HomeMy WebLinkAbout2633 Cougar Path ROW Permit ., _ .,. . .. .,.. ..�.... � o o z
PRIO r -,.� '., „ ,
0� � �� �� ' � i 5 I �
�
� � � �' I �1AY :a .° ?0�5 �
_� «�
v �
By
�r o ��' PERMIT � � ! �L �
�'NES � �
TO WORK W�THIN CITY PROPERTY/RiGHT-OF-WAY/EASEMENTS
.AND - :
APPLICATION FOR INSTALLATION OF UTILITIES .
1. Location � .,E� � �i 0 1, � l4 �"` ���� /`� w _ _
`/ V
2. Nature of Work - � l�� Y � �i4�iC ,SCd(.1�6L6 �% 6L E . �
3. Indicatc below items .to be affected and include a sketch or plan of work to be done.
Cutb & Gutter Stteet Surface
TrafUSidewallc 1}
PondlWetlands (Publically owned
� Traffic Control Devices/Signs or Privately owned _�
Drainage � Utilities
Strucdue/Bnildings Other � O l.J
4. Method of Installarion or Conswction L Ow lra���d�4 vp0��?�!C
. 5. Work to start on or atiDer � � � and shall be completed by: � 30 os� unless an ex�ension
� granted to: b
DATE STAFF/DATE
6. Will detourittg of traffic be necessaryt /" � if necessary to detour traffic, descrbe suggested
mute:
7. Provide with this appGeariou a oopy of the contracton Public Liabiliry insurance.
DETOURS: The Dira:tor of Public Works s6all be no6fied 'm writing at least 72 hours in advance of
any detour being astablished, changed or discorninued.
NANiE OF APPLICANT Q��S' �SG, JiVOd1�4S ��4��✓E S PHONE 6/L " J� 7 7 /
. PLEASE PRINT FAX �G` L• 77' 2. �/B
ADDRESS � S17� G✓i4-Z i4 f�4 /��Y �i��i�E61� �1S �� �yD�
STREET CITY STATE �p
NAME OF PARTY OR ORGANIZATION PBRFORMII�(G WORK �l !7S G Of !�
CONTACT PERSON: ��' �A/J SE� w1 FK EMERGENCY 4 HR. ) PHONE #: S— y- /
ADDRESS.��'��t Sfd�e��if �{ f c�,'.�A►� /�1�J .S",$"!/ � DAY PHONE h S/ - y 9y - 3 / B
STREET CITY STATE ZIP
The undersigned herewith accepts the tertns and conditions of this permit by the City of Prior Lake as herein
coatamed and agree to fully comply therewith to the satisfaction of the City of Prior l,ake.
Signed• ,��'1�ysis�^��sWLr•rw' Titlo: �����i�/�E�E6� Date- �v� f� p.OS
s�aaeirc.noc Page I of 4 .
16200 Eagle Creek Ave. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (612) 447-4230 / Fax (612) 447-4245
nw Eczupa. oaPORrur+r[ir En�.ov�t
s` . ._; '
' EXHIBIT "C"
FOR CITY USE ONLY AUTHbRIZATiON OF PERMIT
FINANCIAL SECURlTY: AMOUNT: TYPE: .
(Cash, bond, LOC e,tc.)
Fee: S �5f� Aa Rxeipt No. 2Z 7 SyO Pecmit No. -C,S "�
LU1B1L1TY 1NSURANCE PROVIDED:
Ia consideaation of agreement to comply ia all respects with the rogulations of the City of Prior 1.ake covering such
operations, aad puisuant to authorizadon duly given by said G�ty of Prior Lake; permissioa is haeby 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 P'IJBLIC'I�VORKS
sy: �— S'?-�3 .
� /DATE
ALL LfiGAL REQUIREMENTS SHOWN ON PAGE ONE (1) AND ON ALL "SPECIAL PROVISIONS" SHALL
BE COMPLIID WITH. THE DAT'E WHEN WORK IS COMPLETED MUST BE REPORTED TO THE C1TY
OF PRIOR LAKfi CITY ENGINEER
. . .. ..... ... .. .
�rc.noc Pegc 2 of 4
t .
__ __ "__ __'__ ""_' ___"' "___ ___' ..' " . .... ........ _Ij/�uuq
,� i ' : � ' . . . �
• . . GAi11D� ���
CTTY OF PRIOR LAKE
�- REGULATIONS PERTAINING TO 'I��E MSTALLATtON OR
REPAIR OF UNDBRGROUND UTII.ITIES IN CTfY STREETS
' OR IN CTfY RIGHT-0E-WAY/EASEIVIENTS
The following regulations and conditions constitute a�art of the applicaiion made by any installer or coatractor for
the installabion of utilities in any City strat right-of-way or City utility easement and the applicant, in making his
applicadon to da such work, shall agree to abide by these regulations and conditions: '
1. The individnal oMaining the permit shall, befora commencing such work, notlfy the City F.�gineer when
the work at each location is to commence; and, when requesbed by the Engineer, shall submit plans and
spacifications. •
2. �non c�mnletion of the nroiect the individLal chall prQ�t(y no i hP C�jy����pa�ent for
final ins ction..
