granted does not confer upon ihe permittee the right to cut, remove
or destroy trees or shrubbery within the legal limits of the right-of-way. Easements that are not specificafly
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 �resentable condition.
16. Replacement of Sod — Wherever top-soil and sod are di�turbed, they shall be replaced in kind and
maintained satisfactorily until the turf is established.
Tne undersigned hereby deciares he/she has read and wili comply with all t�e PERTINENT REGULATIONS as
stated above and relevant City Ordinances. ,
DATC: SIGNE^v:
G:\AdminlFORMS�EXtIIBIT C APPLiC FOR INSTALC.OF LITILITTES.doc .
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