Loading...
HomeMy WebLinkAboutRight of Way Permit 118266 Permit Page 1 of 4 View Permit i+ wa ti Permit: 118266 Right-of-way Permitting System Type: Right-of-way Overview Map I Billing Report I Data Export I System Setup I Logout Registrant Logged In: Nate Briese Registered To: Company: metro general services Contact: maureen clarkson Phone: 763-428-2938 Email: metrogeneralservices@gmail.com METRO Email: metrogeneralservices@gmail.com mos Contractor SERVICES INC. Company metro general services UTILITY & EXCAVATING CONTRACTOR Contact Name maureen clarkson GENERAL EXCAVATING & SPECIALIZED SERVICES Phone 763-428-2938 COMMERCIAL DR RESIDENTIAL Fax 763-428-2968 DALE CAZETT 5790 QUAM AVE. NE E-mail metrogeneralservices@gmail.com OFFICE 763.428.2938 ST. MICHAEL, MN 55376 Street Address 1 5790 Quam Ave NE MOBILE 61 2.369.1 069 METROGENERALSERVICES@GMAIL.COM Street Address 2 City St Michael State MN Zip 55376 Application items Location 14956 Pixie Pt Circle Project ID Start Date a End Date November 2016 November 2016 Su Mo Tu We Th Fr Sa Su Mo Tu We Th Fr Sa 30 31 1 2 3 4 5 30 31 1 2 3 4 5 6 7 8 9 10 11 12 6 7 8 9 10 11 12 13 14 15 16 17 18 19 13 14 15 16 17 18 19 20 21 22 23 24 25 26 20 21 22 23 24 25 26 I 27 281-2-91 30 1 2 3 ':. 27 281-2-9130 1 2 3 14 5 6 7 8 9 10 4 5 6 7 8 9 10 0. Contractor/Utility Project ID 1. Type of Excavation Trench 2. If other If you selected other please describe the type. chase sewer into street to obtain fall 3. Length 12' http://priorlake.mn.roway.net/municipal/permit full.php?pid=118266 12/1/2016 Permit Page 2 of 4 4. Width 8' 5. Depth 12' 6. Size 4" 7. Material pvc 8. Traffic Detouring Nececssary? WILL DETOURING OF TRAFFIC BE NECESSARY?(If so, indicate the detouring route) no 9. Restoration quantity: Curb CURB AND GUTTER (LF) 10' 10. Restoration quantity: Sidewalk TRAIL/SIDEWALK(SF) no 11. Restoration quantity: Signs # no 12. Restoration quantity: Fence Fence (LF) no 13. Restoration quantity: Street Street(SF) 96 14. Restoration quantity: Trees # no 15. Restoration quantity: Boulevard BOULEVARD/GREEN AREAS(SF) no 16. Restoration quantity: Light Poles # no 17. Restoration quantity: Other Any other restoration needed? no Municipal Items Municipal Approval Notes (none) Closure Notes (none) Permit Special Conditions (none) Fee (Prepay) http://priorlake.mn.roway.net/municipal/permit full.php?pid=118266 12/1/2016 Permit Page 3 of 4 0.00 0. Current Insurance Registrant Closure items Municipal Closure items Documents and plans These are files associated with the permit. Map location Search for an address: Show Location Address Format:Address, City, State, Zip gym, Pri0 Lake ':fit Dan Patch ?,7I `.2O `3, Map dratinififaffr6ipeogile Permit Types Current Status Status During ❑ Excavating and Grading ❑ Pending Approval ❑ Active During Permit Ei Pending Closure ❑ Driveway Permit El Closed During ® Right-of-way 11Liability Inspection During http://priorlake.mn.roway.net/municipal/permit full.php?pid=118266 12/1/2016 Permit Page 4 of 4 Liability Notes There are no liability notes attached to this permit. http://priorlake.mn.roway.net/municipal/permit_full.php?pid=118266 12/1/2016 ALO/�0 ��© � DATE(MM/DD/YYYY) A.,� CERTIFICATE OF LIABILITY INSURANCE 11/21/2016 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 Stacy Christen NAME: CITY-COUNTRY AGENCY (q/cNNo.Extl: (763)425-4151 (A/C No): (763)425-6650 317 CENTRAL AVENUE ADDRESS:stacy@citycountryinsurance.com P.O. BOX 437 PRODUCER