application to MnDOT for ROW work

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INSTRUCTIONS FOR COMPLETING APPLICATION FOR MISCELLANEOUS WORK ON TRUNK HIGHWAY RIGHT OF WAY(FORM 1723) Form 1723 is for miscellaneous minor work activities on trunk highway right of way. It may be used for installation of utility customer service line connections that do not cross or parallel the roadway within the trunk highway right of way. Form 1723 is also used for repair and maintenance of existing utility facilities,installing miscellaneous guy wires and anchors,or tree trunming around utility lines. Form 1723 may also be used to place temporary obstructions on the right of way,to perform temporary relocations to accommodate construction projects,and to place objects on the trunk highway right of way under Minn. Statutes§§160.27 or 173.025. Fill Out This Form Completely Print(in ink)or type all information. An incomplete application will delay processing. The form can be filled out online and then printed at: www.dot.state.mn.us/utility/forms/index.html • Be sure to sign it at the bottom.Submit the original form only. • FAXES ARE UNACCEPTABLE • Complete each item on the application. Be specific. If any item does not apply,print"N.A."in the blank. • Provide a detailed location of proposed work and give reference to nearest cross streets. • Include plans of proposed work along with detailed drawings showing type and location of work in relation to MnDOT right of way,on no larger than 11x17 sheets • Detail any type of traffic interference this work may require and submit a traffic control plan. Detouring of the traffic from the trunk highway will not be permitted,except by special arrangements with the MnDOT District Permit office. All costs involved in the re-routing of traffic including,but not luruted to,furnishing barricades,installation or rearrangement of traffic control signs,pavement marking and special flag person services will be chazged to the applicant at rates set by MnDOT for the equipment,labor,and materials used. • Indicate type,kind and size of any object to be placed on trunk highway right of way. Indicate the method of installation and equipment to be used for excavation and compaction. Submit the complete,signed and dated application(all pages of the form)with the required plans to the MnDOT District Permit office. Contacts and addresses can be found at: www.dot.state.mn.us/utility/files/�df/contacts/pernuts-contacts.pdf After the Miscellaneous Work Permit has been approved The applicant will be notified and a security deposit will be required.The pernut will have Special Provisions and drawings indicating the construction requirements. Compliance with these instructions during the work operations is mandatory. All Permittees are responsible for the entire costs of their work activities,including proper traffic control. Work cannot be started until all permit and deposit requirements are met and you have received the approved permit. Security Deposit A security deposit is required for pernuts that authorize work in trunk highway right of way to ensure that work is completed to MnDOT's satisfaction.The actual amount required will depend on the specific situation.The District Permit Section will deternrine the actual amount and type of deposit to be submitted based on the specific situation.Deposits may be in the form of a certified check, cashier's check,or surety bond made payable to"State of Minnesota, Commissioner of Transportation."Deposits must be irrevocable and cannot expire. A permit will not be issued until the required deposit is received. After construction is completed The applicant must notify the MnDOT District Permit Of£ice for fmal inspection. If the construction and all other related work is satisfactory and the turf items aze re-established,the deposit will be returned to the applicant.The approved permit is a legal document and should be retained with other valuable papers. MnDOT Form 1723 Instructions(06-26-2013) Pase I of 1