HomeMy WebLinkAbout16309 West Ave ROW Permit RUG-25-2aQ5 15�59 CITY OF PRIOR �RK:E MGIMT P.a1!�4
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PERMiT
PERM[T'�0 WORK W{THIN CITY PR�O�PD RTY RIGHT-O�•WAYJEASEMEN'�S
APPLICA7lON FOR iNSTAL�.A710N O� UTILlTfES
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2. Nahue of Work
3, Indicate below items to be at��cted and includa a akatch or plan of work to be donc•
� Curb & Guticr � Sueet
TraiUSidcwalk T�'
Pand/Wcttands � (Publicslty ow+ned --
� Traffic Control Deviccs/Signs Or Privat+ely owned r ,,,�}
Dzainage �,,,, Utiiities �C:OC�'�`1� � W �U `1�-� �
Structuro/Bwiidings 4ther ,
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4, Method of Installatiar� or Construction �T S'�' w�� n �� A S �� ��.
5. Wark to start on or after: �S�Q P and shall be completed by: �
extension gTanted to• �y'
DAT� STAFF/DATE
6. Will detouring of tra�c be r�ecessary'1 � if nec�ssary to detour tt�t'fic, dsscribo su8gesl�d
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xoute:�,Q � 'h°-- _
7. Provide with this apglecatio�;s a copy of the cantractors Public Liability jnsurancv.
DETOLJRS: 'Fhe Directox of Pubiic Works shall be notiRa i wri ' at o t 72 hours in adv�u�e of any
d�toar beinb �stablished, changcd or disconrinued.
NAME OF APPLICANT � I GN'1 �1�17�5�(: � � PHONE ���
pi.�ASE PRiNT
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S'CREET C!'i'Y 5TAT£
NAME O�' PARTY OR RC3ANIZ TIdN PERFORNIING WORK C I D
CQNTAC7' PE S�N: � I EMERGENCY (24 HR.) PHONE#i: ,
ppDRE9S: N. pAY PHONE
S'CREfi7' C1TY SxATE �
The uruie�signed lurewith acccPss the terms and coaditions vf this permit by the Cii�' of Priar (.ake as herein contsinod snd a� �
fuUy comply therewith W ti�e s sf �o of tbe Ciry oY Prior l.ake. ���
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AUG-25-2�85 16��a ��ITY OF PRI�7R LRKE MRINT °•��`
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PRIOR �.AKE PUBLEC WORKS DESiGN MANUAI.
pERMIT TO W4RK WITWIN CITY PR R�GHT-OF-WAYlEASEI�ENTS
qppL.ICATION FOR t p�T�AWA►TION OF U71LITlES
FOft CtTY USE ONLY AUTHOR1ZA710N OF PERMIT
AMOUNT: NP��
FINANCIAL SECURITY: (�ash, Bond�
LOC, Etc.)
Fe $ �'�, _ „�,.,,�Receipt No. _
F � Permit No. �.'�"�
LIABIILITY lNSURANCE PROVID�D:
In corosidats►tion ot 89reem6nt to CompSy in all respects wiih ihe regulations of the City of Pr ��eQco�'�� � ��� �
and pursuant 1c> auEhorization duly given by sa�d City of Prior Lak�; permission is hereby g
desct�bed in tFt� above spP��ca�ion, said woric to be done in accordanGe with special Ptovisiong as t�areby stated'
�� �� ���',,� � APpROVE� BY: DEPT. OF PUBLlC WORKS
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ALL I.EC�41. DA �� W EN WORK IS GOM� ET D MllST BE EPOR EO 7� TI1E C1TY OF �PR �R I.AKE CI'IY ENGfNEER-
WITM. TH�
C;IPFRMIT$IIt�W_U�ililylROW �R1Mi75,dDC
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, R,UG-�5 1b��J �ITY '��F PRIOR LRKE MRIhJi P.�3/04
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pRip�t LAKE pUBL.IC'IAtORKS DESIGN MANUAL
REGULATI0�1S PERTAINING TO THE INSTAl.LATJON OR
REPAIR OF UNDERGt�OUND UTI�lTlES IN CITY STREETS
OR IN CiTY RIGHT-OP•'WAYlEAS�MENTS
The ioUawirig regulations and canditions constitute a part of the application m�de by any �staller o� cantractoE' for
the installat'ior� ot utiiitiCS in any City str�A! right-of-way vr Gity utibty easement and 1he appiicant, in making his
application W do such work, sha�i agree to abide by these regulations and conditions:
1. The individu�l obt�ining the permit shell, befae commencing such work, nofify the Gity Engineer when the
work at each �acatwn is to commenca; and. when requested by the Engineer, shatl submit plans ar�d
specificatipns.