3. The public is to be protected by the mdividual, at all times, from the commencem�t of the work until the
completion and acceptance by the City. .The v�staller or contractor shall so eondnct his operations as W
eeuse the minuntun in�nvenieace to ihe public. The installer or contractor shall fucnish, erect, and
maintain, in accordance with the legally acceptod standards, all necessary waraing and ttaffic cantrol sigas,
bamcades, tiaffic cones, and flashing lights to direct and conhol the movement of traffic through the
project in all directions and at all times.
TLe. foregoing provisions shalI not in any way relieve the installer ar cont�actor . of any of his legal
responsibilities or Gabiliries for the safety of the pvblic. .
4. All openings in bituminous surfaces shatl be cut in a straight line with sides smooth and vectical. No
ragged odges wiD be permitted. Ci�tting shall be done witb a concret� saw, cutting wheel, jack hammer, ' .
apad�es or similar �proved tools.
Back511 mat�eiial shall be suitable for highway embanlmie�t construction. No peat, froun lnmps, broken
esphalt, sod, roots, or other widesirable maberial shall be permitted as backfill. Rocks larger than six inches
(6'� in diameter shall not be used in backSiling of treaches.
The back5ll material shall be placed in lay�ers not to excead one foot (1') and mechanically compacted w
not less than 95 percent of modified Pmcto� density.
Th� upper six mches (6"j of the bad�ll shall mett Minnesota Highway Departiment Specifications for
Class 5 material and shall be compacted to not less t6an 95 percent qf modified.ProcCnr density.
As soon as possible after backfill operations are e�pl�ed, the cut bituminous edges of the trench shall be
pai�ted with an ssphalt emulsiom wch as SS-1. Immediately thereafter, the patching material shall be .
placed and mec6anically eompacted to not less then 95 percent of modified Proctor density. The asphaltie
material used 'a► patc6mg ehali be of the aame type as raaoved from the roadvvay, pccopt, that iu no case,
will a plant mn�ed asphalt of less quality than Minnacota Highway Deparmnent Specific�tions 233I be
usod. 'I7�e fmished surface of the patch shall conform to the surface of tho undisturbed roadway.
No permanmt asphalt patches shall be on aay base �yhose temperature is 32 degrees Fahrenheit or less.
Cold wenther patching shall be of temporary nature, using cold mixed asphalt, well graded en�shed rocic or
. similar approved materials. TemporarY Pa�ches ahall be aue to line and grade. TemP��Y Patches shall be
replaced by permanent patches when weather conditioos permit and notification shail � required as sta�d
iu 2.
��� Page 3 of 4 :
____ __ _______ _ _____ ��__ _
._. :`
-
EXHIBIT uC"
:_ 5. Other areas may be required to be compacted at the direction of the City Engineer.
6. Suc6 permittee to be respoasible for maiatenance and repaQ of all trenches f�r a period of one ( I) year and
ifsettlement occurs or excavation caves in, We same shall be promptly indic�ted by adequate waming sigos .
and shall be restored to proper conditioa in.accordance with specifications above provided as soon as
conditions permit.
7. All culverts and ditches shall be replaced in their original positiun and condition existing prior to
conswction and no change shaU �be made in drainage without approval of t6e Ciry Engineer.
8: Permittee shall save the City harmless from alI t6ird party claims for injury or damage whieh may occ�a '
betvveen the time the work comroences and the time it is finally accepted by the City.
9. The permittee may be requaed to jack or bore under certain streets, as determined by the City Engineer.
l0. The applicant shall fumish evidence of public liability msurance of not less than 5100,Q00/300,000 and
property demage of not less than 525,000 issued by an insurance company aothorized to do business in the
State of Minaesota on which the City is named as an additional ins�red pariy.
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 hs employees, harmless and defend same at its sole cost and
expense from any and all claims for demages, actiams or causes of action arising out of the work to be done
herein and the continuing uses by We permittee; including bat not limited to the placing, conshvcting. and
reconstivcting, maintaining, protecting and use of said faciliry under this application and permit for . �
consWction.
