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HomeMy WebLinkAboutROW Permit 107797 71316 Permit 2 50 ,q Page 1 of 5 , Fee- '97) ne9/67:442/74-lirowcri4Approve/Manage Permit Permit: 107797 Type: Right-of-way Overview Map I Billing Report I Data Export I System Setup I Logout Registrant � y Logged In: Susan Zick Ad1-75-- Registered To: IN1/5: / v rte. l Company: DeRudder Excavating Contact: Jeffrey DeRudder c Phone: 952-447-8921 Fax: 952-447-4921 Email: jtderudder@integra.net q)1-- * g Contractor OA-}2_, )1— /roes- Company DeRudder Excavating Contact Name Jeffrey DeRudder Phone 952-447-8921 Fax 952 447 4921 E-mail jtderudder@integra.net Street Address 4910 Hickory Hills Trail City Prior Lake c ( `e ,t9 4 State MN Zip 55372 Application items Location 15389 Breezy Point Road 1 Project ID http://priorlake.mn.roway.net/municipal/permit_edit.php?pid=107797 7/13/2016 Permit Page 2 of 5 Start Date i End Date i June 2016 June 2016 Su Mo Tu We Th Fr Sa Su Mo Tu We Th Fr Sa 29 30 31 1 2 3 4 29 30 31` 1 2 3 4 5 6 7 8 9 10 11 5 6 7 8 9 1011 12 13 14 15 16 17 18 12 13 14 15 16 17 18 19 20 21 22 23 24 25 19 20 21 22 23 24 25 26 27 28 29 30 1 2 26 27 28 29 30 1 2 3 4 5 6 7 8 9 1 3 4 5 6 7 8 9 I 0. Contractor/Utility Project ID 1. Type of Excavation Trench 2. If other If you selected other please describe the type. 1\)Y/ t/3. Length n \� 4. Width ,, 5. Depth 6. Size 7. Material 8. Traffic Detouring Nececssary? http://priorlake.mn.roway.net/municipal/permit_edit.php?pid=107797 7/13/2016 Permit Page 3 of 5 WILL DETOURING OF TRAFFIC BE NECESSARY? (If so, indicate the detouring route) 9. Restoration quantity: Curb CURB AND GUTTER (LF) 10. Restoration quantity: Sidewalk TRAIL/ SIDEWALK (SF) 11. Restoration quantity: Signs # 12. Restoration quantity: Fence Fence (LF) 13. Restoration quantity: Street Street (SF) 14. Restoration quantity: Trees # 15. Restoration quantity: Boulevard BOULEVARD/ GREEN AREAS (SF) 16. Restoration quantity: Light Poles # 17. Restoration quantity: Other Any other restoration needed? http://priorlake.mn.roway.net/municipal/permit edit.php?pid=107797 7/13/2016 Permit Page 4 of 5 Municipal Items Municipal Approval Notes Permit Special Conditions Fee (Prepay) 0.00 Internal Invoice # .I.. 0. Current Insurance /�,.�ij i� Q �� e - SSP /"' � TACi"61�C� Documents and plans These are files associated with the permit. You can attach additional files for your reference. All files can be seen by both you and the registrant. Browse... Notice: The max file size is 10MB. Files larger than 10MB will not be uploaded. Map location How do I draw? • 1. Find the desired location with the search, pan, and zoom tools. 2. Zoom closely to the desired location. 3. Click the 'start drawing' button. 4. The first click establishes a marker. Subsequent clicks create a line. 5. When finished, click the stop drawing button. 6. To re-draw click the 'clear' button. Search for an address: Show Location Address Format:Address, City, State, Zip Start Date: End Date: http://priorlake.mn.roway.net/municipal/permit_edit.php?pid=107797 7/13/2016 Permit Page 5 of 5 June 2016 June 2016 Su Mo Tu We Th Fr Sa Su Mo Tu We Th Fr Sa 29 30 31 1 2 3 4 29 30 31 1 2 3 4 5 6 7 8 9 10 11 5 6 7 ' 8 9 10 11 12 13 14 1516 17 18 12 13 14 15 16 17 18 19 20 21 22 23 24 25 19 201-1 22 23 24 25 26 27 28 29 30 1 2 26 27 28 29 30 1 2 3 4 5 6 7 8 9 3 4 5 6 7 8 9 !. 1,''" :+ 'W"'''''''',''' "*s£ 1 VIII II icw,ma 1 w West St Paul O., Shorewood i Mayer Edina Richfield ti ,,,, CD Waconia Eden Prairie masa (s. I,�, Bloomington, '� �o 4 2iz 35E 52' rood Chaska Shakopee ,------„F6-91°-s�7...;'mg ica Cologne Carver i �.