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HomeMy WebLinkAbout2016-03-10 Right of Way Permit 2016-04 City of Oak Park Heights RIGHT-OF-WAY PERMIT FORM CITY PERMIT NO. : 20j4. O t PERMIT FEE: minimum $150.00 COMPANY PERMIT NO. : DATE: -/0 -/6 APPLICANT INFORMATION: DEVELOPMENT/ ADDITION / LOCATION DESCRIPTION OR. SITE ADDRESS: 1875 Greeley Street South (Oak Park Heights,MN 55082 OWNER (Applicant) : ISD#834 Stillwater Public Schools UTILITY COMPANY: Peterson Companies CONTACT PERSON: Curt Peterson TELEPHONE NO: 612-919-7272 ADDRESS: 8326 Wyoming Trail CI Ty: Chisago City STATE: MN ZIP CODE: 55013 CONTRACTOR INFORMATION: CONTRACTOR PERFORMING WORK: Peterson Companies CONTRACT NAME: Stillwater HS CONTRACT NUMBER: NA PHONE: 612-919-7272 • CONTRACTOR PERFORMING WORK MUST ATTACH CURRENT CERTIFCATE OP INSUARCE NAMING THE CITY AS AN ADDITIONALLY INSURED AND IN AN AMOUNT NOT LESS THAN $1,000,000. WITHOUT SUCH PROOF OF INSURANCE NO PERMIT WILL HE ISSUED. TYPE OF WORK : ( NEW PRIVATE UTILITY REPLACE/REPAIR ^ LJCOMMERCIAL DRIVEWAY APRON (WIDTH?) feet ORESIDENTIAL DRIVEWAY APRON (WIDTH?) feet ((CONNECTION TO CITY SYSTEM (REQUIRES PREPAYMENT OF ACCESS FEES):�('qq�� DWATERMAIN DSTORM SEWER I ]SANITARY SEWER EITHER WHAT THE WORK WILL INVOLVE (REQUIRES SECURITY TO PROTECT INFRASTRUCTURE / COMPLETE RESTORATION. Complex plans may incur additional costs for mitigation plan review and inspections. Must include erosion control, protective measures, and restoration plans all new utilities must be fully located for future GSOC requirements): ®STREET OPEN CUT (requires approved plan with access, traffic control, and inspected full width restoration - security required) PATHWAY CUT (requires approved plan with full width restoration and security for restoration) EDEXCAVATION IN BOULEVARD or CITY OWNED PROPERTY (requires approved plan and security for restoration) .O.W. ACCESS (requires approved plan on use, control, mitigation and restoration. Must have full marking of new utilities) EXPLANATION OF WORK / ADDITIONAL COMMENTS: II Connecting new additions of school to city sewer via a new manhole in 58th Street North. Also, we will be constructing a new turn lane on 58th Street North to serve the school. PROPOSED START DATE: May 2015-Exact Date TBD PROP0SED END DATE: May 2015(3-5 day period total to include restoration) Applicant agrees to abide by and follow all applicable ordinances, laws, rules, and regulations of all regulatory bodies, including but not limited to city, county, state or federal regulatory agencies. Applicant acknowledges that placement of its utilities in any Right-of-way is subject to the rights and rules of the City Of Oak Park Heights. Damage, loss or destruction of applicant's facilities and/or its resulting business interruption will not be restored, compensated or reimbursed by the City in the event the City needs to remove, relocate or terminate such facilities while accessing its utility services in the area for any reason. Private utility locates are required by the owner and/or applicant for the utility in the Right-of-way and in perpetuity. The Applicant shall provide, at its sole expense, full "as-built" drawings for all infrastructure installed in the City Right-of- way. All "as-built" drawings shall be completed by a licensed Minnesota Engineer or Surveyor. "As-builts" shall be provided in paper and digital form acceptable to the City of Oak Park Heights including GPS coordinates in the Washington County Coordinate system. The City additionally reserves the right to remove and/or deactivate any and all installed infrastructure placed in its Right-of-way should these "as-builts" not be provided or should these prove inaccurate. The Applicant accepts in perpetuity the responsibility to perform at its expense all necessary locates (Gopher State One Calls) that may arise or be requested in the future by the City or other parties. The Applicant does release and hold harmless the City from any and all responsibility for utility / service locates. APPLICANT SIGNATURE - by your signature you accept and agree to all conditions as stated above. Must be signed by owner, president or CEO of firm installing utilities. Name Jon Peterson Title President Signature' f' Date: 2-19-16 Phone #: 651-257-0307(direct) PERMIT EXPIRATION DATE: Oe c e Y L t r 311 tot(p SECURITY ESCROW AMOUNT REQUIRED: $ a N F;tt HAS PROOF IOP INSURANCE BEEN SUPPLIED? fe s TYPE OF FINANCIAL SECURITY: D GASB/CEZCR DANNUAL APPROVAL SIGNATURE: TITLE: DATE: Ditec Pw ?liallb T "s Pe(rti'f is sueJec.f fo ik r1, Tt C(-tut Gil Su,Pl,Pn't ev.4( Q1' f an(il t_a/4064/04J da -41 /s /vt Cick f° Zo/C I Client#:7071 PETECOMI ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 2/18/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTNAME: MN-COMMERCIAL LINES PHONE612 349-2400FAX (A/C,No,Ext): (A/c,No): 612 349 2490 COBB STRECKER DUNPHY&ZIMMERMANN E-MAIL ADDRESS: 150 S FIFTH ST STE 2800 INSURER(S)AFFORDING COVERAGE NAIC# MINNEAPOLIS,MN 55402 INSURER A:Amerisure Insurance Company 19488 INSURED INSURER B:Amerisure Mutual Insurance Comp 23396 Peterson Companies Inc INSURER C: 8326 Wyoming Trail INSURER D: Chisago