HomeMy WebLinkAboutAdrian Cir, Red Oaks Rd, Lakeview Cir, Stefan Cir, Rutledge St ROW Permit • t
� PRIO
� O �
'g c � xs
� �" :t '�
4 �
�� �.
� � � � s,, � GG 77
s:. ` 1'`'
U'- �,:� ,
,
k.
�_�}��-
`�INivESO�P - PERMIT
TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS
AND
APPLICATION FOR INSTALLATION OF UTILITIES
1. Location � �' / �i/75 "�Pf �" �',��-J `' � � +
2. Nature of Work �� �� ( es t U�f �0� (�'J�!` ��
3. Indicate below items to be affected and include a sketch or pIan of work to be done.
Curb & Gutter Street Surface
� . , * TraiUSidewalk Trees: �.,� . .
c:` ., -• ""' ��� - •� Pond/Wetlands (Publicall�Qryned
� Traffic Control Devices/Signs , or Privately awned _)
Drain� � `�" ' �. .", ` � ,+ ' � Utiliries
. , , ti . -�—
StructureBuildings Other
4. Method of Installation or Construction 6' �
5. Work to start on or after 3 v2 � a`z�sha�li b bX: 3 � � � u nless. t �n e�Ct o �.
� �::.1�. ti � �y !� ;�'•�'.` i:��'i'�
granted to: by: ' ' '
DATE STAFF/DATE •
• . s - _ ""� . � . _. , . � `,_
�'' '6. - 1 detouri�p�f�Caf�ic'ben�oeSTar�? ]E�[� If necessary to detour traffic, describe suggested
route: '
7. Provide with this applicarion a copy of the contractor� Public Liability Insurance.
DETOURS: The Director of Public Works shall be notified in writin�,at least 72 hours in advance of
any detour be� established, changed or discontinued.
NAME OF APPLICANT �`(� PHONE JV� y I�O� I
PL PRINT FAX � ��
ADDRESS 1� 6 ,�dY 16�0 ���D l..iiaCi�, � Kt, �� �K S�GGI
STREET CITY STATE ZIP
NAME OF PARTY OR O GA1�tIZ �ION PERFOIt,MING WORK /� /' I l
CON'FACT PERSON: �, �'1Gj EMERG NCY 24 HR.) PHONE #: l Z�
ADDRESS �� X(5'10 2�L� � DAY PHONE �1 Y� �
�
STREET CITY STATE ZIP
The undersigned herewith accepts the terms and conditions of this permit by the City of Prior Lal:c as herein
contained and gree to fully c ly therewith to the satisfaction of the City of Prior Lake.
Signed: Title: �� � Date: �� 5�a y
�nsrrc:noc 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 OPPORTUNITY EMPLOYER
�
,
EXHIBIT "C"
TO
PRIOR LAKE PUBLIC WORKS DESIGN MANUAL
PERMIT TO WORK WITHIN CITY PROPERTY RIGHT-OF-WAY/EASEMENTS
� AND
APPLICATION FOR INSTALLATION OF UTILITIES
PAGE 2
A
FOR CITY USE ONLY AUTHORIZATION OF PERMIT
FINANCIAL SECURITY: AMOUNT: TYPE:
(Cash, Bond,
LOC, Etc.)
Fee: $ / V� Receipt No. Permit No. Ur �' � T'' I�
LIABIILITY INSURANCE PROVIDED: ////7�S1"� U,�Q , /Nc
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:
CDORD/Na4'T� W �T�f Ct7'S� �IQOJE���' ��—!(
APPROVED BY: DEPT. OF PUBLIC WORKS
._- B .�.:- '� �-5��y
/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 THE CITY OF PRIOR LAKE CITY ENGINEER.
, ti
GWdmin�FORMS�EXFIIBTf C APPLIC FOR INSTALL OF UTII.TTIES.doc
EXHIBIT "C"
TO
PRIOR LAKE PUBLIC WORKS DESIGN MANUAL
REGULATIONS PERTAINING TO THE INSTALLATION OR
REPAIR OF UNDERGROUND UTILITlES IN CITY STREETS
OR IN CITY RIGHT-0E-WAY/EASEMENTS
The following regulations and conditions constitute a part of the application made by any instalfer or contractor for
the installation of utilities in any City street right-of-way or City utility easement and the applicant, in making his
application to do such work, shall agree to abide by these regulations and �onditions:
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. Upon completion of the qroiect the individual shall promptiv notify the Citv Enqineerinq Department for �nal
insqection.