12. F,xisting Facilities - The utility facility and insWlations shall not interfere with any existing utility facility
on the City's right-of-way or easemems. It is the responsibility of the applieant to ca11 far necessary
locations of existing ntilities. (Gopher One)
13. Private Property -17ie work peimit or permit for consa ucfion as issued does not in any way ianply that the
appropriate easement exists to allow the applicaut w work on private proparty,
14. C�tting Trees - The permission herein granted does not confer upon the permitbea the right to cut, remove
or destroy ttees or shrubbay vrithin t6e legal limits of the right-of-way, easements that are not speciScally
identifiod on the plan attached W this pemut or relieve permittee from obtaining any conse.nt otherwisa
raquired from �e owner of the property adjacent thereto. . �
15. C1ean�Up - Street, trailways and a�d right-of-way sl�ail be s�raped clea� at the end of each work day .
and swept ciean aR�r conshvction is completed and leR in a neat and presentable condition.
16. R�eplscement of Sod - Wherever tap-soil and sod are disturbed, tLey shall be replaced in kind and
maintained satisfacWrily antil the tnrf is established.
'Ihe undersigned h�reby declares hdshe has read a�d will comply with all the PBRTINEIVT REDULATIONS as
slated above and relevant City Ordinanees.
�
DATS: :-� � G� � C�C�.Sr SIt#NED: � .�,i�� ,
/
� Paga 4 of4 - -. . .
� , •
QWEST
• PERMIT REGIUEST FOR C�w e st Communi c Qt i�� n�
_._ �. _ ____ � �..� ___
, P E RN1I'T .�_K£ I C, W
� __.. . _
. _
� r � �-ti:.r��-� � d __ � ��v�� �. �-�.� ,� �.
_� __�. � �_ . . ,. � _ _ �_ � _
.. . ...
; ;� � � ° �_�
; , �
--��:: 2� 33 .C. r ��h_►�?�! ;
. W__��;.�� �� ,
.� �._
_ _. ___ ...,_._...:.__,..__� _..__q .� ;
--�---�� �
�
' ' ...._ �-! __ 15.'. �.����.Z'z�e e n�n�i..� �Cc�.?�..��.t����
,� . _. � . � � � �_ . � ��ovtie.�f' c, �#'
_ __. _ �_. _ _
'o , : ;
� _�� ��,_ _ ` _ �
��� € -
�� E � (
� ~��� E t
z �
� ?
.e .......... ..............,..,.......,...,,.�.....,.q............... .......� ..�_...._. '�, ..� ..i. � "i
�m�
F F
._ .,....., ..> u._ � ..__. =.W. ........ �.�..� ...... .4 ....w.._ . - . { ._ .... �..... _. _.
� .. � ' . . . .�--�-_ !
E � � � f
� _ .��� �e�__..��_
_._.._ .�.. dr � v � . 0 . _. _.�.. �.�... �
��,;�. ��r_�Tr I.�;�1v�1 _ .._. _ ... _ ..._ � R .._�._� .. _. .__ ___.�._..._a__ �v R.��� d � o•�'h ��....___d _ �
� �
. _ �.�.e�s�_ �r� ,�!._i�,
� � :
.__..
_ ..� .... � _ _ � 3 �_ ,--�--�--=-G�° � c
: o ��_
. � � . �- ;
_ _... _
__� ;� _�._._._ _._._; �._.�: __._� . G�._.._ _ ..,_..�� __�__. _. _. � ..� . _T_ .�. ______�_.� �.2._Q ` �iN_._.��� `
; c- �' ; ;
___ __ . _ _ _ . __ p �_. r _� _ _ _ __ _ _ _
t. _ __ : _ __ _._ _ �
_ ___;
�W vw F
_ . _ �. � �.� �,_ �,�. .�._ „_ �. _
-�
� _____,_ �___ � ._m _ __ _. � �_ � _____ _
�_ . _;__ _.�
�
__��_ _..�. � �_ _� � �... _ _ '
;__.. � �_ _4...
�. _�
�-_ � ----_. ___ _�
_ . ��.� �
_ � _, �... �_�` L .,..�.,_. � . �
_ ..�_.. �_ � -_ __� � � _ _ _ _ __
D���
�w._____-� _..�.. �..._.�.__ _.�..��_- ,
_. _ .._ _. � ,
E
_ .. �___ � _, .. ._.._� _ _. _. �A
_ _ _ _ �_ . . _ _;_. � _
, '� ��tert Ord�t �Q!��2�1�~l0
� �
�
KEY:
T-BUR Existtng Cable Application to Place Telephone Plant On:
T-BUR � Proposed Cable CITY �COUNTY _ STATE HWY _ ROW
Counry
� Existing Ped TWP RNG SEC
Municipality t'1" 1 OY' �... 0.4�
� New Ped N Telco Exchange �� �' `t �5
Qwest Job Number ���,�1 �� 3� 1 Print � of �
NOTE: Telco Engineer �1��M Q� /1�1 q,11'�QS
All Utilities will be Located and All Surtaces Telco Engineer Phone 6 ��-3�� 7..41 �
will be restored to Original or Better Condition Date ,�j,���OS
TO SCALE: I� O
Confidential: Disclose and Distribute Only to Employees with a Need to Know