HomeMy WebLinkAbout2001-09-01 Comcast Right of Way Permit City of Oak Park Heights
RIGHT-OF-WAY PERMIT FORM
CITY PERMIT NO. : 20 - PERMIT FEE: minimum $150.00
COMPANY PERMIT NO. : DATE:
APPLICANT INFORMATION:
DEVELOPMENT/ ADDITION / LOCATION DESCRIPTION OR. SITE ADDRESS:
57o7 AlecutAJ A)
OWNER (Applicant) : C O/i.C cc S
UTILITY COMPANY: COttCsa S CONTACT PERSON: re f4
TELEPHONE NO: "�SJ 1 9g7 ADDRESS: c/7Qs D( *cL PG' v th
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CITY: M L fr h-e-'}'G VI k .. STATE:M V%ZIP CODE: 5T 93
CONTRACTOR INFORMATION:
CONTRACTOR PERFORMING WORK: U V l U Q rS 04.1 S'-e r u rc e-5
CONTRACT NAME: —Fro U I 5 CONTRACT NUMBER: 7`3 23 Q PHONE'73
CONTRACTOR PERFORMING WORK MUST ATTACH CURRENT CERTIFCATE OF 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 BE ISSUED.
TYPE OF WORK :
L INEW PRIVATE UTILITY
((REPLACE/REPAIR
LICOMMERCIAL DRIVEWAY APRON (WIDTH?) feet
RESIDENTIAL DRIVEWAY APRON (WIDTH?) feet
CONNECTION TO CITY SYSTEM (REQUIRES PREPAYMENT OF ACCESS FEES):
nATERMAIN I LSTORM SEWER ❑SANITARY SEWER
['OTHER
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) :
I (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)res
L�EXCAVATION IN BOULEVARD or CITY OWNED PROPERTY (requires approved plan and security for
restoration)
62r.O.W. ACCESS (requires approved plan on use, control, mitigation and restoration.
Must have full marking of new utilities)
EXPLANATION OF WORK / ADDITIONAL COMMENTS: .P, ,
RE I E
AUG 21 2009
Wt. twit( Alv -F )( Clue +0 OptiA cut
Poo,a
PROPOSED START DATE: W I4(vl f c rM i He d
PROPOSED END DATE: (j0 Da rs
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.
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