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 Ciry. 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, tra�c 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 shall 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 percenf 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
ptaced and mechanically compacted to not less than 95 percent of modified Proctor density. The asphaltic
material used in patching shall be of the same type as removed from the roadway, except, that in no case,
will a plant mixed asphalt of less quality than Minnesota Highway Department Speci#cations 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 shalf
G:4ldmin�FORMS�EXFIIBIT C APPLIC POR INSTALL OF UTILITIES.doc
•
be replaced by permanent patches when weather conditions permit and notification shalt be required as
stated in 2.
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 waming
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
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 $100,000/300,000 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 City 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 fr`om 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 facility under this application and permit for
construction.
12. Existing Facilities — The 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 appl'i.cant to �call for necessary locations
of existing utilities. (Gopher One)
13. Private Property — The 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 City Ordinances.
t
DATE: SIGNED:
G: Wdmin�FORMS�EXk�IT C APPLIC FOR INSTALL OF UTII.iTIES.doc
�
m :
�
z
�
�
�
i_� ���`��' � �
s •,;u�"' jC % �
�?,r :3�"��
�? ` �' + '.��� ��. % ;
'� � �--�
� ��^ '� ; �, i
;/
` � � ; � ' � -
i w ` //' // � /� % / / i / i
�
�.. � "P�'�� ��' � � +- % / i
�
'`�- `.-.,, �, i � , i � � i i� �
� �., �.,�� � �+' �% i�� i
y
�
� 7""'•�'� ; �� i �� i
� . �'�
—� � ` _�`''�.,, ��� / �� i ,
%
�' // } � �� � ; `.,. ,�. �/ ,
i� � �
i � � '��, �'
�
� �
_ � � . �,.
, �
/ ' " � �;�.
�� � � � * � •� �
� N � � .�
� � O Ul I � � �'� � " .
� , ,
,
o � -� O� n � + I '�. �
� ,� 'Q . �
� � I J i Fp�.�� ; ;
,
- - + i I + i y� � �
� � . �.
�. � ��S' . �,: , _ ,'
.��
+ � ••
i�� - � � � � '� � �
x
�
�� � � �1 C� �. ' °� ��
' ; --� tv � � � �,� .. � �* � �
_ _._ _ O U'i � " � *
.,
.
0o n � i i i + �� �. � ,
`�. ` ,�
�_ - -- - _i_ _-- - �, ,
3 -�
- , .�.
� , ��
— � � � � _ � `. �� ' �
O N . �, � �
� � �, � � � (P �� � � �� �� �" C �
� .E. � � 1i _ � � r C�' n ��, ,
v i j � t � � �n � �, �,� \ � i .
�
�
i .
� %
� � ` i � � m � � + . ,� ; % � � /
----
_i � '
- _ � +� ; � Er ;
� - •
� � �- , . �
-'�
� � � �� �
, _ 2 0•
, ,_
` .. .. . .. .' . -� _. ._...
� � "` � O U� � � �� � �'' `
� •
—I N -�`.j.� �r ��: � �._.. � �
� � � `,�� � � '
, �� j d �
- -F' � 'a �� —I ' + �
-- �', _ � � __ ,
� � I, � , � � n � + � ' `� �� �
i
I "' � - � , �
� � _ � ,- �
: . ��;.
_ - ! �'
� �� � � � � � � �` � + R �� ° q
+ � �`� ,
; ��
i � -' �� � � Rp
, , ,
.
;,.
