HomeMy WebLinkAbout3016 - 3000 Bobcat Trl ROW Permit vJ�loivG 1nU la:Jl I'AA O1Z44l4LOS V11Y Vr Y'K1VK LAnC .�.,_.,,. UUL
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�jNNES��� PERMIT ��,,e��fC /jJiG10S0/D7l
TO WO�tK W�THIN CITY PROPERTY/R�GHT-OF-WAYlEASEMENTS
�AND
APPLICATION FOR INSTALLATION OF UTILITIES •
1. Location ��! � -� .3�D0 �ciG C�'� ��0.► �
2. Nature af Work Pl 0-�� � PP��' But�E.c� �-�.��tp�llo�1� �.�,(d lC21�.� l lf'2 �
3. Indicatc below items .to be affected and include a sketch or plan of work to be done.
Cutb 8c Gutter Strcet Surface
'IYaiUSidewalk Trees:
Pond/Wetlands (Publically owned
; Traffic Control Devices/Signs or Privately owned _)
� Drainage Utiiities
Structure/Baildings Other
4. Method of Installation or Conswction �� d w� P� M ll-o► o A �lC�
. 5. Work to start on or atber: �r��I4S and shall be compkted by: `� � unless e�► euo�siam
g�anted to: bY
DATE STAFF/DATE .
6. Will detouring of iraffic be necessary? � b If necessary to detour traffic, descr'be suggested
route:
7. Provide with this applic.ation a oopy of the con� actors Publie Liabiliry Insurance.
DETOURS: The Dinctor of Public Worlcs shall be notifi� m writi�g at least �2 hours im advance of
ainy ddour being established, changed or discon�tinued.
NA1vME OF APPLICANT �ur.e.S� �mM�n�CO (n C - PHONE �1 �"� _ � i $ .
PLEASE PRINT F�
ADDRESS .� db w t�� ZO.�A ��� a�nn 2.� D�1 I n(I �O�Qe � lf m(J 5S� � s .
� STREET CITY STATE �
NAME OF PARTY OR ORGANIZATION PBRFORMIlJG WORK D � I U S!�e.L � C.0 M wt u r 1 �(�l �1l �
CONTACT PBRSON: " ��o ��RSENCY C24 DAY PHONE #. G S I-�f 9 3 4l
ADDRESS S
ST CITY STATE ZIP
The undersigned herewit6 accepts d�e terms and conditions of this permit by the City of Prior Lake as herein
contained and agree to fully com ly therewith to the satisfaction of die City of Prior T.ake.
Signed• � ��,e- �� r 3� P�ern�� �Date' �•3[� ��� �
raanenc.uoc Page 1 of 4 _
16200 Eagle Creek AJe. S.E_, Prior Lake, Minnesota 55372-1714 / Ph. (612) 447-4230 / Fax {612) 497-4245
AN EQUAL OPPOR'NNI'IY EMPIAYER
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. EXHIBIT "C"
FOR CITY USE ONLY AUTHORIZATiON OF PERMTf
FINANCIAL SECLJRIIY: AMOUIVT: TYPE:
(Cash, bond, LOC etc.)
�ee; ��d' � Rxei� No. Z Z 756� Permit Na '"ds'S�
I.IABII.ITY 1NSURANCE PROVIDED: �� �1IS'l VJ� - -
In consideration of agr�ement to comply ia all respects with tLe regulatio�s of the City of Pri� Lake covering such
operations, and pursuant to authorization duly given by said City of Prior Lake; permission is bereby granted for the
work to be done as descnbed in the above application, said work to be don� in a«:ordance with special provisions as
hereby stated:
� . APPROVED BY: DEPT. OF P'UBLIC'WORKS
By: //%� r, �
/DATE
ALL LEGAL REQUIREMEN'i'S SHOWN ON PA(iE ONE (1) AND ON ALL "SPECIAL PROVISIONS" SHALL
BE COMPLiED: WITH. TF� DATE WHEN WORK IS COMPLETED MUST BE REPORTED TO THE? C1TY
OF PRIOR LAKE CITY ENGINEER
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�,�cnoc Pa�e 2 of 4
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EXHIBIT "C"
CTCY OF PWOR LAKE
REGULATIONS PERTAINING TO THE MSTALLATION OR
ItEPAIlt OF UND�RGROUND UTII.TI'IES IN CITY STREETS
� OR IN CTTY RI(3HT-0E-WAY/EASEIvIENTS
The fiollowing regulations and conditions constitute a�art of the apptication made by any installer or contractor for
the installation of utilities in any City smet right-of-way or City utility easement and the applicant, in making his
applicaaon to do suat► work, shall agree to abide by these regnlations and conditioas: '
1. 'Ihe individual obtaining the pem2it shall, beforo commencing such worlc, notify the City Engineea wh�
the work at each location is to commence; and, when requested by the Engineer, shall submit plans and
spacifications. �
2. Unon cqmnletion of the �,,,rQject the individu�l shall ,p��jv noti Yhe Ci EnEineerin� D�psrtment or
fina� j�y�ection..
3. The public is to be protected by the mdividual, at all times, firom the commencement of the work unril the
completion and acceptance by the City. The installer or conhactor shall so conduct his c�perations as to
eeuse the minimum incflnva�ience to ihe public. The instRller or contractor s6all furnish, erect, and
maintaiu, in accordauce with the legally acceptad standards, all necessary waming e�d traffic control sigas,
barricades, traff'ic cones, and flashing lighis to direct aud control the movement of traffic through the
project in all directions and at all t�es.
The. foregoing provisions shalI n� in any way relieve the installer or cvntractoi . of any of his legal
' respaa�sibilities or liabilities for the safety of the public. � .
