HomeMy WebLinkAboutPleasant St & Ridgemont ROW Permit DEC-12-2��5 �9 � 44 C I T`�' OF PR I OR LAl:E P1A I NT P. �1i�4
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PERMIT TO WORK WITHIN CiTY PROPERTY RIGHT-OF-WAY/�QSEMENTS
AND
APPI�tCATtON FOR INSTALLATION OF UTiUTtES
l. Location INTt�rL�Ef�� �IZ� �t,,.E��4�vT" c.5r � 12co�Erc.oN't' k�-vE
2. Narure of Wark {Z.�P�� 2 c� F G,c, sn,.�� 5�.�,e. Lr,.�
3. t�idicate below items ta be affected and include a sketch or plan of work to be done.
Curb & Gutter �_ Str�et
� TraiUSidewalk �Trees:
Poi1d/Wetlar�ds (pubtically owned �____
� Traffic Control Devices/Si,�ns Or Privstely owned )
_ Draina�*e Utilides
ShvctureBuiltiings Otl�er _ _ _
4. Method of Installation or Constr�.icdon ___ e ��+a� � C'�,�,sra-�� � uG c�oz-i�- „� 4�c�c,ccc..c.
5. Work to start on or aFter: Z Ja-+� o�- and shall be conipleted by: �� m�H O 6 unless an
extension a anted to: _ by;
DATE STAFF/DAT�
6. 1'Vill detouring of traffic be necessary? ES 1f neeessary io detour traffic, describe suggest�3
route: Dv[.0 r�- A.�: _ � Co� oe .s.ov 57' ro � o� s .r� o�. r ��
7. Provide �vith this appIicatioiz a copy of the conrractors Public Liability Insurance.
DETOURS: Tite Direetor of Public `Vorks siiall be notified in writin� at Ieast 72 hours in advance of any
detaur being t;stablished, cl�anged or disconiinued.
NAME OF APPLICANT S�j-,+= �M��ao�� PHONE Cs�TI —�'`j 1!/
PLEASE PR.1N1'
ADDR�SS �'8o z �.�n».��... IZ t1 ST t�A-�.�c. /Y1 N ,ST O�
STRBET CITY STATE Z[P
NAME O�' PARTY OR ORGANIZATION PERFORMTNG �'VORK CG1
CONTACT PERS()N: I G2e.-� F�a¢.-f� EMERG�NCY (Z4 HR,) P��ON�#: .3Za-T1.�'�i3'¢
ADDRESS: �-Bo $ae� g. G's��..r.�cr.� Z� Sr i',a.�.,� �••�•o DAY PHbNE (�1 Z-�3 /D -�4Z1
S7REET C1TY STATE 21F S"�hc 7 Z
The undersigned herewith accepG� the c�m�s and condi;ions of this permit by the Ciry of Prior Lake s� fierein containcd and agrez to
fu1ly comply d►ere ' '� actio of the City of Prior Lake_
5ign � � vE✓t Date• ��/��d S
' 12715/26�5 12:19 FAX 6512969113 ECI � 003/006
bEC-12-2005 �9 � 45 C I T`I OF PR I OR LR�CE t�A I rIT P. 02iC�4
EXHIBIT "C"
. TO
PRIOR LAKE PUBLIC WORKS DESIGN MANUAL
PERMIT TO Wt�RK WItHIN C1TY PROPERTY RIGFI7•OF-1NAYlEASEMEN
ANb
APPLICATION FOR INSTA�I.ATION OF UTILITIES
PAC�E 2
FOR CITY USE ONt_Y AUT�-tORiZnTION OF PERMiT
FINANClAL SECURITY: AMOUNT: TYPE:
(Cash, Bond,
LOC, E1c.)
