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HomeMy WebLinkAboutApplication for installation utilities r+cs,ss�vss> HENNEPIN COUNTY ` DEPARTMENT OF PUBLIC WORKS � �;� PERMIT FEE _$50.00 320 Washington Avenue South ` Hopkins, Minnesota 55343 � � (612)930-2550 ? 1`�`�t� �� APPLICATION FOR INSTALLATION OF UTI�ES = ;� � County Road No. Permit Na � Municipaliry � � LOCATION AND/OR DESCRIPTION OF WORK Application is hereby made for permission to place, construct and thereafter a' � maintain a along or across County Highway No. (from, at) � to Applicant _ , ,i;Y; Address ` G F:t,a:� , �� , ` , . � ...�:,�.:��.-..�.�.�....:�.�+��"�. � ` . , � � � Phone - Phone(Emergency) Party or organization performing work Env i t�1 '' ?': � I nc. Add ress �r�� C• i�o tn;:u t.;�t :,ti� :._ :: , S� i :_ _ , _ Phone(Business) ��1� � ��1���� �� Phone(Emergency)� �'� � 1.TYPE OF CONSTRUCTION -Submit five copies of detailed print showing type and location of installation. ;€ � Underground �� �'��� ❑ Aerial ❑ Other ' 4: 5 2.TYPE OF UNDERGROUND CONDUIT � �. 2 Size Depth Size Depth � �< ❑ Multiduct ❑ Iron " � ❑ Plastic ❑ Copper ;� � ❑ Concrete ❑ Cable � p Steel "' S' ❑ ',� f�" 2' (other) ' �. •�;�-:. �; 3. METHOD OF INSTALLING UNDER ROADBEDS ❑ Boring-Jacking- Pneumagopher(48" minimum depth) ` - ❑ Casing-Carrier Pipe required for all installations exceeding 4 inches in diameter. ❑ Open Cut- Explain why necessary � 4.AREA TO BE DISTURBED ` ' - TRAVELED SURFACE SHOULDER BOULEVARD ❑ Concrete ❑ Bituminous ❑ Sod ❑ Bituminous ❑ Gravel Q Field Grass STRUCTURES ❑ Curb&Gutter ❑ Culverts ❑ Trees ❑ Sidewalk ❑ Road Signs ❑ Shrubs :� ;; ❑ Signals ❑ Other 3 5.All work done under this permit, including restoration,will be completed on or before —`�' J �'M ^,ate � �` If work cannot be com leted within dates s ecified,a weitten re uest for ermission of extension must be made to Henne in Count De artment of Public Works. If a � r% P p 4 p P Y P request for extension is not made prior to the expiretion of the Permit,the Permit shall become null and void on the expiration date. c� `� Except for negligent acts of the County,its agents and its employees,the Utility or Permittee shall assume all liability for and save the County,its agents and its employees, q harmless 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 "i k� not limited to the placing,constructing,reconstructing,maintaining and using of said utility under this application and Permit for construction. g (I,We)the undersigned, herewith accept the terms and conditions of the regulations as laid down by the County of Hennepin and agree io fully comply therewith to the ,� satisfaction of the Hennepin County Department of Public Works. PRIOR TO STARTING "�r����� '_:r�:;rt-.eet �-��= `.��.�.ir..1 =:,:�.� c;-.. ; Organization ; � CONSTRUCTION� CALL By(Print Name) F�• �rY ��� Date �; �" 930-2550 s�9�at��e � � _ � � . HC5136back(4/93) PERTINENT REGULATIONS �. Safety 1. Ali warning devices and barricades shall conform to the Minnesota Manual on Uniform Traffic Control Devices. 2. All warning devices barricades,flagmen and equipment shall be provided by parties or organizations performing the work. 3. Standard warning devices and barricades shall be placed as designated by Hennepin County. 4. Standard warning devices and barricades and safety vests shall be kept clean and in good repair at all times. 5. Detour routing shall require 5 working days advance notice to the Hennepin County Utility Section. 6. Excavation shall be cribbed,sheeted and/or fenced when necessary,or as required by Hennepin County. 7. Inclement weather shall be reason for delay of the project start or suspension of the project as determined by Hennepin County. OPERATIONS 1. Permit on Job- Permits or copies shail be kept on the site of the work while it is in progress in the custody of the individual in charge, and shail be exhibited upon request made by any county official. 2. Provisions and Specifications-These general provisions and specifications shall be considered as forming an integral part of each and every permit issued for operations on county roads.The work authorized by this permit shall be done at such time and in such manner as shall be consistent with the safety of the public and shall conform to all requirements and standards of the County of Hennepin as herein specified.If at any time it shall be found by Hennepin County that the work is not being or has not been properly performed,the permittee,upon being notified,shall immediately take the necessary steps,at their own expense,to piace the work in condition to conform to said requirements or standards. 3. Annulment-In the event of wilful failure or neglect by said permittee or their employees to perform and comply with the prescribed conditions,restrictions and regulations,the Department of Public Works may revoke and annul this permit and order said permittee to remove any and all structures or property belonging to said permittee from the legal limits of the highway or counry property. In the event the permittee leaves the highway in a condition needing repair or construction,the Hennepin County Department of Public Works may repair such highway and the costs of such repair or construction shall be paid by the permittee. 