City,MN 55013-9382 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF IADDL NSURANCE NSR SWVD POLICY NUMBER IUBR MM/DDY E/YYYY) (MMroD�) LIMITS A X COMMERCIAL GENERAL LIABILITY CPP2095245 01/01/2016 01/01/2017 EACH $1,000,000 PREMIS CLAIMS-MADE X OCCUR aEoNccTurrence) $300,000 X Contractual Liab MED EXP(Any one person) $5,000 X XCU PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY CA2095244 01/01/2016 01/01/2017{Ea eocideD SINGLE LIMIT $1,000,000 X ANY AUTO _ BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS - AUTOS — X HIRED AUTOS X AUTOS AWNED (Perr acddentROPERTY DAMAGE $ $ B x UMBRELLA LIAB X OCCUR CU2095246 01/01/2016 01/01/2017 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X.RETENTION$10,000 $ A WORKERS COMPENSATION WC2095247 01/01/2016 01/01/2017 X STATUTE OTH- ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 . DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) License/Permit Requirements Additional Insured only if required by written contract with respect to General Liability: City of Oak Park Heights CERTIFICATE HOLDER CANCELLATION Cityof Oak Park Heights SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 14168 Oak Park Blvd N ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 2007 Stillwater,MN 55082 AUTHORIZED REPRESENTATIVE I .170da****4. ' cf....4.e ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S778397/M766056 VLH City of Oak Park Heights 14168 Oak Park Blvd N.•Box 2007•Oak Park Heights,MN 55082•Phone(651)439-4439•Fax 439-0574 Thursday March 10,2016 IDS# 834 Stillwater Public Schools 1875 Greeley Street S Stillwater,MN 55082 Curt Peterson Peterson Companies 8326 Wyoming Trail Chisago City, MN 55013 Re: Terms and Conditions of Right of Way Permit 2016-04—IDS 834 The conditions of this permit is applicable to all construction related activity within the City's Right-of-Way including but not limited to traffic control, 58th Street excavation,tie in and installation of sanitary pipe and structures, street and curb replacement, storm sewer alterations and or additions, street lane alterations,and trail relocation. The following conditions apply to Right of way Permit 2016-04- IDS # 834: 1. The City reserves the right to inspect any and all work that impacts City infrastructure. The City's inspector for this project is Lucas Miller of Stantec. Contact Lucas Miller at least forty eight(48)hours in advance to schedule inspections. Lucas Miller Construction Manager Stantec 2335 Highway 36 West St. Paul, MN 55113-3819 Phone: (651) 604-4705 Cell: (612) 875-2430 Lucas.J.Miller@stantec.com 2. The permittee and or its contractor must adhere to the Minnesota Manual on Uniform Traffic Control Devices for any and all work that impacts traffic. 3. The permittee is responsible to effectively communicate planned road closures to impacted businesses and to the public one week in advance. The City will post road closure notifications on its website,but is not responsible for the permittees outreach. The permittee must provide detailed road closure plans and detour plans.No road closures are permitted without advanced City written permission and which shall also require advanced notice and or outreach,a road closure plan and a clearly marked detour. Fifty Eighth(58th) Street has high traffic flow between 7 AM—6 PM; road closures shall not impact traffic during peak times. Closure of 58th St. will only be considered for utility work within the Right of Way. 4. The City reserves the right to inspect the following,including but not limited to the list below. It remains the Contractor's responsibility to provide not less than forty eight (48)hours' notice for each and every inspection. a. Sanitary sewer pipe and structures installation i. Manhole installation inspection. ii. Pipe installation inspection. iii. Air and mandrel testing. iv. The permittee shall televise the sanitary sewer pipe post construction and provide video and reports to the City. b. Street Patch Inspection—must be full street width patch i. Street Excavation Patch-The means and methods for street patching shall be done under traffic with the proper signage and flaggers.No closure of 58th St. will be permitted by the City for this scope of work. Consider doing grading and patching work in phases. ii. Subgrade and compaction test c. Storm Sewer i. Installation inspection ii. Lamping d. Concrete Work—All concrete curb work requires inspection and testing per MNDot Standards i. Air test ii. Temperature test iii. Slump test iv. Strength test(breaking cylinders) e. Turn Lane Inspection i. Grading inspection ii. Paving inspection 2 f. Trail Installation i. Grading inspection ii. Paving inspection g. At the conclusion of the project,the Contractor must provide complete AS BUILT Drawings and record plans in hard copy and electronic format suitable for direct incorporation into the City's GIS systems. THE ADDITIONAL TERMS AND CONDITIONS AND PROVISIONS ARE Agreed and Accepted by the CONTRACTOR /11/(J4 Signed LL,K Ke4AJ QVS iIn Print Name&Title - Q-rna N�T RY Signature FOR THE ABOVE Person Affix Stamp Here: 4 JULIE A.HULTMA NOTARY PUBLIC•MIN \ , : My Commission Expires Jan.Si•' 3