HomeMy WebLinkAbout2007-12-10 OPH Right of Way Permit City of Oak Park Heights
RIGHT -OF -WAY PERMIT APPLICATION
CITY PERMIT NO.: (V A PERMIT FEE: minimum $150.00
CONST. PERMIT NO.: Co' - 3 31 DATE: /2 -Jo -0 7
APPLICANT INFORMATION: d 1
DEVELOPMENT/ ADDITION / LOCATION DESCRIPTION OR SITE ADDRESS:
Boutwells Landing Care Center (Addition) - 13575 58th St.N., OPH
OWNER(Applicant): VSSA - Boutwells Landing
UTILITY COMPANY: St. Utilities CONTACT PERSON: Jay Walters
TELEPHONE NO: M: 612 - 369 -3056 ADDRESS: 190 Ryan Ln.
CITY: Little Canada STATE: MN ZIP CODE: 55117
CONTRACTOR INFORMATION:
CONTRACTOR PERFORMING WORK: St. Paul Utilities
CONTACT NAME: Jay Walters LICENSENO.: PHONE: M: 612- 369 -3056
• CONTRACTOR PERFORMING WORK MUST BE LICENSED BY CITY & PROVIDE REQUIRED
INSURANCE CERTIFICATE
• HOMEOWNER MUST PROVIDE CERTIFCATE OF INSURANCE NAMING THE CITY AS AN
ADDITIONALLY INSURED, IN AN AMOUNT NOT LESS THAN $1000,000.
WITHOUT SUCH PROOF OF INSURANCE NO PERMIT WILL BE ISSUED.
TYPE OF WORK:
)(NEW PRIVATE UTILITY ❑COMMERCIAL DRIVEWAY - APRON (WIDTH) Ft.
CSat 1 N W)
❑ R EPLACE/REPAIR ❑RESIDENTIAL DRIVEWAY - APRON (WIDTH) Ft.
CONNECTION TO CITY SYSTEM (REOUIRES PREPAYMENT OF ACCESS FEES):
❑WATERMAIN El STORM SEWER ❑SANITARY SEWER ID OTHER
WHAT THE WORK WILL INVOLVE:
(REQUIRES SECURITY TO PROTECT INFRASTRUCTURE / COMPLETE RESTORATION. Complex plans may
incur additional costs for mitigation plan review and inspections. Must include erosion control, protective measures, and
restoration plans - all new utilities must be fully located for future GSOC requirements based on the attached requirements
for water, sewer and other utilities).
❑ STREET OPEN CUT (requires approved plan with access, traffic control, and inspected full width restoration - security required)
❑ PATHWAY CUT (requires approved plan with full width restoration and security for restoration)
❑ EXCAVATION IN BOULEVARD or CITY OWNED PROPERTY (requires approved plan and security for restoration)
O.W. ACCESS (requires approved plan on use, control, mitigation and restoration. Must have full marking of new utilities)
'' EX P PLANATION OF WORK / ADDITIONAL COMMENTS:
CJ L U h C L C ,D 9 - (':u.n h . . p l i ` s t a d1U`n t 5$ S' .
PROPOSED START DATE: 12- 10 101 PROPOSED END DATE: 01 7a/ kg" FILE
COPY
Applicant agrees to abide by and follow all applicable ordinances, laws, rules, and
regulations of any other 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 of the City Of Oak Park Heights.
Damage, loss or destruction of applicant's facilities will not be restored,
compensated or reimbursed by the City and in the event the City needs to remove or
damage them in accessing its utility services in the area for any reason. Private
utility locates are required by the owner and /or applicant for the utility 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.
i +.•,.
DATE:
TO BE COMPLETED BY CITY:
LICENSE & /OR CERTIFICATE OF INSURANCE PROVIDED? YES / +�+'
PERMIT EXPIRATION DATE: REQUIRED SECURITY:
None - D.A.
TYPE OF FINANCIAL SECURITY: ❑ CASH / CHECK - NA
� PRO - S - TUBE: TITLE: Public DATE:
A l; Works Director RI NI 01
FEE CALCUL ' • N: ROUTING:
Right -of -Way Fee: $150 00 Original to Finance
Copies to: Public Works
Security Fee: NA Property File
Applicant
Total Due: $150.00