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HomeMy WebLinkAboutRIGHT-OF-WAY APPLICATION - 21-00468 - 110 E MAIN STREET - AERIAL WORK ON POLES ALONGPage 1 of 3 Right-Of-Way Encroachment Application ITD 2110 (Rev. 08-16)And Permit For Utilities itd.idaho.gov ITD Permit Application Number Key Number Project Number Beginning Station Ending Station Segment Code Roadway Type (Urban, Rural, Interstate) Number of Lanes Fee $50 Paid No Charge Inspection Fee Required $ Performance Bond Required $ Applicant Information (Please Print or Type) Pe r m i t Ty p e New Installation Upgrade Relocation Other Gas Water Cable Telephone Electric Sewer Fiber Optic Other Overhead Underground Overhead and Underground Both Involved Installation Method Jack Bore Pavement Cut Trench Casing Plow Other Lo c a t i o n Route Beginning Milepost (e.g. 0.123) Ending Milepost (e.g. 0.123) Section, Township, Range GPS Coordinates Latitude Longitude Elevation County(s) Name of Nearest Crossroad Distance and Direction From Crossroad (Feet) N S E W Distance From Center of Road (Feet) Right-of-Way Line (Feet) Edge of Pavement (Feet) Right-of-Way Width (Feet) Angle of Crossing (Degrees) Vertical Clearance (Feet) Depth (Inch) Facility Specifications Potential (V, KV) Pipe Size (Inch) Pressure (PSI) Structure Attachment Type (Requires Bridge Approval) Co n t a c t s Construction Contractor Phone Number E-Mail Address Traffic Control Contractor Phone Number E-Mail Address Traffic Control Plan Submitted Projected Start Date Project Duration Yes No I certify that I am the Authorized Utility Company Representative and request permission to construct the above facilities within the State Highway Rights-of-Way in accordance with the General Provisions printed on the reverse side of this form, the Special Provisions, and the Plans made a part of this permit. I request receipt of the approved Permit in the following manner: Paper Electronic Company Name Authorized Representative (Print) Phone Number Mailing Address City State Zip Authorized Representative's Signature E-Mail Address Date A copy of this permit, complete with special provisions, plans and traffic control requirements, shall be kept at the work site at all times when work is in progress. Subject to all terms, conditions, and provisions shown on this form or attachments, permission is hereby granted to the above-named applicant to perform the work described. Local Government Approval (when required) Signature Title Date Department Approval ITD’s Authorized Representative’s Signature Date Note: The permit will be considered Temporary until final inspection and approval by an ITD representative. Hwy 33 334.35334.27 19 & 30 6N 40 E -111 47'.35" W 43 49'33.21" N 4875 Madison S 2nd W 60.40' 90 48"N/A N/A N/A N/A N/A 27' 333.76' 5'131.26' Track Utilities LLC on behalf of Lumen-Michellae Belnap michellaebelnap@trackutilitiesllc.com208-899-7408 Specialty Contruction Supply/Roger Carey rcarey@specialty208.322.6800 Track Utilities LLC on behalf of CenturyLink Michelle Smith 208-605-8055 Idaho Falls, ID 834011790 E Precision Dr Msmith@trackutilitiesllc.com as soon as approved 6/1/21 General Provisions: ITD Permit Application Number _____________________ ITD 2110 (Rev. 08-16) Page 2 of 3 1. No work shall commence until the permittee is given notice to proceed by an authorized representative of the Department. The permittee shall notify the Department five (5) working days prior to commencing the permitted work or as otherwise approved. This permit is valid for one year and SHALL BE VOID if all work is not completed and as-built drawings submitted, and the Department has not been contacted to make final inspection for approval within one year of the issuance date. 2. The permittee shall observe and comply with all applicable laws, ordinances, regulations, orders and decrees. By signing this permit, the permittee, his designated representative or successors, agree to indemnify, save harmless, and defend regardless of outcome the State from the expenses of and against all suits or claims, including costs, expenses, and attorney fees that may be incurred by reason of any act or omission, neglect, or misconduct of the permittee or its contractor in the design, construction, and maintenance or use of the facility covered by this permit. The permittee is responsible for obtaining all other necessary permits and approvals prior to starting work. The permittee must adhere to Idaho Code 55, Chapter 22, “Underground Facilities Damage Prevention,” prior to any excavation work. 3. During the progress of all work, traffic control devices shall be erected and maintained as necessary or as directed for the protection of the traveling public. All utility companies, or contractors working for utility companies, are required to identify the name of the utility company at the work site. All traffic control devices shall conform to the Manual on Uniform Traffic Control Devices for Streets and Highways (latest edition adopted by the Department) and all other Department requirements. All flagging personnel shall have flagging certification valid in Idaho (some other State’s are accepted). All traffic control plans shall be prepared and signed by a Traffic Control Supervisor or Professional Engineer. 4. All utilities shall be installed under culverts. 5. Except as herein authorized, all underground crossings shall be bored or jacked. 