HomeMy WebLinkAbout4525 Jackson Trl NE ROW Permit U5/16/U'L 11iU 15 31 N'AX 6124474'l63 C11'Y OF NR10R I.AKE �002
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e� P�RMIT
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TO WORK WITHIN CITY PR4PERTY/RIGHT-OF-WAY/EASEMENTS �
AND _
APPLICATION FOR INSTALLATION OF UTILITIES .
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2. Natura csf Vf/ork 1.ns �o� �-� �1nder�r��� ser.�� < <�,r�.
3. Indicatc below items .to be affected and include a sketch or plan of work to be done.
G�irb & Gutter Street Surface
'IYaillSidawalk Trees;
Pond/Wetlands (Publically owned
� Traffic Control Devices/Signs or Privately owned �
Drainage Utilities
Structure/Buildings Other �g�� S
4. Method of Installation or Consu�uction _ ]�ry�, n n I,en
-- ,
. 5. Work to start on or after: S 0 S" and shall be compkted by: 1 � S unless an extension
g�anted to: by:
DATE STAFF/BATE
6. Will detoaring of traffic be n�cessary? /V � If nxessary to detour traff c, describe suggested
route:
7. Provide with �is applicarion a oopy of the contractors Public Liability Insurance.
DETOIJRS: The Director of Public Works shall bo notified 'm �g at least 72 ho�us in advance of
any detour being established, changed or discontinued.
NAIVIEOFAPPLICANT 'r�l (,��,, IP`QC����,��r(jG �/l< PHONE �Oc�' �'Ll-3gI �
PLEASE PILINT FAX G,�S� — y$ 2—�S$O
ADDRESS _�JZSO �(.�,�[ P c�7 = L t ���,�� i"�IV c I I 7
STREE CITY ' STATB ZIP
NAME OF PARTY OR ORGAN�ZA ION PBRFORMIIJG WORK � t i U.STE �P C'O rHm i(,r1 i C���o�
CONTACT PERSON: �q EMERGENCY (24 HR. ) PHONE #: �o! L 4 r q -/ 9 S/
ADDRESS DAY PHONE
STREST CITY STATE ZIP
The undersigned hecewitb accapts the bernas and conditions of this pe�mit by the City of Prior Lake as herein
contained and agree to fully comply therewith to the aatisfaction of the Ciry of Prior Y.ake.
Signed- Titla:� f M j'f" �n��n��' Datc: 2- " R� D�
�aa�tc.noc Page I 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
... �... . .. .... . .. . .. . . . . ..a va ....v .... .. .. . . q.J V�V�]
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EXHIBIT "C"
FOR CITY USE ONLY AUTHbRIZATiON OF PfiRMIT
FINANCIAT. SECURiTY: AMOUNT: TYPE: '
(Cash, bond, LOC etc.) :
Fce: � -v� Receipt No. ��,�� Permit No. �J -OS'/
LIABILITY 1NSURANCE PROVIDED: _ �4/'S' 1 .S /7
; In consideration of agreement to comply ia sil respeds with tlie regulations of the City of Prior Lake covering such
operations, and pursuant to a�horization duly given by said City of Prior Lake; permission is hereby granted for the
work to be done as descn'bed in the above application, said wotk to be done in acoordance with specisl provisions as
hereby stated:
. ' APPROVSD BY: DEPT. OF P'UBLIC 'I�VORKS �
. �: �' � =o,s- :
/DATE
ALL LEGAL REQUIREMENTS SHOWN ON PAGE ONE (1) AND ON ALL "SPECIAL PROVISIONS" SHALL
BE COMPLIED WITH. THE DATE WI��N WORK IS COMPLETED MUST BE REPORTED TO THE GITY
OF PRIOR LAKE CTTY ENGIlYEER
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. EXHIBIT "C"
CITY OF PRTOR I,AKE
REGULATIONS PERTAIMNG TO THE MSTALLATTON OR
REPAIR OF UNDERGROUND UTILITIES 1N CTfY STREETS
' OR W CITY RIGHT-0E-WAY/EASEMENTS
� The following regulations and conditions constitute a.part of the application made by any installer or contractor for
the installation of utilities in any Ciry streei right of-way or City utitity easement and the applicant, ia making his
application to do such work, shall agrce to abide by Wese regulations and conditioas: •
i. The individuai obtaining the permit sha11, beforo commeucing such work, notify the City Engineer when
the work at each location is to commence; and, when requesbed by the Engineer, shall submit plans aad
spacifications. .
2. IJnon comnledon_ of the� roiect the individLal cha�� nrom noti �r c;ri �p�nerrinE�gp arimeni for
final ms aon.
3. The public is to be protected by the individual, at all times, fin� �e commeacement of th� work unti! the
completion and acceptence by the City. The installer or contractor sLall so conduct his operations as to
! cause the minimwn inoonveaience to the public. The instatler or con�actor shali furnish, erect, and
maintain, in accordance wiih �e legally accepted standards, all necessary watning end traPtic control signs,
barricades, traffic cones, and flashing lights to direet and control the movement of traffic through the
project in all directions and at all times.