CUSTOMER ID#: OSSEO MN 55369 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:Auto-OWners Insurance Company INSURER B: Metro General Service Inc 5790 Quam Avenue Ne INSURER C: INSURER D INSURER E: St. Michael MN 55376 INSURER F: COVERAGES CERTIFICATE NUMBER:12 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 ADDL SUBR EFF PICY EXP LTR TYPE OF INSURANCE INSR MD POLICY NUMBER (MM/DDY/YYYY) (MM/DD//YYYY) LIMITS GENERAL LIABILITY 104606-08032742-12 06/15/2016 06/15/2017 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300,000 A CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 X PRIMARY PERSONAL&ADV INJURY $ 1,000,000 X CONTRACTUAL LIAB GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGO $ 2,000,000 X POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY 48-005071-00 06/15/2016 06/15/2017 COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO (Ea accident) A ALL OWNED AUTOS BODILY INJURY(Per person) $ X SCHEDULED AUTOS BODILY INJURY(Per accident) $ X PROPERTY DAMAGE $ HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ 1 $ UMBRELLA LIAB X OCCUR 48-005071-01 06/15/2016 06/15/2017 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB I CLAIMS-MADE AGGREGATE $ 4,000,000 DEDUCTIBLE A I RETENTION $ $ A WORKERS COMPENSATION 101706-08033039 06/15/2016 06/15/2017 WC STATU- 0TH- AND EMPLOYERS'LIABILITY Y/NANY Y TORY LIMITS ERs OFFICER/MEMBERPROPRIETOR/PARTNER/EXECUTIVE N/A 500,000 (Mandatory in NH) E.L.EACH ACCIDENT $ If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS belowE.L.DISEASE-POLICY LIMIT $ 500,000 A Rented/Leased Equipment 104606-08032742 06/15/201606/15/2017 $196,480.36 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder is listed as additional insured: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF PRIOR LAKE ACCORDANCE WITH THE POLICY PROVISIONS. 4646 DAKOTA STREET SE PRIOR LAKE, MN 55372 AUTHORIZED REPRESENTATIVE —) ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD COMMENTS/REMARKS Cancellation 30 Days Written Notice OFREMARK COPYRIGHT 2000, AMS SERVICES INC. • � tRr�vilii.� Cityof Prior Lake RECEIPT0 4646 Dakota Street SE ,;'P Prior Lake MN 55372 U 952-447-9840 jiii Receipt: 7522 Received Of: Date: 12/01/16 Metro General Services Customer: Metro General Services 5790 Quam Avenue NE Saint Michael MN 55376 Receipt Item Receipt Description GL Number Total Right of Way Permit 118266/ 14956 Pixie Pt Cir Zoning&Subdivision Fees 250.00 Right of Way Permit Registration 118266/14956 Pixie Pt Cir Right of Way Registration 25.00 Receipt Total 275.00 TENDERED: Checks 687 275.00 Total:275.00 City of Prior Lake RECEIPT 4646 Dakota Street SE Prior Lake MN 55372 952-447-9840 ReceivedReceipt: 7523 Of: Date: 12/01/16 Metro General Services 5790 Quam Avenue NE Customer: Metro General Services Saint Michael MN 55376 Receipt Item Receipt Description GL Number Total Permit Based on Valuation Escrow for ROW#118266 7 -o Z1.i Building Permit 2,500.00 Receipt Total 2,500.00 TENDERED: Checks 688 2,500.00 Total:2,500.00 • , (.31\ ct) o CIDJ' •ii '� , CD:i I a. E III t-i 0. rt. 0 lC-i tw ti ` CMCCD N - an rt , i �� VI Lo g ci) ..., u) 1 pli o O ro o cra G + N o) tillW °C$r. Z, i I A Ni t. . iii r • ›- 5i. )--3 Pd (..:i cip,... c.„ T.,,, , , ..., , 0 ,i .„„ ... .„.„,‘ „:„. . . . ,..„. pdv. 1 , , .i.) Nr F,,, ON CD con `C, , T ...„ r- Pk 4 n w -"c P1S -1 ill 0o rD R i r ' s . . ri. el) CM • PPD 4-, . k...)11.' i w D. ?L' tiTi N ., 17 -,, , ,°,,S, J0.41110 Ili F--,,,,,,