HomeMy WebLinkAbout14620 Wilds Parkway ROW Permit VJ�1V/VG 1IlU 1J:J1 rHA OLGY4l4LOJ V11Y VN rK1UK �.AhL' � p02
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�INN E So�A P�RMIT
TO V'VORK R�T�IIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS
AND __
APPLICATION FOR INSTALLATION OF UTILITIES .
1. Location I�(eaC� � � I�S �f��lv 1 V UU
2. Nature 6f Work ���I�.l �q.i �Y� a�- �e.lephm�, Se r�; c�e ����. ��
3. Indicatc below items .to be affected and include a sketch or plan of work to be done.
Curb �t Gutter Street Sutface
Tra�7/Sidewallc Trees;
Pond/Wedands (Publically owned
� Traffic Control D�vices/Signs or Privately owned _)
Drainage Uti(ities
StruchueBnildings Other G���1 l� � �
4. Meihod of Installation or Construction D� �t � 1, � � 1_� c�a P �� „ f
. S. Work to start on or after: y I S � S' and shall be compkted by: �� unless an extension
� graated to: by:
DATE STAFF/DATE
6. Will detouring of traffic be necessaryl IV d if necessary to detour traffic, descrbe suggested
route;
7. Pmvide with ffiis appiieation a oopy of the contractors Public Liabiliry Insurance.
DETOURS: The Diroctor of Public Worlcs shall ba notified in writing at least 72 hours in adv�oe of
any detour being established, changed or discontinued.
NAME OF APPLICANT o� I US �le,�� M �q i C, a71�e r�S . PHONE ��y 9�"� "'3� g
PLEASE PRiNT FAX �l -4�2.��.�SC�
ADDRESS 3<.J� S�_ (..f����Y1o�10` N�t� �JI I 1 .
STRSET CITY STATE ZIP
NAME OF PA.RTY OR OR AN TION PBRFORMING WORK ��'i US I°LI�C'eM M���.Cl��' ���5
CONTAC'T PERSON: �+�, � EMERGEAiCY (24 HR.) PI�ONE # �z..9 iq - I 4 SI
ADDRESS DAY PHONE - � 9 �{- �7_ �7�_
STREET CITY STATE ZIP
The undersigned herewith acc�pts the terms and conditions of this permit by the City of Prior [.ake as herein
contamed and agree to fully comply therewith to the satisfaction of the City of Prior I.alce.
Signed: Title: �('�'�"'.� i �Date: �
naaerrc.eoc Page 1 of 4
16200 Eagle Creek Ave. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (612) 447-4230 / Fax {612) 447-4245
AN EQUAL OPPOR7UNI'(Y EMPLAYER
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EXHIBIT «C•
FOR CITY USE ONLY AU'IHORIZATiON OF PERMIT
FINANCIAL SECLJRITY: AMOUNT: TYPE: .
(Cash, bond, LOC etc.)
Fa: � S('•Qa Receipt No. 1'��►,C��7� Permit No. �'��'n�
LJABIl.ITY INSURANCE PROVIDED: �A�'b'l �� , _
In consideration of agreement to compiy ia all respeds with the regulations of the City of Pri� Lak� 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 descnbed in the above application, said work to be done in e�ccordance with special provismns as
hereby stated:
� APPROVED BY: DEPT. OF P'[JBLIC 'WORKS
B,,: � 3 /� o.s— .
� /DATE
ALL LEGAL REQUIREMENTS SHOWN ON PAGE ONE (1) AND ON ALL "SPECIAL PROVISIONS" SHALL
BE COMPLIED: WITH. 7Y� DA'TE WF�N WORK IS COMPLETED MUST Bfi REPORTED TO TI� CITY
OF PRiOR LAKE CITY ENGINEER
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�rcnoc Page 2 of 4
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EXHIBIT °°C"
CITY OF PWOR LAKE
REGULATIONS PERTATNING TO THE MSTALLATtON OR
REPAR� OF UNbERGROUND UTILTTIES IN CTCY STREETS
' OR IN CITY WGHT-0E-WAY/EASEMENTS �
The following regulations and canditions constitute a.part of the application made by any installer or contrador for
the installation of utilities in aay City street right-of-way or City utility easement and the applicant, in making }us
application to da such work, shall agree to abide by these regulations and conditions: •
1. 'Ihe individual obtaining the pemut shall, before commencirig such work, notify the City Engineer whe.n
the work at each location is to commence; and, wh� requesbed by the Engineer, shall submit plans and
spacifications. .
