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�� � WORK ORDER 4� ��GT�J
� ,NN E S O , t Q• PERNIIT .
TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS
AND
APPLICATION FOR INSTALLATION OF UTILITIES •
1. Location �7 � �'OUG�/�. /�,r��ff
2. Nature of Work /�/�J� /�/ �� �� ��� �`� C • .
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 (Publically owned
; Traffic Control Devices/Signs or Privately owned _�
' Drainage Utilities
StructureBuildings ther ��/�U�L . G�S S
4. Method of Installation or Construction �Q�l ��
5. Work to start on or after:�� �U and shall be completed by: �a ' �o � unless an � extension
� � granted to: bY�
DATE STAFF/DATE . .
6. Will detouring of traffic be necessary? N� If necessary to detour traffic, describe suggested
route:
7. Provide with this application a copy of the contractors Public Liability Insurance.
DETOURS: The Director of Public Works shall be notified in writin� at least 72 hours in advance of
any detow being established, changed or discontinued.
NAMEOFAPPLICANT CenterPoint Energy, Minnegasco PHO� 612-321
PLEASE PRINT FAX 612-321-5480
ADDRESS �00 Linden Avenue West, P.O. Box 1165, Minneapolis, MN 55440-1165
STREET CITY STATE Zll'
NAME OF PARTY OR ORGANIZATION PERFORMING WORK Michels Corp .
CONTACT PERSON: Dale Anderson EMERGENCY (24 HR.) PHONE #: 612-372-5050
ADDRESS DAY PHONE 612-369-4504
STREET CITY STATE ZIP
The undersigned herewith accepts the terms and conditions of this permit by the City of Prior Lake as herein
contained an ree to fully c ply therewith to the satisfaction of the City of Prior Lake.
Signed. Title: Eng . As s is t. Date: ��' ��
��,� 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 OPPORTUNI7Y EMPLOYER
. � ' ' . ` .. . �
• � . �
, a
EXHIBIT KC" �
FOR CITY USE ONLY AUTHORIZATION OF PERNIIT
FINANCIAL SECURITY: AMOUNT; TYpE: -
(Cash, bond, LOC etc.)
n0
Fee: � 2 '�J �. Receipt No. b�o 27 3 Permit No. _ V P" ��- "Z /
LIABILITYINSURANCEPROVIDED: -��'ee�-wr�d z'� ..r,-;„ r � �„�„�_- � T: ,, �
/�' l2t SK SERv � CE S
In consideration of agreement to comply in all respects with the regulations of the City of Prior Lake 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 described in the above application, said work to be done in accordance with special provisions as
hereby stated:
f�2M /T 1�oES N� i��?Ha2l2E Luo4K p��EcTiNC� Cu,QB 3 6u �rT+E2
,�ND�a,� l.•�b¢�2 C�v,�2,S�' APPROVED BY: DEPT. OF PUBLIC WORKS
s-r�E� r Sv�¢.FivC E By: � �-.-- �% �- � 3- o�f .
/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 TI� CITY
OF PRIOR LAKE CITY ENGINEER
��� Page 2 of 4
.. . � . ' - ,
EXHIBIT "C"
CITY OF PRIOR LAKE
REGULATIONS PERTAINING TO THE INSTALLATION 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 made by any installer or contractor for
the installation of utilities in any City street right-of-way or City utiliry easement and the applicant, in making his
application to do such work, shall agree to abide by these 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. Unon co �letion of the proj��t, the individLal shall rn omn�l_v notifv the Ci Engin ring Deoartment for
final ingpection.
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 City. 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, �affic 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 shalt 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 material 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 meet Minnesota Highway Department Specifications for
Class 5 material and shall be compacted to not less than 95 percent of modified Proctor density.
As soon as possible after backfill operations are completed, 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 compacted to not less than 95 percent of modified Proctor density. The asphalric
material used in gatching shall be of the same type as removed from the roadway, except, that in no case,
will a plant mixed asphalt of less qua�ity than Minnesota Highway Department Specifications 2331 be
used. The finished surface of the patch shall conform to the surface of the undisturbed roadway.
No permanent asphalt patches shall be on any base whose temperature is 32 degrees Fahrenheit or less.
Cold weather patching shall be of temporary nature, using cold mixed asphalt, well graded crushed rock or
similar approved materials. Temporary patches shall be true to line and grade. Temporary patches shall be
replaced by permanent patches when weather conditions permit and notification shall be required as stated
in 2.
�rrc.noc Page 3 of 4
.. , �,
EXHIBIT "C"
5. Other areas may be required to be compacted 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 of the City Engineer.
8. Permittee shall save the City harmless from all third party claims for injury or damage which may occur T
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 fumish evidence of public liability insurance of not less than $ 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 Ciry 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 claims 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 faciliry under this application and permit for
construction.
12. Existing Facilities -17�e utility facility and installations shall not interfere with 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 - T'he work permit or permit for construction as issued does not in any way imply that the
appropriate easement exists to allow the applicant to work on private property.
14. Cutting Trees - The permission herein granted does not confer upon the permittee the right to cut, remove
or destroy trees or shrubbery within the legal limits of the right-of-way, easements that are not specifically
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 presentable condition.
16. Replacement of Sod - Wherever top-soil and sod are disturbed, they shall, be replaced in kind and
maintained satisfactorily until the turf is established.
The undersigned hereby declares he/she has read and will comply with all the PERTINENT REGULATIONS as
stated above and relevant Ciry Ordinances.
DATE: SIGNED:
e�a�RC.°°� Page 4 of 4
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