4. Execution-The permittee shall use diligence in the execution of the work authorized under this permit in order not to endanger or unnecessarily obstruct travel along the said highway.Operations shall be so conducted at all times as to permit safe and reasonably free travei over the roads within the limits of the work herein prescribed.All safety measures for the free movement of traffic shall be provided by the permittee at their own cost. 5. Conformity to Laws - The installation shall be made in conformity with all applicable laws, regulations and codes covering said installations. All installations shall be made in conformity with regulations of governmental agencies for the protection of the public. 6. Removal-If at any time the permitted structure or facility shall fail from any cause whatsoever,the permittee shall have the same removed or repaired within 48 hours after receipt of written notice to do so,unless by reason of some extraordinary happening Hennepin County may extend such time limits. 7. Existing Facilities-Applicant must protect all existing installations. 8. Private Property-The Permit as issued does not in any way imply an easement on private property. 9. Damage to Roadway - If pavement or roadway is damaged, same shall be restored to its original or better condition, at the sole expense of the permittee. 10. Quality ot Work-Finished surface,base and sub-base of road upon completion of work shall be equal to or better than specifications for original road. 11. Cutting Trees-The permission herein granted dces not confer upon the permittee the right to cut,remove or destroy trees or shrubbery within the legai limits of the highway or relieve permittee from obtaining any consent othenvise required from the owner of the property adjacent thereto. 12. Boring or Jacking-Installation of pipe under roadways,shall be jacked or bored as designated by the Hennepin County Department of Pubiic Works. 13. Liner or Casing Pipe-Shall be required for installations exceeding 4 inches in diameter. — 14. Pressure Grouting-Shall be required as designated by Hennepin County Department of Public Works. 15. Drainage-All waterways and lines of drainage shall remain operative. 16. Pole Anchors-No pole anchors,anchors,braces or other construction on right of way except by permit authorization. 17. Driving Limitations-No driving onto highway from ditch or driving on shoulders or over curbs where damage will occur. 18. Lugs on Equipment-No lugs shall be used on equipment traversing road which will damage the road surface. 19. Clean-up - Street surface and roadside shall be kept clean, neat and presentable throughout construction as determined by the Hennepin County Department of Public Works. 20. Dust Control-Shall be provided upon request of the Hennepin County Department of Pubiic Works. 21. Trees and Vegetation-Burning or disking operations and or the use of chemicals to control or kiil trees,brush and other vegetation is prohibited without prior approval. 22. Restoration - It shall be further understood that the permittee will be responsible for maintenance ot any failures due to settlement, erosion, lack of vegetation growth, rutting,or other job related problems for a period of three(3)years after completion of project and Notice of Completion of work has been received by Hennepin County. 23. Manholes-All manholes,shut-off valve covers,etc.,shall be placed 1/2"lower than finished grade. HC 5137(1/95) HENNEPIN COUNTY DEPARTMENT OF PUBLIC WORKS ����� 320 Washington Avenue South Hopkins, Minnesota 55343 (612) 930-2550 UTILITY PERMIT& SPECIAL PROVISIONS SPECIAL PROVISIONS 1. RESTORATION BASE SURFACE SHOULDER BOULEVARD- Ditch Type Type Type Topsoil Depth Depth Depth Sod Prime Joint Width Seed Tack Cu re 2.TRAFFIC DIRECTION AS PER ATTACHED PLATE NO. 3. REMARKS t•;,:�LS P1.AC�:J Iir 1J9=i WITItUt11 I'�i:P1IT. NO WORK PERMITTED WITHIN ROADWAY SURFACE DURING WINTER (NOVEMBER 15th thru APRIL 15th), UNLESS "SPECIAL PERMISSION" IS OBTAINED. NO WORK WILL BE PERMITTED ON SATURDAYS, SUNDAYS OR HOLIDAYS, UNLESS "SPECIAL PERMISSION" IS OBTAINED FROM THIS OFFICE. IT IS EXPRESSLY UNDERSTOOD THAT THIS PERMIT IS CONDITIONED UPON REPLACEMENT OR RESTORATION OF THE ROADWAY TO ITS ORIGINAL OR BETTER CONDITION. ALL LEGAL REQUIREMENTS SHOWN ON REVERSE SIDE AND ON ATTACHED "SPECIAL PROVISIONS" TO BE COMPLIED WITH. THE DATE WHEN WORK IS COMPLETED MUST BE REPORTED TO HENNEPIN COUNTY DEPARTMENT OF PUBLIC WORKS PERMIT SECTION. TELEPHONE: 930-2550 LIMITATIONS If the County shall make any improvement or change on all or any part of its right of way upon, over, under or along a county road, and such change or improvement requires the moving or changing of public utility facilities in such right of way, then, in that event, the applicant herein shall, after notice in writing by the County, alter, change, vacate or remove from the county road that part o# its facilities necessary to conform to the improvement at its own cost and without any cost to the County. APPROVED: HENNEPIN COUNTY DEPARTMENT OF PUBLIC WORKS. BY - . Date ' -----------------------------------------------------------------------------------------------------------� NOTICE OF COMPLETION OF THE WORK HENNEPIN COUNTY DEPARTMENT