2• IlltQn comnletion of th nmj��, the individ»Ai ���z�j� natify�e City,�ginee�in� ror
� tion .
3• 'The public is to be protected by the individual, at all times, finm the commeacement of the work until ffie
completion and acceptance by the City. The instailer or conh�actor shall so conduct his opetations as to
! eeuse tbe minimwn in�nvenience to the public. The installer or contractor shall fiirnish, erect, and
maintain, ia accordance with the legally accepted standards, all necessary waming and traftic control sigas,
barricades, trafftc cones, and t�ashing lights to direet and control the movement of trat�c througL the
Pro.lect in ap directions and at all times.
The. foregoing provisions shall not in any way relieve the instailei or contractor of any of his legal
responsibilities or liabilides for the safety of the public. .
4. All openings in biwminous swrfaces shaIl be cut in a saaight line with sides smooth and v�l. No
ragged edges will be permitted Cbttmg shall be done wit6 a concrete saw, cuttin whee '.
spades or similar approved tools. B �, ,�ck hammer,
BackSll mateiial shall ba suitable for highway emb�ni�ent construction. No peat, frozea lnmps, brokm �
asphalt, sod, roots, or other undesia�able material shall be pennitted as backfili. Rocks larger than six inches �
(6") in diameter shall not be used in backfilling of h�enches.
The backfill material sLa11 be placod in iayers not W exceed one foot (1') a� mechanically compacted to
not less than 95 percent of modifted Proctor density,
The upper six inches (6") of the backfill sha11 me�t Minnesota Highway Departrnent Specifications for
Class S mataial and shall be compacted to not less than 95 percent qf modilied.Proctor density.
As soon as possible after backfill operations are completed, the cut bituminous edges of the treneh shall be
Painted witb an asphalt emulsion wch as SS-1. Immed'rately thereafter, the patching materiai shall be
placed and mecbanicaily compacted to n4t less then 95 percent of modified procta density. The asphaltie
material used in patching shali be of the same type as removed from We roadvvay, e�ccept, that in no c�se,
will a ptant mnced asphalt of less quality than b(innesota HighW,ay Deparnuent Specifications 2331 be
used. 'C'he fmished surface of the patch shall coaform to the surface of the uadistutbed roadway.
No permanmt asphalt patches shall be on any base whose temperature is 32 degrees Fatvenheit or less.
Cold weather patchiag shall be of temporary nature, nsing cold mixed asphalt, well graded entshed rock or
sitnilar approved materia(s. Temporary patches shall be true to line and grade. Temporary patchas shall be
replaced by perman�nt patches when weather conditions pe�mit and notifieation shati be required as stated
in 2.
su�rrcnoc Page 3 of 4 .
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EXHIBIT "C"
5• Other areas may be required to be compacted at the direction of the City Enginecr.
6. Such pecmittee to be responsible for maintenamce and repair of all trenches for a period of one (1) yeer and
if settlement occurs or excava6on caves in, the same shall be prompdy indic�ted by adequate �yaming $igns
and sha(1 be restored to pmper condition in.accordancc with specifieetions above provided as soon as
conditions petmit.
7. All culverts and ditches shall be replaced in their original position and condition existing prior W
conswction and no change shall be made in drainage without approval of the Ciry Engineer.
8: Permittee sfiall save the City harmless from a11 third party claims for injury or damage which may �'
bctween the time the work commences and the time it is finally accepted by the City.