{ F �� =vage Burnsville t�, � �j Q10 Apple Valley Rosemount 9T ' 9. Coates r �� ssumption 282 d" 52 Jordan IV zsLakeville 15 9 Farmington Belle Plaine Blakeley Hampton St Benedict ®Elko New Market. 55 Go gie ED Union Hill New Prague Castle Rol map d9:AWOffr6siPeogde Draw New Location: Reset Start Drawing Choose Line Color: Red u Choose Icon: 1111 c42 ciP IP 1? I ''''.-..' 1P 0 0 0 0 0 0 0 0 Permit Application Disposition: Approve Approve Pending Reject http://priorlake.mn.roway.net/municipal/permit edit.php?pid=107797 7/13/2016 R 10.6 City of Prior Lake 4646 Dakota Street SE RECEIPT _ Prior Lake MN 55372 '' ;' i' '' ''' ; 952-447-9840 iii Received,..„ ,_,,,,ti))1„)... , „, 4..tstNib(il. Receipt: 6188 Of: Date: 07/13/16 DeRudder Excavating Customer: DeRudder Excavating 4910 Hickory Hill Trail Prior Lake MN 55372 Receipt Item Receipt Description GL Number Total Right of Way Permit 107797/15389 Breezy Pt Rd Zoning&Subdivision Fees 250.00 Right of Way Permit Registration 107797/15389 Breezy Pt Rd Right of Way Registration 25.00 Receipt Total 275.00 TENDERED: Checks 12085 275.00 Total:275.00 A ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/20/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Michelle Leonard NAME: Christensen Grou Insurance PHONE (952)653-1000 FAX (952)653-1100 P (A/C,No,Ext): IA/C,No): 11100 Bren Road West E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Minnetonka MN 55343 INSURER A:Acuity 14184 INSURED INSURER B: Jeff DeRudder dba DeRudder Excavating INSURERC: 4910 Hickory Hills Trl INSURERD: INSURER E: Prior Lake MN 55372 INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 Master Liability REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR' POLICY EFF POLICY EXPD/ LIMITS LTRINSD WVD POLICY NUMBER IMM/DYYYY) IMM/DD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000_- X45413 6/14/2016 6/14/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ Included GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO X POLICY JECT LOC PRODUCTS COMP/OP AGG $ 2,000,000 - OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED X45413 6/14/2016 6/14/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) Underinsured motorist $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ X45413 6/14/2016 6/14/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE_ ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A A (Mandatory in NH) X45413 6/14/2016 6/14/2017 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Prior Lake Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 4646 Dakota Street SE ACCORDANCE WITH THE POLICY PROVISIONS. Prior Lake, MN 55372-1714 AUTHORIZED REPRESENTATIVE Stacy Bury/MLL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) Susan Zick From: Nathan Briese Sent: Wednesday, July 13, 2016 3:43 PM To: jtderudder@integra.net Cc: Susan Zick Subject: RE: permit fee Come to city hall and pay Susan she will be here until 4:30 today. We are located in the lower level!! Original Message From:jtderudder@integra.net [mailto:jtderudder@integra.net] Sent: Wednesday,July 13, 2016 3:41 PM To: Nathan Briese Subject: permit fee Hi Nate You should have received our COI from our agent in an email. I am wondering who do I see to stop in and pay for the right of way permit today? I had not received notification that is was ready yet. Also how late are you open until? Thanks, Teresa DeRudder DeRudder Excavating 612-919-4130