2, Ueon cornQletion of the vroiect the individua! shall aromn�v notifx t e Cit En ' a tor final
ins ' .
3. TF�e public is to be protected by the individual, at aI1 times, irom ihe commenaement of the work untii the
Comp�ticn and acceptance by if�e City. 'fhe instatler or contractar shall so cvnduct his operations �s to
Cause the minimurn in�onveltience to t�a publiC. The installer or co�traCtor shall turnish, er�Ct, and
mafritain, in �ecordance with the legally accapted stand�rds, ai! necessary warning and traNic conttol Sig►�s,
barricades, traffic cones, and flash+ng lights to direct and controt thE movement ot t�atfic through the project
in 8U directions and at aE! times.
The foregving provisiores shalt not in any way retisve the installer or contractor af any of his lega�
responsibilities or 6abilities fvr the satety of the pu�lic.
4. Alf openings in bituminpus surfaees shall be cut in a straight line with sicles smvath an� vertical. No ragged
edges will be perm'stted. Cu�ing shall be done with a concrete saw, cutting whegl, jack hamrner, �es or
simiiar approved toofa,
Backfifl material shall be suitab6e for highway embsnkment constructian. Nn peat, frozen iumps, broken
asphalt, sod� roots, or other undesirable materia! shal{ be permitted as bacicfili, Rocks large�' than six
in�hes (6"} in diameie� sh�ll r,oi be used in backfftkng of trenches.
The back�ill material sh�ll be plaeed in layers noi to exceed one foot {1'} and mechanicaily ctirnpacte�l to
noL less than 95 percent of rnodtfied Proctor density.
The uppe� six inchas {6"} of the backfill shall meet Minnesota Highway Departrnent Specifications for Class
5 m�t�rfal and shall be compacted to not #ess than 95 percent of modifisd Proctcx dsnsity.
,4s soon as possible after b�cktiil op�rations are completed, the cut bituminou5 edges of tk�e trench shall be
p�iMe4 wiEh an asphali emulsion Suct� as SS-1. Immed'+ately thereaiter, the qaitching rr�aterial shaN be
�lac�d and mechanically campacted to not Isss tha� S5 percenl of modiT�d ProCtor d�nsih►• The asphaltiC
m�terial used in patching shaU be di the same type as �emoved frorra the raadway, except, that in no c�se,
will � plant mixed asphait of {ess qua[ity than Minnesata Highway Depa�tment Speciflcaiions 2331 be used.
The tiniahed surface vf the p�tch shall ooriform to the su�iacs of the undisturbed roadway.
Na permanent asphal# patches sha!! be on any base wh4se temperature is 32 degrees Fahrer�heit or less•
s rn'��lar approv d� aten Es Temporary pat hes shail be�t ue I�ine a grade. patches�sh�
G:IPERMITSIROW„U�i��ROW PERMITS.doc
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De teplaced by permanent patches when we�ther c�nditions perrnit and notification shali be requi�ed as
stated in 2.
5. Qthe� areas may be required to b� compacted at the direcUon of the City Engineer.
6. St�h permittee to be responsible for maintenance and repair of a!! trencfies for a period of one (1) year and
it settiemsni occurs or excavation aaves in, the same shail be promptly indlcated by adequate warning
signs and snaU be restored to praper canditian in accordance with speci�ications abave p�ovided as soon
as conditions permit.