9. The permitt�e may be reyuQed to jack or bore under c�tain stt�eets, as decermined by We City Engineer.
10. The applic�nt shall furnish evidence of public liability msurance of not less than a I00,000/300,000 ead
properiy demage of not less than $25,000 issu�d by an insurance company autharized to do business in the
State of Mimne.so� on which the City is named as an additional insured party,
1l. Bxcept for the negligent acts of the Ciry, its agents and its employees, the peimittee shall asse�me all
1i�►biliiy for, and save the City, its ag�ts and its employees, hamless and defend same at its sole �st ��d
expense from any and all claims far damages, actions a causes of action arising out of the work to be done
herein and the continuing uses by the permittee, iacluding bat not limited to the placing, constryctmg, and
reconstivcting, maintaining, protecting and use of said f�iliry under this application and pamit for
conshvc[ion.
� 12. Existiag Fac�ties - The utility facility and installations s1iall not interfere witii any existing utility facility
on the City's right-of-way or easements. It is the res�onsibility of the applicant to call for necessars+
locations of existing ntilities. (Gopher One)
13. Private Property - T7ie work permit or peimit for construction as issued dces not in any way imply that tha
appropriabe easement exists to allow the applicaut w work on private property.
14. Gtiamg Trees -?he pe,mission herein granted does not confer upon the permitte� the right W cut, t+emove
or destroy aees or shn,bbery within the legal limits of the right-of-way, easement� that are not specifically
identified on the plan attached to this permit or relieve ppmittee from obtaining any consent athawise
required from 8ie owner of the property adjacent thereto.
15. Clean_Up - Street, trailways and afiected right-of-way shall be scraped cieaa at the end of each work day .
and swept clean at�cr conshvction is completed �d left in a neat and presentable condition.
16. Replac�m�ztt of Sod - Wherever top-soil and sod are disturbed, they shall be nplaced 'm kind and
maintained satisfactorily ontil the turf is established.
The undersigned h�reby deciazes he/she has read and will compiy vrith al! th� pgRTIDIEN!' RE�ULATIONS as
stated above and r$levant Gtity Ordinances,
DATE: SIGNED:
. . �rc.°°c Pag� 4 of 4 _ ...
Fax #892 -sa� -5397 � $SW rd r Fox�m . Number ��I�OS Sa 2 -
/� � �n s���� ���
�� �J y � i� � ��`� f` pate ub d �
Wire Genter"_������`�"y 0� 5�'tY � �� �'l ��I D�"5 tL
9
Instaflatiort 8� Repair � � � h�
Orde 7 .�O CustomerNam�e /,�
TN `� �- -/ Address � 7 ��i S + �"WClty �- r O Y La P
1, Held !or BSW ❑ Phone .�s2 � �'jQ ot � CBR
2. Held - cannot locate ENCAP ❑
Subdivision Lot # B{ock
3, OOS - Can not fay temp ❑ County ✓��a Section Range
4_ Held for F1-F2, also need BSW ❑ Township
s. Tamp ptaoe�need sketcn S bmitted B / �/��j
expfainedbelow fJame � • �Y v�n ECil�Pager#!���-7'706�
6. Found temp • same job l� Supervisor �' +� V
oiher location (� Ornoe � � -3 � /� agei # a� 3 �
7. Add line ❑ Customer was contaded verbal � card ❑
�I1 �� ��.8 L-Info L J S o� (,�h��°u�►'�- ,� S � �
� Hudso ing Yro��g� � � _ � — —
o! Feet/Type
�(}Q � 3 r L,E F,R,S N,E,S,W 1-2-9�56-7 W,S,P,O,C G,A,IN,H 3-6 S,N P,N C
Ck When Contnlete
Proposed Route L7 Neighbor Addrowes ❑ Aproximate Proparty I..ine O Drivawnya dc Sidawalks d WiAth vro BW � SW (if in B3 W Yrth) O
Utilities (stneUigh<s, hyAr�mis. �f�) � Street names dt disl fm cntrline - ped O Distanoe from cwb to tecm or ped O Indicale North di►roclion ❑
Distanee frn tam to intuteeting toad ❑ BS W l�nBth (n rig,ht nf way 6c priv�te prop) O BS W d+stnn� fm carb to bury touta O
Pto-bury L7 Ordw Due Date:
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Road Push ❑ Permit Required 0 Hand Dig ❑ (Include cross strcet and caordindw)
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