4. All openings in bituminous surfaces �all be cut in a straight line wit� sides smooth and vertical. No .
ragged edges be permitted. C�tting shall be done with a conc�+ete saw, cutting wheel, jack hammer,
spades or similar approved tools.
Backfill mateiial shall ba suitable for highway embanlanex�t cons�hvction. No peat, frozea fimps, broken �
esphalt, sod, roots, or other tu�esuabte material shall be permitted as backfill. Rocks larger than six indies
(6'� io diameter shall not be used in backfiil�g of trenches.
'Ibe back5ll ma�erial shall be placed in lay�eis not to exceed one foot (1') and mechanically c�pacud to
not less than 45 pe�+cent of modified Pmcco� density.
The upper six mches (6") of the �'ill shall med Minnesota Highway Deparm�ent Specifications. for
Ciass 5 materia! and shall be compacbed to not less than 95 percent qf modified.Proct�r density.
As soon as possible after backfill operations are compl�ed, the cut bituminous edges of the trench shall be
painted with an asphalt emulsion such as SS-1. Immediately thereafter, the patching material shall be .
placed and mechanically compaded to not less tban 95 perceat of modified Proctor density. The asphaltic
mataial used 'm patching �ali be of the same type as removed from the roadvray, except, that in no case,
will a plant mued asphalt of less qaality than Minnesota H'ighway Departrnent Specifications 2331 be
used. 'Cha fmished surface of the patch shall conform to the surface of the uadisturbed roadway.
No permanent asphalt patches shall be on any base whose temperature is 32 degrees Fahnnheit or kss.
Cold weather patching shall be of temporary nature, using cold mixed asphalt, well gra�d crushed rock or
. similar approved materials. Temporary paUches shail be true to line and grade. Te�nporary Patches shall be
replaced by permanent patches when weath� c�nditia�s permit and notification shall be required as sta2ed
iu 2.
s�ircnoc Pag� 3 of 4
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EXHII�IT "C"
5. Od�er areas may be required to be compacted at the direction of the City Enginecr.
6. Such permitta to bc responsible for maiabenance and repair of all trenches for a period of one (I) year and
if settlement occurs or excava6on caves in, t6e same shall be promptly indic�ted by adequate waming sigus .
end shatl be restored to proper coudition in.accordance witi� specificatioAS above provided as soon as
conditions permit.
7. All culverrs and ditches shall be replaced in their original position and condition existing prior to
construction and no change shall be made in dramege without approvat of tha Ciry Engineer.
8: Permittee shall save the Ciiy harmless from all third party claims for injury or damage which may occ� '
behveen the time the work commences and tlie time it is finally accepted by the City.
9. The pern�ittee may be roqu6�d to jack or bore under ceatain sh�eet4, as determined by We City Bngineer.
] 0. The applicant shall furnish evidence of public liability msurance of not less than S 100,000/300,000 and
property demage of not less than S25,000 issued by an insurance company suthorized to do business in the
� State of Minnesota on which the City is narned as an additional insvred pariy,
11. Except for the negligent acts of the City, its agents and its employees, the permittee shall assnme all
liability for, and save the City, �ts agents and its employces, harmless and defend same at its sole cost and
expense from any and all claims fur damages, actions � causes of adion arising out of the work to be done
herein and the continning uses by the permittee; including bat not limited to the placing, constructing, and
� reconsuucting, maintaining, protecting and use of said facility under this appiication and permit for _ -
consnucrion.
12. Existing F�ilities - The utility facility and insta�ations shall not imtrfere widi any existaig utiiity facility
on the City's right-of-way or easemems. It is the responsibility of ti�e applicant to catl far necessary
locatioas of existing ntilities. (Gopher One)
13. Private Property - The wark permit � permit far constntction as isaued does not ia any way imply that the
appropriabe easemtnt exists to allow the applicant w work on private property.
14. (�tting Trees - The permissian herein granted does not confer upon the pemiittee the right to cut, reanove
or destroy trees or shrubbecy witi�in the kgal limits of the right-of-way, easan�is that are not specifically
identified on the pIan attached to this permit or zrelieve pamittca from obtaining any conse,nt otherwise
raquired from the owner of the property adjacent therero. . �
15. C�Up - Sh�eet, treilways and affected right-of-way shall be scrapod cle� at the end of each work day .'
�d swept clean after consUruction is completed �d left in a neat and presenteble c�ndition.
16. Replacernent of Sod - Wherovar top-soil and sod are disau�bed, they shaq be replaoed in kind aad
maintained satisfactvrily anh'1 the turf is established.
'Ibe nndersigned hereby declares hdshe has read � wiil �mply with all the PBRTII1ENf REaULATTONS as
stated above and relevant City Qrdinanc�s.
DATE� �/. SIGNED:
�rc.00c Pagt 4 of 4 _ �.. .
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QWEST
PERMIT REGIUEST FOR OW2St �Ornmun�IC0.tior�S LnC.
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KEY:
T-BUR Existing Cable Application to Place Telephone Plant On:
T-BUR � Proposed Cable CITY �COUNTY _ STATE HWY _ ROW
County �C Ot�
� Existing Ped TWp RNG SEC
Municipality �Pc�ior Lcj.t�e
� New Ped N Telco Exchange � Z �"�' �"�,��j
Qwest Job Numberl`lM � 5 0� ��� Print � of �
NOTE: Telco Engineer M C�� .9,@ ��� {�
All Utilities will be Located and All Surfaces Telco Engineer Phone � t a. "�3 O� � Z
will be restored to Original or Better Condition �ate �� � l� �
TO SCALE: N O
Confidential: Disclose and Distribute Only to Employees with a Need to Know