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Home My WebLink AboutTH13 & CR23 @ E 170th St & Village Lk Dr ROW Permit CITY OF PRIOR LAI� �"� �� nn � fmoo2 08/�1.1�3 FRI 14:48 FAX 81244T42 D u � . � • .. �• � � FEB 2 7 LUU4 , �� YRlp� � - , �� ., � .� .�- -�: � . y E,,, .� Y:� � - � � `"� � � ` ,.: � fi . ' �� a..°'�� , YERMIT �fNIYES�� TO �'VORK WTTffiN CITY PROPERI'Y/RIGHT-OF-WAY/EASEMEN'I'S AND APPLICATION FOR INSTALLATION OF UTILII'IES � , , � • :, '��_?��,�,�. , �/iti _ � 1. Locaaon � � .� ` � �� ' �Qo 5 {e" ��MC� 2. Nature of Work.��"�"`'"` ��ec./ �' 3. Indicate below iteias to be a$ected and iaclude a sketch or plan of work to be doae. _ ' � Curb & Guttu � Street Surface . TraiUSidewalk Trees: . • '• Pond/Wetlands (Publically owned . or Privately owned _� ' Traff'tc Control Dcvices/Sigas Utilities � D Other StructureBuildings . , . 4. Method of Installatian or Constrciction �� ''' � N '�' and shall be completed by: �..(3� � O�: u�less an extension 5. Work to staR on or aRer: � �Q`� _ � granted to: b y' . DATE STAFF/DATE i1/�O If necessary to detour �affic, describe suggested 6. Will detouring of traffic be necessary? , • route: � . 7. Provide with this application a copy of the contractor� Public Liability Insurar►ce. DETOURS: The Director oE Public Worics shall be .,ntifed in w'tttin° 'r iP'°+ �� hn�rs in advance of any detour heing established, changed oc discontinued. � �� PHON�G�s��` � T NAME OF APPLICANT • P . P �, r gpX � c7 •• g �/ e ti�� !� `' �' n�i s/11•r! 'SS Z�) : i AD)RESS _ . CITY STATE STREET NAME OF PARTY OR ORGA.NLZATION PERF�K�III`iG WORK Ge _�N-�.�"�L' _ MERGENCY (24 HR) PHONE � CONTACT PERSON:�' �`S �,v S U DAY PHONEI i'� � '' �' � � �� ADDRESS /'S %� N� r* STATE ZIP STREET C� � The undersigned herewith accepu the terms and coaditions of this permit by the City of Prior Lake as herein .contained and agrce to fully comply therewith to the satisfaction of the Ciry of Prioi Lake• � c � �,t • ' � Title: ��!�( �� S� cy�' Date: �� Signed: T . , _ � Page 1 of 4 16200 Eagle Creek Ave. S.E., Priar Lake, Minnesota 55372-1714 / Ph. (612) 447-4230 / Fax (612) 447_424� � _ . __.... ..,,.,mm� rnirrv FMpi 1]YER _ - t�ooz OS/01��3 FRI 14:48 FAX 81244T4263 CITY OF PRIOR LAKE D � . � �� nn (?� � �1 u : .. �• � � 2 7 1UU4 • , F�EB , o � YRI ._ . , � .., �� y .� :�<- �� . . H ��' - �_� � � '° x ``""� : �, ' fi ., �� ..;,:. � PERNIIT M �NN E5�� TO �'VORK WITBIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS AND APPLICATION FOR INSTALLATION OF UTII�I1'IES � j " ' � .�C� �1ti . � 1. Locaaon . � � ` .r ' `� �Qo 5 t e c�.h� n� a 2. Nature of Work,�� ' 3. Indicate below iteias to be a$ected aad include a sketch ar plan of work to be done. _ ' � Sheet Surface � Curb & Gutter Trees: . TraiUSidewalk (publically owned . • '� Pond/Watlands or Privately owned _� . ' Traff'ic Control Devices/Sigbs Utilities � D � a g e Other Structure/Buildings . . . � • . 4. Method of Installation or Construction 2�� / unless an extension snd shall be completed by: g 3� ��- 5. Work to staR on or after: _..�.L �{Q�-- , graated to: �---� by � STAFF/DATE DATE it/�O If necessary to detour traffic, doscribe suggested 6. Will detouring of traffic be necessary? , • route: � • 7. Provide widi this application a copy of the contractor� Public Liability Insurance. n�t' „�� Pa�r �� hours in advaace of DETO[JRS: The Director of Public Works shall be ..,, in writin any detour being established, changed oc discontinued. ' '' PHO G L 2�� '� NAME OF APPLICANT • t N e �^ g p ' PRINT F � � —/ e �c!