;
� � � %
sF
�� � ' � �
-- — _ * �' ,
_ �� *
+ --� Iv �
�
� � �
' o tn �
,
W t�
+ -�� j �"
,
_._ ,
,-- ; I
,
,
� + ; ;
C� ' � ,
� , �-
i , �, �
, ;
' � I
��, � ' � / ' : , ,' � -
�, � * + * � �`� A '� -
� m ,��' � , �, ;
o � �
� * --- - j `,, ` ; _ _
u� ' � � � ' -� , + * i
�
� �
�
� � � �
O ' �
� �� � � ,
` � \ -� ---
cn - ___l ; �, , —
- � ' �, , _ �
m �� EFAN SE �� '� � � � � +
�� �i � � F
- _ _ _ 1 —.� �y
_-- ', y�'' �� o o� �� �, " + ---� �
+ ��� ° ' � � � � � d � � � �---i � �. ; s'. :
� � , �
� - �
,N + N
� �_ � ` ,
,
�
I I� (�', / 5
. . I '4' �/ � - .�yo \\ .t, . 9 ' 'I � `` r " . . . _. _
� ,
�
i'
I , �F i . -- - ' iU �� � �. ,- v �. � . P . -
�--- �� l ,�, �, � G�� \ j� d���
Y � �
--� -- --= n � � � A �. (' j �!� �� . �\ W � � � ������� �� � � �
� ' / I �� � , ` �� � `°�
� - -- --- � �
�� � I a , ,, , .�� �, � '�
� + � � x �, � � % �
+ 1__� ,; � �' � �t t • � �,,��'" ;: � �' ���" ,_
�
„
,
, � � � � �-�_ � �� ; �� �'� ` ^�� � �� ' ���\ ��� � �
� �� � - �
,
_- -- -- .�°�- j .__. i � ; � T- _, � + y' , \ \�
�
, ,
_� � ��, ��
,
,
.� t� - � ,
� � �� Ul
e
' C)1 O i `- �—_ --,- ` \ :\
� # � � �
••' (�J � � i / + j \ + � o�
• ; �
'� i
�•� e , / I �` +
. , - � , `. i A
N
,. ,
�� . . ,
� �;' � ` i M C " /� + I \ �' � 'N
" ""' w _ ,__ A G � •
, �
� I �S i �' � _. I .} �. + �'' - .. ; I '�'�
�
� � � —� � � � � •
� �p -� _ - �
N , I �' d� O .� o.• .
c U7 - ' � �`.' .�
c � .1' T - � '� ,_ �, �.
�� � m � a Y � � � -- -- - � � N � � � � �
� �.
�.
n �•
o � ,.
; �. ,.
.
� - --
m i �°" �
__ , �
� � � � ;
r° + � ;,:
--I •"
j ' - - ' ' ' ` t� r
_- i
i (n � C � — -- , . • _
� � � � .
; � + m �` i,,+ � + , r � �
� r � �V � � � ��� N i � %a �- � � _
/� Iy
��^ � � I ' � t J �� �� % ! .,
�I � �
,� I '1
I \ •
� �
•�' _. -- I . _ . ,` i . . : I .
_��_ k�_;_� .. .`� . _ � i : , ,,.,.
I ��R��D�. �� ._.__�._. -�u .'�S/xLt7WU- �.. r .. � �-�� ___ ._
—
I � � 1NOW3�71� O'21�EMON p ' -•--• -._.�
���� 1 � _ _ S sE � I � ,
m J • • � �J�J :�}
� ��€�g�� ._._._.� p.�.,�. f:.J.�.-�•" � O � �l
. - -�� �� �
I n �����m _ � '� � � —�� ,� _�
� � $ �o�, �-- - ,
� � , -- � —
,� -
i
� �� ���„'� �{ � ,�, �L � �,� � 4
—
i � ��- �- , a.I
, . , . ,.' j r
-,� � �� �� �' ¢ � o --
° ��g, I . "�� ' _ m - --- --
�
..n � �a-��i��x ..._ u : ' �'' - i " � ,
T. I —_ � 1 C . I � N
m I
C ' /^ __ —
_ � g s � v , �- — --- -
� V , `_. . — _. .._
ty � o
: t/J � i�. � - c � � � � I� ' ,•' a) �
1 � � � ��6� � � � � � ' *
� ' °����'o�.;.__� I I 'O.. __._ .. -- ---
� I �
I r D � <
�.��'�� - . .. � � F
� � y ..__ ---�---
I I "�."0�9�:�..� '�' �_ I "}' 1 / f
�.. ,�i��'�1�4� i I.-._.._ .i..._ .__.___ � + r
, ry � �_
� I � G�� .� I I ,�„ � ..—.�_ ___ .�V.__ U' � _., Z
r � .. _. _ �� � .
� � �� _ ; � ; rn� N+ �'a
i
6 � i ,� _ -- � N
�
_
_:.-- �
, - ___ ___
m
,
