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Home My WebLink AboutTH13, CSAH23, Village Lake Dr ROW Permit i ��. �� I��' � -'�� + }$t `1'�t,c,.� � Y ki.�,� A�°.� � LL �� U ' � ..+�;�3,,,� r�N � � . � JNN E s° � P PERNIIT TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS AND APPLICATION FOR INSTALLATION OF UTILITIES 1. Location Tf{ I oZ 3 (�C i N ��D W 5 fp� �� 1 0 "� � 3- 0 3, 2. Nature of Work C T S 1'Z . M P �{ I 3. Indicate below items to be affected and include a sketch or plan of work to be done. Curb & Gutter Street Surface ; TraiUSidewallc Trees: , , Pond/'Wetlands (Publically owned � Tra�c Control Devices/Signs or Privately owned _� , Drainage ,: Utilities StructureBuildings Other (� . � • � � S 4. Method ofInstallation or Construction P�� Rt iU e�� i�a R� 5. Work to start on or after: `� � and shall be completed by: ` unless . an extension. � granted to: by: ' �. " ' � DATE 0;`r G'� � C�e,,,s , STAFF/DATE • 6. Will detouring of traffic;be necessary? d if necessary to detour traffic, describe suggested route: ` 7. Provide with this application a copy of the contractor� Public Liability Insurance. M �„p�S �p �� CON F; �� 1 w. c;�r.� \ DETOURS: The Director of Public Works shall be notified in writingat least 72 hours in advance of any detour being established, changed or discontinued. NAME OF APPLICANT M�� -. M� M E ��` pgp �o I a. ��0 3•�� 3�C� PLEASE PRINT FAX ° I S'� •`E`�4 • q c, 6 a � a,DVxxESS 1 �{ � � a-- `c,�,�•�e,� e e riVe . '�. `. • �'v . �5' 3 } 2-- STREET CITY STATE ZIP NAME OF PARTY OR ORGAI�IIZATION PERFORMING WORK I`'� L-AS �Cp C. - C „ CONTACT PERSON G 3 A �2 EMER �NCY 24 HR.) PHONE #� S � 8 a9 ADDRESS �040 p�K p2 W� Ifow lZ�+ �trM1�► 5'S'�S"DAY PHONE STREET CTTY STATE ZIP ` �4 . 3C3x t �3 � ii2 i2I'iuEiSibll@u l i8i"cwlui occeyu u�e icniis aiiu cut�uiiions oi inis permit by the C;ity oi Yrior Lalce as hereni ained an lly compty therewith ta the satisfaetion of the City of Prior Lake. _, \ _ ` _ _ � _ Signed: Title: �: r�ct 5 v�• Date• � �rrc.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 OPPORTUNITY EMPLOYER � �-- � EXHIBIT "C" TO PRIOR LAKE PUBLIC WORKS DESIGN MANUAL PERMIT TO WORK WITHIN CITY PROPERTY RIGHT-OF-WAY/EASEMENTS AND APPLICATION FOR INSTALLATION OF UTILlTIES PAGE 2 . , , FOR CITY USE.�NLY AUTHORIZATION OF PERMIT FINANCIAL SECURITY: AMOUNT: TYPE: (Cash, Bond, LOC, Etc.) Fee: $ Nf7 Receipt No. Permit No. (�P'" 0 7"! 7 LIABIILITY INSURANCE PROVIDED: �ROTEGT�O�I CeNNECT/OnI , /IVC . In consideration of agreement to comply in all respects with the regulations of the City of Prior Lake covering such operations, and pursuant to authorization duly given by said City af 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: �a�i.�A?�' c��T!/ Ci,rY PRcvEcT� o2-Ob . T APPROVED BY: DEPT: OF PUBLiC WORKS . By. �� ..�f '�" �� 7 '� /DATE ALL LEGAL REQUIREMENTS SHOWN ON PAGE ONE (1) AND ON ALL "SPECIAL PROVISIONS" SHALL BE COMPLIED WITH. THE DATE WHEN WORK IS COMPLETED MUST BE REPORTED TO THE CITY OF PRIOR LAKE CITY ENGINEER. � G:�,4dminlFORMS�E7�IIBIT C APPLIC FOR INSTALL OP UTILTTI&S.doc ,� i � EXHIBIT "C" TO PRIOR LAKE PUBLIC WORKS DESiGN MANUAL REGULATIONS PERTAINING TO THE INSTALLATION OR REPAIR OF UNDERGROUND UTILITIES IN CITY STREETS OR IN CITY RIGHT-OF-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 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 and conditions: 1. The individual obtaining the permit shall, before commencing such work, notify the City Engineer when the work at each location is to commence; and, when requested by the Engineer, shall submit plans and specifications. 2. Upon completion of the project, the individual shall promptiv notifv the City En4ineerin4 Department for final inspection. 