�� ` - 8 ADDRESS . CITY • STATE STREET N.4ME OF PARTY OR ORGA.NIZATION PERFOR�IG WORK Ge' �N-��' _ CONTACT PERSON: ' MERGENCY (24 HR) PHONE � ADDRESS �'S %� N� � 7' �r. A_��.t� 5�� DAY PHONEIo% 7 � � S � �— STREET CITY STATE � � The undersigned herewith accepts the terms and conditions of this permit by the City of Prior Lake as herein .contained and agrce to fully comply tharewith to the satisfaction of the City of Prio� Lake• • � J Title: �� S�1 ;' Date: �� S�gned: � Page 1 of 4 �,TC.nac Fax (612) 447-424� 16200 Eagle Creek Ave. S.E.. Priar 1.ake, Minnesota 55372-1�7 p' Av (612) 447-4230 / , Q8/O1/,03 FRI 14:49 Fe+iX 61244742B3 CITY OF PRIOR LAI� f� 003 . �.., . . EXHIBIT "C" � TO . PRIOR LAKE PUBLIC WORKS bESIGN MANUAL . PERMIT TO WORK W1TN�N ClTY PROPERTY RIGHT-OF-WAY/EASEMENTS AND APPLICATION FOR INSTALLATION OF UTiLITIES PAGE 2 FOR CtTY USE ONLY AUTHaR1ZATiON• OF PERMIT FINANCIAL SECURlTY: AMOUNT: _ NPE= . (Cash. Bo�d, LOC, Etc.) - Fee: $ /V� Receipt No. _ ' PeRnit Na U�' �"�� LIABIILfTY INSURANCE PR�VIDED: �� /NC in consideratian af agreement to comply in all respects with the regulaUans of the City of Priar Lake cave�ing such operadons, and pursuant to authorizatian duty given by sald City of Prior Lake; permission is hereby granted for the work to be done as described in the abave applicatian, said work to be done (n accordance with special provisions as hereby stated: ' � C �- p' -� . � L�`N , � ,��- • $UD ps/1�� N� �Q N — APPROVED 6Y: DEPT. OF PUBLIC WORKS � � �. �(/BLfG GJO/��C S D/RECTai� BY� �oa� � 952 - �{��- 98�D ALL �EGAL REQU WHEN WORK S COMP E ED MUST BE REPORTED TO T E OF LA E CIT`f ENG NEER. W ITH. TH E DATE G:�Admin\FORMSI6XHLBIT C APPLIC FOg INSL'ALL OF IJTQITIES•dx �.,,,....�..�..�.-._ .�.._ ._ .�...-----._--_._ . . _--____.._ _�._...._._..---- - ..._. ...___ --_.w. _..�_.__.__..w...._..._..�......._......_ - c:i•rY ur� rxiux tax� �uua � 08/Ol/03 FRi 14:49 Fe1X 81'G4474Yti� . EXHIBIT "C' TO PR10R LAKE PUBUC WORKS DESIGN MANUAL REGULATiONS PE GTR U UTILITIES N CITI( STREETS REPAIR OF UNDER OR IN CITY RIGHT-OF WAYIEASEMENTS The following regulatians and conditicns constitute a part of the appfication made by any i�staller o� contractor for the installatian of uGiities in any City street right=of-way or City utility easement and the appl'�can� in making his appiication to do such work, shall agcee to abide by these regulations and conditians: 1. The individual abtaining the pem'�it shall, before commencing such wo�ic, notify the City Engineer when the work at each loca�on is to commence; and, when �equested by the Enginee�, shall submit plans and specifications. 2. Uaon completian of the aroiect the individual shali aroma�v notifv the Citv Enaineerin4 Deoartment for final inspection. 3. The public is to be protected by the individual, at all times, from the commencement of the work untii the compietion and acceptance by the City. The installer o� contracto� shall so conduct his operatians as to cause the minimum inconve�ience to the public. The installer or contractor shali fumish. erect, and maintain, in accnrdance with the legally accepted standards, ail necessary waming and traffic control signs, barricades, traffiE 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 bitum tl �C�� a �shalhb�e done w'th a t co ncrete s wt ng w eel�. ja k hammer, spades aa edges will be.perm 9 similar approved tools. Backfili material shall be suitabf aes �ab9e materiab sha I be permitted� s backfilia Rocks larger k s x asphalt, sod, roots, or other un inches (6") in diameter shall nat be used in backfilling of trenches. The backfill material shall�be piaced in layers not to exceed one foot (1') and mechanically compacted to not less than 95 percent of mod�ed Proctor density. The upper suc inches (6") af the backfili shal( meet Minnesota Highway Department Specifications for Class 5 material and shall be compacted to not less than 95 percent of madified Proctor density. As soon as possibie after backfili 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 piaced and mechanically compacted to not less than 95 percent of madified Proctor density. The asphaltic material used in patching shall be of the same type as