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Home My WebLink About14236 Wilds Dr ROW Permit � � O� , � � a , , �' Sr � c " � 4 ri' �' . . . t �� . 7 •. �, � . G[ 77. � :��: .:�� x FJ �;{ � r I ''� :,, ,�,�: ~ � ' � �`� �U � �D��, �I N N , s o�P PERMIT � A PR �_ . F zoos TO WORK WITHI'.K CITY PROPERTY/RIGHT-OF-WAY/E SEMENTS AND By APPLICA'TION FOR I1rTSTALLATION OF UTILITIES �� 1. Location ` I �`I �,-. G W . � � S � �a � v � • ' . � " � � "'t'� � * 2. Nature of Work J�2.`J i CC-, o+ � 4 � S . � ( o w r� 3. lndicate below items to be affeated and include a sketch or plan of work to be done. Curb & Guttr,r Street Surface TraiUSidewalk Trees: � ' Pond/Wetlancis (Publically owned � Tra�e Control Devices/Signs or Privately owned � ) ' Drainage ' Utilities � � Struciure/Buildings Other S a C� 4. Method of Installation or Consta�iction o�a �� "`' 5. VJork�to start on or after: � 6 � and sha11 be'completed by: 'S S� a L` unless an extension granted to: bY� . DATE STAFF/DATE 6. Will detouring of traffic be necessary? � o If necessary to detour tra.�c, 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 wririn�at least 72 hours in ad��ance of any detour being established, changed or discontinued. NAME OF APPLICANT �� K c� M L� i E l� .� M�0 � a e a w� PHONE +�� 3 `�� 3 P L E A SE PRINT FAX . �C� • ��' �''� 8 6 U. � ADDRESS I�.3C} e'1 u�- �fE. � i/ �E 1"') � `-S"3� �?� s STREET CITY ' STATE ZIP NAME OF PARTY OR ORGANIZATION PERFOR�v1ING WORK !�'► � A s i�b c�-1 �`X C�l V A i': �+' C� CONTACT PERSON: �'�� ` _ � " �-- EMERGEI�TCY (24 HR.) PHONE #: �aa � ' � � � ' ��` 6 � A,DDRESS S��t.d '� A i�K ��• �� I�3 t� o�z�� S''S"7 qS DAY PFiONE STREET �,K(�I'�' STATE ZIP . r �;;e u. , ,�with acceg�s t1�e teinis atjd conditions of'tnis permit by tile City oi yrior "Lalce as herein co d an e t 1y therewith to the satisfaction of the City of Prior Lake. , � � D Signed: _ Title: ��e.��:� � o�+,. � J(� • Date• e�srrc.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 OPPORTUNIIY EMPLOYER r ' k ' EXHIBIT "C" TO PRIOR LAKE PUBLIC WORKS DESIGN MANUAL PERMIT TO WORK WITHIN CITY PROPERTY RIGHT-OF-WAY/EASEMENTS AND APPLICATION FOR INSTALLATION OF UTIUTIES PAGE 2 , FOR CITY USE ONLY AUTHORIZATION OF PERMIT FINANCIAL SECURITY: AMOUNT: TYPE: (Cash, Bond, LOC, Etc.) Fee: $ ��• QD Receipt No. R�sZ- Permit No. UO �4G '.?� LIABIILITY lNSURANCE PROVIDED: T�tG Ny�r;s f�IcsnG�/ 7 In consideration of agreement to comply in all respects with the regula6ons 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: APPROVED BY: DEPT. OF PUBLIC WORKS . By: �� J'�"�''� ' /DATE ALL LEGAL REQUIREMENTS SHOWN ON PAGE ONE (1) AND ON ALI: "SPECIAL FROVISIONS" SHALL BE COMPLIED WITH. THE DATE WHEN WORK IS COMPLETED MUST BE REPORT�D �O THE CITY OF PRIOR LAKE CITY ENGINEER. � � ; , I � i � � G:UdminIFORMS1EXtiIBIT C APPLIC FOR INSTALL OF U7'ILII1ES.doc . � . •` EXHIBIT "C" TO PRIOR LAKE PUBLIC WORKS DESIGN MANUAL REGULATIONS PERTAINING TO THE lNSTALLATION OR REPAIR OF UNDERGROUND UTILITIES IN CITY STREETS OR IN CtTY RIGHT-OF-WAY/EASEMENTS The following regulations and conditions constitute a part of the appiication made by any installer 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 anc� conditfons: 1. The individual obtaining the permit shall, before commencing such work, notify the City Engineer when the work at each location is to corrimence; and, when requested by the Engineer, shall submit plans and specifications. 2. Upon completion of the proiect the individual shall promqtiv notifv the Citv Enaineerina Department for final insaection. • 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 fumish, erect, and maintain, in accordance with the legally accepted standards, all necessary warning and traffic controi signs, barricades, traffic 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 ln bituminous surtaces shall be cut in a straight line with sides smooth and vertical. No ragged edges wiJl 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 compact�d 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 painfed 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 asphaltic material used in patching shall be of the sarne 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. �i i'ic rii �i„ icu Si,ii iaGc ui i ie Naii;i � si �aii c;on�orm io me suriace of the unclisturbed 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 G:1Admia�FORNLS\EXHIBIT C APPLIC FOR INSTALL OF UTILITIES.doc Y � be replaced by permanent patches when weather conditions permit and notification shall be required as stated in 2. 5. Other areas may be required to be compacted at the direction of the Ciry 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 sp�cifications above provided as soon as conditions permit. 7. All culverts and ditches shall be replaced in their original positi�n and. condition existing prior to construction and no change shal► be made in drainage withoutiapprovat 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 finall� 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 furnish 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 insui�ance 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 #rom 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. ` I 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 responsibi(ity c�f the applicant to�call for necessary iocations of existing utilities. (Gopher One) ; 13. Private Property — The work permit or permit for constructionias issued does not in any way imply that the appropriate easement exists to allow the applicant to work on Iprivate property. I 14. Cutting Trees — The permission herein granted does not conf�er upon the permittee the right to cut, remove or destroy trees or shrubbery within the legal limits of the rig�t-of-way. Easements that are not specificafly ' identified on the plan attached to this permit or relieve permittee firom 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 di�turbed, they shall be replaced in kind and. maintained satisfactorily until the turf is established. � The undersigned hereby dec{ares he/she has read and will comply:with al{ the PERTINENT REGULATIONS as stated above and relevant City Ordinances: f 1 DA i c: - l� �('� l� SIGNEQ: i G:�Admin\FORMS\E�.1{lBIT C APPT.IC FOR INSTALL OF UTILIITES.doc � . ; . . . � ,. � � � o�� .�(_ „� � Ss y , W � ��g�a6 �� `, C,,., � `� ^-� � �� ' �� 3