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Home My WebLink Aboutapplication to MnDOT for ROW work ��0 C ITY OF ORONO ,, y. Street Address: Mailing Address: Telephone(952)249-4600 y�, � 2750 Kelley Parkway P.O. Box 66 Fax (952)249-4616 `,9kFSH��" Orono,MN 55356 Crystal Bay,MN 55323 www.ci.orono.mn.us October 14, 2014 Steve & Barbara Collins 3680 Jacobs Mill Road Long Lake, MN 55356 RE: Submitted MN DOT Application for Misceilaneous Work on Trunk Highway Right-of-Way The City has received a copy of your application to plant trees on the property addressed 3760 Jacobs Mill Road (PID 32-118-32-21-0010). The requested tree planning does not appear to be located within a highway right-of-way, rather on a lot within the Jacobs Mill Subdivision. Therefore the city has no objections to the planting of two trees at the above address. If you have any questions, I can be reached at 952-249-4620 or at cmattson@ci.orono.mn.us. Sincerely, CITY OF ORONO � � Christine Mattson Planning Assistant ro�m iit��o-to-tui�) Document Management System# MINNESOTA DEPARTMENT OF TRANSPORTATION `�N�'� D;Sn;�t Pe,m;�p APPLICATION FOR MISCELLANEOUS WORK ON � TRUNK HIGHWAY RIGHT OF WAY C.S. T.H. � R.P. (THIS SECTION FOR MnDOT OFFICE USE ONLY.) ATTACH A SSETCH OF THE PROPOSED WOR%AREA AND RELATION TO TRUNR HIGHWAY. SUBMIT TO DISTRICT PERMIT OFFICE OF MlNNESOTA DEPARTMENT OF TRANSPORTATION. APPLICAN'f TELEPHONE ADDRESS(Street,City,State,Zip) �ev�. Ci�.r�2 �c,.rl�c�� s (�12-13J-�1`1('� 36�G' =1a�abs M� Rd'� �rvti.� � �UIFJ SS35� PARTY PERFORMING WORK TELEPHONE ADDRESS(Street,City,State,Zip) j53�� r�-�vr� 7`�'.�s b l2-Z�Z-�'l2-I 33� �f� 5�--. �t� �ac�a p�t�` LOCATION OF PROPOSED WORK (Ciryt1'ownship) (Co�mry) (D�stance) (N-S-E-� SPECIFIC ROAD INT ECl'IO O LANDMARK �2�:� � f �,��.� r��' � � ��.� �z Hi wa in ' �� i� � Miles �'�'� of (�, , WII.L TffiS FACILITY BE WITHIN TRIBAL LANDS? ❑Yes ❑No IF YES,WFIICA ONE? NATURE OF WORK � r ��cc�,�v��=�5 �u 6�oc.k p ur' �(.2c.tr U �w y � a� lZ ��(�v�SS �v��r�� F �� 25--x� �c� � n bi�� t �es SURFACE TO BE DISTURBED (Check Appropriate Boxes) J� �i ❑Roadway ❑Shoulder ❑Concrete ❑Bituminous ❑Gravel [�''�urf Only �� n�� 6 ��(�"�- -�r��-i_�'�� ' ❑Other(explain) '"1 73W►-�'� LY�s� �d� ��"^ S� GT �►Gc DEPTH OF EXCAVATION BELOW NUMB�,EoR� &SIZE OF E CAVA NS METHOD OF INSTALLA ON/CONS CTION SURFACE (_ ('_ L �t�Z �v-�' l�(�f ` �Q� �6�2 �G�Qf^ ��i'�Q :5,��l�c� {C 'r�2.1 WORK TO START ON OR AFTER WORK TO BE COMPLETED BY IS TRAFFIC DETOUR NECESSARY? Yes No l�C/1(�,,�� i:e-�f'►�l7�-I� IS`` (tF YES,TRAFFIC CONTROL PLAN IS REQUIRED.) APPLICANf'S ACCEPTANCE,WAIVER AND INDENINIFICATION The undersigned applicant 6ereby agrees to comply with appGcable atatutes,rules,and the standard conditions and speciai provisions of this permiw The applicant understands and agrees that no work in connection with this application will be started uMil the applicallon has been approved and the permit issued. The applicant is aware of circumstances or hazards that may arise while performing the work associated wit6 tlus application that could result in injury,loss,damage or desth,and the applicant assumes the risk of such circumstances,dangers and hazards,whether reasonably foreseeable or nok The applicant also understands that this permit may also be subject to the approval of local road authorities having joint aupervision over said atreet or highway,and may be subject to appGcant's compliance with the rules and regulations of the Minnesota Environmental Quality Board and/or any other affected governmental agencies. The undersigned applicant expresaly agrees t6at except for negligent acts of the State,its agents and employees,the applicant or his/her agents or contractor shsll assume all liability for,and save the State,its agents and employees,harmless from any and all clsiros for damagea,actions or causes of action arfsing out of the work to be done in connectlon with this application and permit NAME AND 7'TTLE EMAIL ADDRESS �lllFF� �� •-�1f�5, �C.