removed from the roadway. except, that in no case, will a plant mixed asp�fa�e fia�ch shall t the surface of the undi urbedpoadway.ns 2331 be used. The firnshed surface p No permanent asphalt patches shall be on any base whose temperature is 32 degrees Fahrenheit ar less. Cold weather patching shall be af temporary nature, using cold mixed asphait; weil graded cN atches hall similar appraved materials. Temporary patches shall be true to line and grade. Temporary p - _ ... _ _ . C:MM�a�\FOAMS�E7�CI' C ATPUC FOR WS7YILL OFITrD1T�4.doe • C1'lY Ur YRtUR Lr1K� . �61uu� 08/O1/03 FRI 14:50 Fe�X 6124474'263 . . '� .� � w be replaced by permanent patches when weather conditions pe�mit and notificatian shali be required as � . stated in 2. 5, Other areas may be required to be compacted at the direction af the City Engineer. 6. Such permittee to be responsible for maintenance same be p�omptly i dicated by ad quate if settlement occurs or excavation caves in, the signs and shail be restored to proper ccndition in accordance with specifications above provided as soon as conditions permit. 7, All cuiverts and ditches shali be replaced in their original position and condition existing prior to construction and no change shall be made in drainage without approvai of the City Engineer. 8. Pertnittee shall save the City ham'�less from ali third party claims for injury or damage which may occur between the time the worfc commences and the time it is finally accepted by the City. g, The permittee may be required to jack or bore under certain streets, as detetmined by th� City Enginesr. 10. The applicant shall fumish evidence of public Iiabtili an nsurance company authorized �to do business In property damage of not less than $25,000 issued y � the State of Minnesota an which the Clty is named as an additional insured party. 11. Except for the negligent acts of the City, its ae� lo ees, and�defend ame at its sole cost and liability for, and save the City, its agents and its p y expense from any and all claims far damages, actions or causes. of action arising out of the worlc 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 facltlty an the City's right-of-way or easements. It is the responsibility of the applicant to�call for necessary locations af existing utilities. (Gapher 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 shn�bbery within t se �ermit�or el eve from obta n ng ny consent othen+vise identified on the plan attached to th p � required from the owner of the property adjacent thereto. 15. Clean — Street trailways and affected right na�a ne t and presentable conditi each wark day and swept clean after construction is completed and le 16. Replacement of Sod — Wherever top-soil and sad are disturbed, they shal( be replaced in kind and maintained satisfactorily until the turf is established. The undersigned hereby declares helshe has read and will comply with all the PERTINENT REGULATIONS as stated above and relevant City Ordinances. � , ' . � � SIGNED. � � DATE: _ � �G ` . �/ - _ O:�Admie\FO1tbtS1fi7�8R C A?PL1C FdR �37ALL OP V[[[�716�•d°' \ ^xi:1L' � ' ` � �! ' � �� ` J V `` . Z �� — 7 . � �� . �..1� � 'S. . i ,-., � � �. � \ � � . , � \ � 1 1 I ; `p"'� ` C, . • �. ' \ ` ` �' � I (� ��d � (�� ,Cj`� . 1 �� m � �� `�.l 't .s� c o_ -� -• � P. � � .� � , .a. � o � � tf--�' - � � �' � : o �� ,�� " ` � � i � � , � � � _ �� `' W ` �''� j � � �� a �; 4 ;' . R� , c � � �AI �° ` ' �. s � r. `r • . � W � • '• � w ' • p dd a � . � '` ' , '� $ � � � a � � � � � sses d� � . � '• i� , �� a C �� . ,� ; . � � � �� . . . . 4 � � \ • � a . � (p g . - � � � � �,� � . D � � � t . . . �: . � �� a � a � . � � � \ . �� - : � � �� o � � $ , . . � ' ``' � ' �, � , 9 `` . �� 4 � � • ' p` ` �� •.,` � , � o��'�� . �' `" � � . , p -� «' Z# � � � � c.o. .-oo � � ..! O Cj � � � � . 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