OF PUBLIC WORKS DATE OPERATIONS DIVISION-PERMIT SECTION 320 WASHINGTON AVENUE SOUTH HOPKINS, MINNESOTA 55343 Be advised that all work including restoration authorized under Permit No. issued to for work in the Municipality of on County Road # at was completed on and is ready for inspection By (Print Name) (Signature) (THIS FORM MUST BE COMPLETED AND RETURNED WITHIN 24 HOURS OF COMPLET/ON OF TH�' WORIC� HC5137 back(4/93) SPECIAL PROVISIONS (ROADWAY SURFACE) , A. CONCRETE PAVEMENTS 1. Openings The opening made in a concrete pavement must be so located that no side is within three (3) feet of a construction joint. If the side of the opening is within three (3) feet of construction joint, the concrete pavement must be removed to the joint. Before breaking the concrete,the slab must first be cut with a concrete saw full depth, and the exact location thereof must be approved by the Hennepin County Department of Public Works.All broken concrete must be removed from the site and disposed of. NO OPENING SHALL BE MADE IN PORTLAND CEMENT CONCRETE DURING WINTER MONTHS EXCEPT FOR EMERGENCIES. 2. Backfill and Compaction After the excavation has been completed, the requirements for the backfill, i.e.,kind of material, compaction, etc., shall be the same as specified for the repairs made for"Trenching or Sub-surface Operations". (See Paragraph "C"below). 3. Replacement of Concrete The concrete used for the final surface repair shall consist of 3A42 high early strength concrete to meet Minnesota Department of Transportation Specification dated 1988, Spec. No. 2301. This concrete to be secured only from commercial plants which can furnish a mixture that is approved by Hennepin County. The final finish must be burlap dragged or broomed so that it will match the surface of the adjoining concrete slab, and cured with an approved curing method. All construction joints shall be replaced. The fresh concrete patch shail be protected from all traffic contacts for at least 72 hours after it has been finished. B. BITUMINOUS PAVEMENTS 1. Openings When necessary to cut openings in bituminous surfaced roadways, the size of opening and location thereof must conform to size and location specified in the Permit, or to size specified by Hennepin County. When cutting the opening, the edges are to be cut in a straight line, and sides to be smooth and vertical. No ragged edges permitted. Cutting to be done with saw, mill or similar approved tools.All excavated bituminous material to be removed from the site and disposed of. NO OPENING SHALL BE MADE IN B/TUMINOUS PAVEMENTS DURING WINTER MONTHS EXCEPT FOR EMERGENCIES. 2. Backfill and Compaction After the excavation has been completed, the requirements for backfill, i.e., kind of material, compaction, etc., shall be the same as specified for the repairs made for"Trenching or Sub-Surface Operations". (See Paragraph"C" below.) 3. Replacement of Concrete Base Use procedures listed under A-3.Allow the concrete to cure for 72 hours before placing bituminous materials. 4• Bituminous Tack Coat A tack coat shall be applied to all adjacent bituminous and concrete faces before placing the bituminous materials. 5. Restoration of Blacktop All blacktop surfaces are to be restored as soon as possible after backfilling has been completed. The kind and grade must be approved by Hennepin County. Replacement of the bituminous material shall be as directed by Hennepin County. 6. Damage to Blacktop Any blacktop area which has been scarred by equipment, lugs, cleats, teeth, etc., shall be replaced or repaired as directed by Hennepin County. C. TRENCHING OR SUB-SURFACE OPERATIONS 1. Openings Trenches for conduits, water, steam, oil and gas pipes, sewers and other utilities placed within the right of way shall be located as approved by Hennepin County. Trenches for construction along the highway shall not be opened for a distance of more than 300 feet at any one time, unless especially authorized. 2.Storage of Excavated Materials Excavated or other material shall be placed or stored on the side of the operation farthest from the traveled road unless otherwise authorized by Hennepin County, and in such manner that there will be no interference with the flow of water in any gutter, drain, pipe, culvert, ditch or other waterway. 3. Backfill and Compaction After excavation has been completed, it may be filled with the excavated material which has been removed, with the following exceptions: If the excavated material consists of mucky, soft or unstable soil, boulders or large rock, it must be removed and disposed of outside the county right-of-way and replaced with granular(sandy) material. The refilling of the trench shall be done with approved material compacted by the ordinary compaction method and shall follow as rapidly as possible the placing of sub-surface structures and shall be completed in such manner as will conform to the earth shoulder or subgrade or as directed by the Hennepin County Department of Public Works. 4. Replacement of Gravel Base The gravel base shall be replaced with approved material and compacted. All compaction must be in accordance with the Minnesota Department of Transportation Specifications dated 1988, Section 2105.3F2 "Ordinary Compaction Method".