� �![`��5��, � / DATE (�! � ( SIGNATURE ��/��s� ' DO NOT WRITE BELOW THIS LINE PERMIT NOT VALID UNLESS BEARING AUTHORIZED MnDOT SIGNATURE AND PERMIT NUMBER AUTHORIZATION OF PERMIT It is eapressly understood that this permit is conditioned upon restoration of t6e trunk highway right-of-way to its original condition or to a satisfactory condition. In consideration of the applicant's agreement to comply in aii respects with the applicable laws and the conditions of the Commissioner of Transportation pertafning to this permit,permission is hereby granted for the work to be performed as described in the above application,sald work to be performed in accordance with the following standard conditions and special provisions: SEE ATTACHED STANDARD CONDTTIONS AND SPECIAL PROVISIONS Date All Work To Be Com leted B Authorized MnDOT Si ature Date of Authorized Si ature DISTRIBUTION DEPOSIT REQUIREMENTS DEPOSPT TYPE Original to Area Maintenance Engineer ❑ No Deposit Required Cashier's Check# Applicant ❑ Deposit Required in the Amount of$ Certified Check# Subarea Supervisor Date Deposit Received Money Order# Roadwa Re 13tions Su ervisor Depaslt w be returned upon satujactory complelion ojall work Bond# DATE WORK COMPLETED The date when the work is com leted must be re orted to the MnDOT District Pe�mrts O ice) Pape 1 nf 2 � �, �`� �� (� C`�� /2 `_ Y � �fs � �`� �2�� 1 ro� � � �G�`s �.�-�`� � � � , � �� 1, , � . i � � =� � �� =� - � �-----------�_ � ''�' � e\. �� , � _ /5 ��,-y.� � a� �� l �� . \ . � % � � ---,�-----�' � , � ,� �� s� � ��s r� � �� C�<F __ _ ____ ____________________ � ' STANDARD CONDITIONS OF MISCELLANEOUS WORK PERMIT 1. The permit holder must comply with all applicable laws and regulations, including Worker's Compensation laws. 2� If work to be done lies within a city or platted town, permission must also be obtained from such city or town. 3. Where work on or near the traveled roadway is necessary, proper traffic signs,channelizing devices,warning lights, and barricades shall be erected to protect traffic,employees,and pedestrians. All traffic control devices and methods shall conform to the Minnesota Field Manual on Temporary Traffic Contro)Zone Layouts, Minnesota Manual on Uniform Traffic Contro) Devices(MMUTCD), Minnesota Standard Sign Manual, and the appropriate provisions of Standard Specification 1710. 4. Unless adequately protected by a traffic barrier,there shall be no work within the clear zone, nor shall pipe materials, equipment or other objects be stored within the clear zone as determined by the MnDOT and as defined by the latest edition of AASHTO's"Guide for Selecting Locations,and Designing Traffic Barriers". 5. Excavations must be cribbed when necessary,depending upon type of soil, in order to prevent cave-ins. All excavations,trenching and/or jacking and boring pits shall be shored or sloped in accordance with OSHA requirements. 6. No guys,stays, or any structures are to be attached to trees on trunk highway right of way. 7. No poles, anchors,anchor braces,or other construction shall be placed on the roadway shoulder or within the prescribed clear zone. 8. Installation of pipe under concrete or bituminous pavements shall be done by jacking or boring or other approved methods. 