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 furnish, erect, and maintain, in accordance with the legally accepted standards, all necessary warning and traffic control 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 in bituminous surfaces shall be cut in a straight line with sides smooth and vertical. No ragged edges will 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 materiaf 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 compacted 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 painted 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 same type as removed from the roadway, exce�t, that in no case, will a plant mixed asphalt of less quality than Minnesota Highway Department Specifications 2331 be used. The finished surFace of the patch shall conform to the surface of the undisturbed 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:�Admin�FORMS�EXFIIB[T C APPLIC FOR INSTALL OF UTILITIES.doc �� . � . . .' • :, + 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 City 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 waming signs and shall be restored to proper condition in accordance with specifications above provided as soon as conditions permit. 7. All culverts and ditches shall be replaced in their original position and condition existing prior to construction and no change shall be made in drainage without approval 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 finally 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 insurance 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 from 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. 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 responsibility of the applicant to call for necessary locations of existing utilities. (Gopher One) 13. Private Property — The work permit or permit for construction as issued does not in any way imply that the appropriate easement exists to allow the applicant to work on private property. 14. Cutting Trees — The permission herein granted does not confer upon the permittee the right to cut, remove or destroy trees or shrubbery within the legal limits of the right-of-way. Easements that are not specifically identified on the plan attached to this permit or relieve permittee from 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 disturbed, they shall be replaced in kind and maintained satisfactorily until the turf is established. The undersigned hereby declares he/she has read and will comply with all the PERTINENT REGULATIONS as stated above and relevant City Ordinances. � � DATE: 3 ( � � I SIGNED: • G:1Admin�FORMS�EXFIIBIT C APPLIC FOR INSTALL OF UTILIT'fES.doc �� p'1 ` y ��i ��1�a�Y, ��zy : J y �� . � � t f � A �' �'r�t'�{f'� �`5'�'„ 4 � � � � � _ . - . � , �s� � �d , 4 t ' p. � . . ! � • �)C�S`��I�C,— . , i — r� I ;, .., .S' , . . . � � '' I �; � �� -. � � j ; � �; � �'�� — �5 � � � I i �'�� Y •�� , --� 1 '' I !� �Z , � I � _ � � Y �� ' 1 F °d ti � � � I � O�f A � � � � �� . r'U I � � � bq� � � t 1 ��, r � 1 1y� ' �^1� V :�V �rJ' �F I I � --- � ,\\ � 0� � � .� � �; , � � c - o. � � � A I i �� , ,'_��- �ti`� r� � l' �� `\ � � ` °°`� I � _ o� � � � � --- � �\ �� `� � � � � � �.�� i � `� - , .�-- %, � � �� ' �'�� ' � � ��: � _ � � � ._ O ` � � � \ �\ \\ \ !; i .,' � , � �� ; : � � o �� 3\ � : � M��+� O: �� N\ \\� � r___..:... _........ _.__.... _ . ta x � _ � A Z M �� I �--" ° � � � � � \� \� \� � °�' � • • ��\ aor�1 �� .��0 � � �� •�, � � � �' F�� ' \ ��\�\\ • M � ' �� - � r. � O � au�� C \ a .,, �'�� + � r� 3 � �i g � __ � � � � W A � ip � r � \� � \`� � �1 � V � . . 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