Fee: �
�,st�•Od Receipi No. � _Permit No. �,�,. " �
LIAI311LITY WSURANCE PROVIDED: ,� �
In con,ideration of agreem�rrt to comply in all res;,ects with the regulations of ihe C8y of Prbr Lake covering such operafions,
and pursuar�t 10 autho+yz�Gon duty given by sa�d City ot Prior l.ake; permission �a hereby granted for 1he vuutk to be done as
descrlbad in the abov'e applicat�nn, said work lo be done in accotda�ce wilh sPecial Drovisions as hereby staleci:
��� �� m j,� ,�,� pS� ��j/ APPRO D BY: DEPT, OF PiJBLIC WORKS
' r G G� l cr- gy; j%����i�� /Z'��i'�fS�
b✓�v►� �� � -�. ' /DATE
�1� rhl�� W���'"�1 _ �D� ar�� �••� . .
�kLL LEGAL REQUIR�MENTS SHOWN ON PAGE ONE (1) A►N[� ON ALL "SPEGI/U. PROY�SION�' SHAU, eE COMPLlED
W17H. THE DATE WHEtd U�lORK IS COMPLETED MUST BE REPORTED 70 THE GITY OF PRIOR LAKE CITY CNGINE�R.
a�ren�nsutow vert�M.ow �F�wcrs.roc
•� 1�/13/2005 1�:19 FAX 6512989113 ECI � 004/006
DEC-12-2005 09�a5 r_IT'� OF PRIOR LAKE MAINT p,g3rp�
EXHIBIT "G"
TO
PRIOR LAKE PUBLIC WORKS DESIGN MANUA�
rni.�++��r - - rr� � .r.n
REGUI.ATIONS PERTAINING TO THE INSTALl.AT10N OR
REPAIR OF UNDERGROIJNU UTiI.ITI�S tN C(TY S7REE7S
OR lN Cl1'Y RICyNT-O� WAY/EASEMENTS
The tollowing regulations and conditions constitute a patt af fha application made by any installer or contractor for
the installation ot ulilitic:s in any City stree! right-of-way or Ciiy util(ty easement and the appli�ant, in making his
app►►cation io do such work, shall agree io abide by these �egulatians and conditions:
1. The indivtdual obiaining the permit sha�l, hefo�e cammencing such work, noMfy the City Engineer when the
work at Qach bcattort is to commence; and, when rzquested by the Enc�ine2r, shall submit plans and
specifications. �
2. Uppn comalet�o oi thF nroieci, th� i n ividual shall promatly notifv the Citv En4ineerinq Deoartment tor finaf
insnettfon.
3. The public is to be proteoted by the individual, at all t�me�, from the cor�mencement of the work until the
campleGon and acce{�tance by 1he �ity. The installe� nr cbntractor sh�ll so conduct his operalions as to
cause tt�e minimum inconvenience io t1�e public. The instalfer �r contractor shall iurnis�, erect, and
mai�tain, in accardance with the (egally accepted siandards, all necessary warning and traffic coMrol signs,
barricades, tratf"�c cones, and flashing li�hts to direct and aontrol the movement of traftic through the project
in a11 direciions and at all times.
The foregoing p�ovisions she1� not in any way re6eve the installer or contractor of any of his lagal
responsibilities or li;�bilitfes for ihe safely of the public.
4. All openings in bituminous surfaces shall be cut in a straignt line witn sides smooth and vertical. No ragged
edges wi11 be permitted. Cutting shalt be do�e wiih a cQncrete saw, cutting wheel, jack hammer, spades or
similar approved tools.
eackitu material shall be suitable for highw�y cmbankment consuucL'on. Na peat, irazen lumps, broken
asphalt, sad, roots, or other undesirable matcrial shall be permitted as backfill. Rocks la�ger tl�an six
inches (6") in diameter shall not be used in backfi)ling ot trQnches.
7he Dackfill materiat shall be plac�d ;n layers not lo excepd on� toot (1'} and mechanically cornpacted ta
not less than J5 petcent of modiP�ed Proctor density.
Th� upper six inches (6") of the backfill shall meet Minnesota Nighway Depariment Specif"icaGons for Class
5 material dnd shall De compacted to not less tha� 95 percenl of modified Prodor density.
As soon as possible efle+� back�ill ap�atlons ar8 oompleted, the cul bituminous edg�s of Ihe trench sl�all ba
painted wilh an aspha►t emulsion such a� SS-1, Immediately thereafler, the patching material shall be
placed and mechanically compacted to not less than 9S percent of moditied Prxtor densiiy, The asphaltic
material used in patching sha11 I�e of fhs same rype as removed frona the roadway, except that in no case,
wiu � plant mixed asphalt ef less quality than Minnrsot9 Highway Departmsnl Specificatio�s 2331 be used.