9. When open trenching or excavating in existing roadways,all subgrade, base,and surfacing materials shall be replaced with the same type,depth,and density of materials which were removed, unless approved by the Area Maintenance Engineer. 10. All work that involves trenching, backfill, or compaction must be done to MnDOT's Standard Specifications for Construction. Depending on the construction work to be performed, use of one or more of the following specifications may be needed: Excavation and Embankment 2105,Aggregate Base 2211,Aggregate Shouldering 2221, or Structural Excavation and Backfills 2451,Subgrade Preparation 2112. Compaction methods must be approved in advance by the District Permit Office 11. If pavement or roadway is damaged,same shall be restored to a condition as good as or better than the original condition. 12. All pavements shall be replaced in accordance with State specifications. 13. If settlement occurs or excavation caves in so that replaced materials settle(bituminous mat or concrete base), same shall be restored to a condition as good as or better than the original condition. 14. No lugs shall be used on equipment traversing the road which will damage the road surface. 15. No driving onto highway from ditch or driving on shoulders will be permitted where damage will occur. 16. No foreign material such as dirt,gravel, or bituminous material shall be deposited or left on the road during any construction activities. 17. Roadside shall be cleaned to original status upon completion of work. 18. Underground construction must be so constructed as not to harm or unnecessarily destroy the root growth of specimen trees. 19. Cutting and trimming of trees within the right of way and removal of resulting stumps require prior approval of the Area Maintenance Engineer or his authorized representative. 20. If MnDOT shall make any improvements or changes upon,over,under,or along the trunk highway,then and in every case the applicant herein named shall after notice from MnDOT proceed to alter, change,vacate, or remove from trunk highway right of way said works necessary to conform with said changes without cost whatsoever to the State of Minnesota. 21. After work on a project is completed,the permit holder must notify the Area Maintenance Engineer or his authorized representative that such work has been completed and is ready for final inspection and acceptance by MnDOT. MnDOT Form 1723 Standard Conditions of Miscellaneous Work Permit(7-15-2013) Page 2 of 2 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. 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N ID: � ' Print Date: 10/6l2014 i Owner D S Collins&B D Collins Market $563,000 iName: Total: Parcel 3680 Jacobs Mill Rd Tax $7,010.06 j Address: Orono, MN 55356 Total: (Payable: 2014) i � Property Residential Sale �1,170,000 � Type: PYIC@: This map is a compilation of data from various sources and is fumished"AS IS"with no � Home- Homestead Sale 03/2006 representation or warranty expressed or � St@8d: DBte: implied,including fitness of any particular � purpose,merchantability,or the accuracy and completeness of the information shown. � Parcel 5 acres Sale � Area: 217,967 sq ft COde: COPYRIGHT OO HENNEPIN COUNTY 2014 i f � Think Green:� t http://gis.hennepin.us/Property/print/default.aspx?C=451397.5887247905,4981841.700900... 10/6/2014 � ��:-�� . E�;,.,� �: . d J' ! �� f M �Y I+l � i '� �'' .Y� 'h � 1 t ' 3 a �� t a . I �� . N k �� {e-� �. , 1/ j f � � t ....r � Y � i` ��'.. 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