7. All culve�ts and ditches shail be replaced in their original position and conditior► existing prfor to
cArsstruction and no change shall be made in drainage without approval of the City Engineer.
8. Petmittee shall save the City harmlES� from all third party claims for injury or damage which may occur
between the ume the work commences and the tirne it is f�ally accept�d by the City.
9. The permittee may be required to jack or bore under certain 5treats, as determined by the City Engineer.
10. T�e �pplicant shall furnish evidence of public liabil�ty insurance of not iess than S'IOQ,0�0/34Q,000 and
propecty da�a8e af nat lesa than $25,040 (ssued by an insurance eflmpany authorized to da business in
the State of Minnesota an whi�h the City is named as an additional insured paRy.
11. Except fpr tt►e negEig�nt acts af the City, its agents and its empl�yaes, tre permittee shaN assume ail
fiability for, and save the City, its agents and its empEoyees, harmless and defend eame at iis sofe cost and
expettse from any and all claims fpr damages, actions ar causes of action arising aut ai the work to be
done herein and ihe Continuing uses by ihe pe� mittee, including but not limited tv the placing, canstruciing,
and reconstructing, maintaining, pratecti�g and use of said facility under this application and permit for
canstructivn.
12. �xisting FaGititi�s -- The utitity facility and inst�tlations shail not interfere with any sxisting utilily faciiity on
the C�ty's r+ght-of-way or easements. It is the responsibility of the applicant to c�ll for necessary iocatians
of exisiing uulities. (Gopher Qne)
13. Pr�vate Praperty —'fhe work permit or permiE f�r construction as issued does not in any way impEy that the
appropriate easement exisSs to allow ihe applicant to work on pr�vate praperty.
14. Catting 7rees -- The permission herein granted does not conter upvn the permiltea the r'ght ta cui, remave
ar destroy trP.es or shrubbery within the legal (imits of the right-af-way. Easements that are not speci'flcal{y
ic#entified 4n the plan attached to this permit or relisve permittee from obtai�ing any consent otherwise
required from the owner oi the property adjacent thereto.
15. C188n-Up �- Stteet, trailway� and aftected right-oi-way shap be scraped clean at the snd of esch wwk day
and swept clean after construction is completed and Eeft in a neat and presentabls condiUon.
16. Replac�ment of Sod — Wherever top-soil and sod are disturbed, thsy shall be replaced in kind and
maintained satistactorily until the turF ia est�blished.
Thg undersigned hereby declares helshe h�s read and wii! c�mpiy with aft the PERTfNEN7 R�GUTATtONS as
stated above and relevant C+ty Ordinances.
DATE: ,�,'��+- �„�.._ SfGN��: `7" �
G;{pERMITSUWW_VGtayINOW ►ERMITS,doc
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t+�tS t�4 �:[��,.}'�'�Ut�� &�ari,nga are aaewaed
r-���--� �lJ�T�`� �^O.��S� 9:� � _
Sub,ject ta easements of record it any
O Denatee est or found iron p�.pe monuments
��A � $ D�notes aet wood hub snd taek
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�,_.,__ propoaed garage Zl�r elevation
'�g,�� Denotea exiating elevation�
��`' Propoeed top ot block elevation � Danotee proposed iini�h grade elevation
���` Uenotes directfon of aur#sce draina8e
.� Proposed laowest floar elsvatian '
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�: �a��uw� G�o� F��. C����� , `�' � ��. " �
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* I tterebY certiiy that this ia a true and correat repre�enta��.nn ofi � BUrvey oi the boundaries
��'S�Qt� A�um��J .
..� i"?�.�,- ..I 1��. t�.:..t,_ s� .....h.ti.. � �i� �nu�tv, k�innesota as •on #ile an�t at recorcl
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16�44 RUG 25, ���5 ra� N0� 5�38284 #38�31� PAat� ��3
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IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statemerit
on this certificate does nat confer rights to the certificate holder in lieu of such endorsement(s},
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 ceriificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a corrtract between �
the issuing insurer(s), authorized representative or producer, and the certi�cate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afiorded by the policies listed thereon.
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