�� The. foregoing provisions shall not in amy way relieve the installer ar contractor of any of his legal
responsibilifies or liabilitics for the safety of the public. .
4. All openings in bituminous swrfaces shall be cut in a sfraight line with sides smooth and ve�. No
�88ed edges will be permitted. C�ting shall be done with a concstte saw, c�tting wheel, jack hammer, ' .
spades or similar approved tools.
Backfill material shall be suitabk for highway embanl��nt constivction. No peat, frozea Iwnps, broken ��
asphalt, sod, roots, or other undesirabie material shall be permitted as back811. Rocks larger than six ind�es �
(6'� in diam�er shatl not be used in backfilling of treoches.
The bacWilI material shall be placed in iayers not to exceed one foot (1') � mtchanicelly compacted to
not less than 95 perc;ent of modified Proctor density.
The upper six iaches (6'� of the bad�'ifl shall meet Minnesota Highway Departinent Specifications for
Class 5 materia! and shall be compacted to not less ttian 95 percent qf modified.Proctor density.
As soon as passibie after backfill opera6ons are completed, We cnt bitumiuous edges of the trench sh�all be
painted with an asphalt anulsion �ch as SS-1. Immediately thersaRsr, the patching material shall be
placed and mechanically compacted to not less than 95 percent of modified Pmctor density. The asphaltic
matcrial 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 quaiity thau Iu(innesota Highway Deparhnent Specifications 2331 be
used. ?he fmished surface of the patch shall conform to the surface of the updisturbed roadway.
No permanent asphalt patches shaU be on any base whose temperatune is 32 degrees Fahrenheit or less.
Cold weather patching shall be of temporary nature, nsing cold mixed asphalt, weU graded cnxshed rock or
. similar approved mat�rials. Temporary patches shall be true to line and grade, Temporary patches shall be
replaced by permanent patches whar weather conditions pelmit and notification shall be required as stated
in 2.
��� Pege 3 of 4 .
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EXHIBIT uC"
5. Other areas may be required to be compactad at the direction of t6e City Enginecr.
6. Such permittee to be responsibte for mainbenance and repair of all trenches for a period of one (1) year and
if settlement occurs or excavation caves in, t6e same shall be promptly indic�ted by adequate waming signs
and shali be restored to proper condition in.accordance with specificarions above provided as soon as
conditions permit.
7. All culverts and ditches shall be replaced in their original position aud candition existing prior to
construction and no chaage shall be made in draaiage without approval of tha Ciry Engineer.
8: Permittee shall save the City harmless from alt tfiird party claims for injury or damage which may occw� '
between the time the work commences atid the time it is finally accepted by the City.
3. Tt�e permittee may be requ6�ed to jack or bore under certain streets, as determined by the City Engineer.
10. The appticant shall furnish evidence of public liability msurance of not less then $I00,000/300,000 and
property demage of not less than 525,000 issued by an insurance company authorized to do business in tho
State of Minuesota on which the City is named as an additional insured pariy.
11. Except for the negligent acts of the City, its agents and its employees, the permittee shall assume all
liabiliiy for, and save the City, its ag�ts and its eraployees, harmless and defend same at its sole cost and
expense Gom any and a!I claims for damages, actions o� causes of action arising out of the work to be done
herein and the continuing uses by tiie permittee; including bnt not liniited to the placing, constructing, and
reconstivcting, maintaining, protocting and use of said facility under this application and permit for .
conshtaction. �
12. Existing Facilities - The utility facility :md installations shali not interfere with any existing utility facility
on the City's right-of=way or easements, It is the res�oasibility of the applicant to call for necessary
locations of existing utilities. (Gopher One)
t3. Private Property - T1ie work permit or permit f� conctruction as issued dces noi in any way imply that the
appropria�e easement eacists to allow the applicaut to work on private property,
14�. G�tpng �Ye�s - The p�mission herein granted does not confer upon the peTmitte� t� right to cut, remove
or destroy trees or shrubbery withum the legal limits of the right of-way, easements that are not specifically
identified on the plan auached W this permit or relieve peamittee from obtaining any conse� otheawise
required from 1�e owner of the property adjacent thereto. , -
I5. C1ean-Up - Street, trailways and afiected right-of-way shall be scraped cksa at the end of each work day , �
and swept ciean at�er conshuction is c�pleted and left in a neat andpresentable c�dition.
16. Replecernent of Sod - Wherever top-soil and sod are distwfied, thay sha11 be repiaced in kind and �
maintained satisfactorily vntil the t�uf is established.
The nndersigped hq�eby declares helshe has t�ead and will comply with al! the PBRTIIQ6N1' RE(�UI,,ATIONS as
stated above and relevant City Ordinsnces,
DATE�_ �^ � D � SIGNED•
� Pagt 4 of 4 . _ _.. . .
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