Tha flnishc�d surface of the patCtt sha11 conform to the suHaae vf the undistu�bed roadway.
No permanerrt asphalt paRches shalf be on any bas� whose temperature is 32 deg�ees Fahrenheit o� less.
Cold weather patching shall be of temporary nature, using co1C mixed asphalt, well graded crushad rock or
simitar �pproved materials. i'emporary patches shall be true to line and c�rade, Temporairy patches shall
C;VERM173UlOW W�TilylRONf PFJIMITS.Jee
�� ' 12/15/2005 12:19 FAX 6512989113 ECI � 005/006
DEC-ZZ-�0�5 �9�45 CIT`� OF FRI�R LAKE MRINT p,pqiga
be �eplaced by permanent patches when weathcr conditions permit and noGfication shail be requi�ed as
sWled in 2.
5. Other areas may be required to bA campacted at the diteclion of the City Engineer.
s. Such permitlee to be re�pansible for rt�aiMenance and repai� of al) trer�ches 1or a period oi one (1) year and
iF settlemerrt ocaurs er excava'tton cav�s in, the sarn� shdll b� promptly indicat�ed by adequate warning
signs and shall be restored to p�oper candition in accardance with 6pecifications above provided as soon
as condilions permit.
7. All culverts and d'rtches shall be replaced in their �rlginal pasiUon and condition ex�sting p�ior to
�or►5truction�nd na change shau De made in drainage without appmval of lhe City Engineer.
8. Permitlee shall save ihe Cily harml�RS from all thircJ party claims for injury or damage which may occur
Detw�en the time the work Commences and the time it is finally accepted by thC City.
9, The permiltee may he requi�ed to jack or bo�e ur�der nerlain streets, as determined by the City Engineer.
10, 7he applicant shal{ furnish evldenGe ot public (iability Insurance of not less than $100,Od01300,�00 and
property damage of not less than $25,000 issued by an insurance company authori�d to do business in
the State of Minrtesota on which the City is n�med as an additiona) insured pariy.
11, Except fnc the negligent acts of the City, its age�nts and lts employees, the permitt2e shalt assume atl
liability tor, and save the City, its agents and its employAas, harmless and defdnd same at its s�le oost anc!
cxp�nse frorn any a�d all claims for damages, actions or causes of action arising out of tRe work to b�
done hcreln a�d the contlnuing uses by th� permittee, including but not limited to the placing, constructing,
and reconstructing, maintaining, protecting and use of said facility under this appticatiun and permit for
construction.
12. Exisiing Facilities - The utility facility and installaY►ons snaN not intarfere with any existing utility facility on
the City's right-of-way or easements. Ii i� the respansibility of the applicant to call for necessary locations
of exi�ting utili6es. (Go{�her One)
13. Private Property -� The work permit or pe,•mit for construction as issued do�� not in any way imply that the
approprlate easement exists to allow the applicant io work on private property.
14. Cutti�g Trees - 7he pormission herein granled �o6s n�t confer upan lhe permittes the right to cut, {emove
or destroy trees or sh�ubbery within the lega! limlts of the right-of-way. Easements that are nOt spe�cifically
identifred on the plan atlached to this permk or �elieve permittee from obtaining any con4ent otherwise
required irom the owner of the property adjacent thereto.
15. Clean-Up - Street, lrailway5 and affeqted rlght-ot-way shall be scraped clean at the end ot each wo�k d�y
and swept cle�an after constructan is completed� and left in a neat and presentable conditiort.
16. Replacemerrt ot Sad - Wherevo� top-soil and sod are disturbed they shall be replaced in kind and
maintained satisfactorily untfl the turt is establ'�shed.
. The under�igned hereby declares he/she has re�d and will comply with alt thc PER7INF►�T REGULA710NS as
stated abov� and refevarrt Ciry Ordinances.
OATE: ) ,II4I n��"" SIGNED: .
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TOTR� P.04