6. Parked equipment and stored materials shall be as far from the traveled way as feasible. Items, excavations or obstacles within 30 feet of the traveled way shall be properly marked and/or protected. 7. Upon completion of the permitted work, the permittee shall restore the site to original condition or better at no expense to the Department. Restoration includes, but is not limited to, repair of any and all damage, correction of any interferences with highway drainage, restoration of survey monuments and traffic control devices, and all required grading and seeding. All rubbish and debris shall be immediately removed from the work area, to the satisfaction of the Department. 8. The permitted work shall be subject to inspection at any time by the Department. The Department shall be reimbursed by the permittee for any additional inspection required under the Special Provisions of this permit. All work shall be in conformity with the permit requirements including location and depth or height, and current government and Industry standards. The permittee shall provide satisfactory evidence to the Department that the work was performed, and the utility located, as required by this permit. 9. A copy of this permit, complete with special provisions, plans and traffic control requirements, shall be kept at the work site at all times when work is in progress. 10. This permit shall not be deemed or considered an exclusive right, and shall not prohibit the Department from using any of its highways, streets, or public places or affect its right to full supervision and control over all or any part of them, none of which is hereby surrendered. This permit shall not prohibit the Department from granting other permits or franchise rights of like or other nature to other public or private utilities. The Department reserves the right to make at any time such modification, addition, repair, relocation, or removal of an existing encroachment(s) or its appurtenances or any encroachment(s) or subject(s) authorized by this permit within the highway right-of-way as may be necessary to permit the relocation, reconstruction, widening, and maintenance of the highway and/or to provide proper protection to life and property on or adjacent to the highway. Said change or removal shall be made at the sole expense of the permittee, or its successors and assigns. All such modifications, relocation, or removal by the permittee shall be done in such a manner as will cause the least interference with the traveling public or any of the Department’s work. 11. The Department may revoke, amend, amplify, or terminate this permit or any of the conditions herein enumerated if the permittee fails to comply with any or all of its provisions, requirements, or regulations as herein set forth or through willful or unreasonable neglect, fails to heed or comply with notices given, or if the utility herein granted is not installed or operated and maintained in conformity herewith. 12. The permittee shall maintain at its sole expense the structure or subject for which this permit is granted. 13. If trench or pavement settlement should occur, or any other kind of displacement, due to the work covered under this permit, within two years from the date of installation, repairs shall be made by the permittee as directed by the ITD Authorized Representative at no cost to the Department. If the permittee fails to make the necessary repairs, the Department will make the repairs and bill the permittee. No new permits shall be issued to the permittee until such claims have been settled. 14. Any modification or addition to, or removal or relocation of, work granted by this permit may require a new permit for approval by the ITD Authorized Representative. All work within the highway right-of-way shall be documented on as-built drawings and submitted to the District within 30 days of completion of work. Also see attached Special Provisions District Staff Review Review Reviewer’s Signature Date Recommend Review Reviewer’s Signature Date Recommend Yes No Yes No Traffic Planner Maintenance Permit Coord Design Construction Property Mgmt Appeal Review Review Reviewer’s Signature Date Recommend Review Reviewer’s Signature Date Recommend Yes No Yes No Local Agency CE DTE Hearing Officer DE Director STE Board *Attach reason(s) for denial and/or recommendations for variance. ITD 2110 Instructions, Rev. 08-16 Page 3 of 3 Instructions For Completing ITD 2110, Right-Of-Way Encroachment Application And Permit - Utilities You may be able to expedite the application process and reduce site designing and engineering costs by requesting a pre-application conference with the Idaho Transportation Department (ITD). Contact your local ITD District Office and ask to speak with the Permits Coordinator to schedule a meeting. District 1 600 W. Prairie Ave. Coeur d’Alene, Idaho 83815-8764 (208) 772-1200 Counties served: Benewah, Bonner, Boundary, Kootenai, Shoshone District 2 P.O. Box 837 Lewiston, Idaho 83501-0837 (208) 799-5090 Counties served: Clearwater, Idaho, Latah, Lewis, Nez Perce District 3 8150 Chinden Blvd. Boise, Idaho 83714-8028 (208) 334-8300 Counties served: Ada, Adams, Boise, Canyon, Elmore, Gem, Owyhee, Payette, Valley, Washington District 4 216 S. Date St. Shoshone, Idaho 83352-0820 (208) 886-7800 Counties served: Blaine, Camas, Cassia, Custer, Gooding, Jerome, Lincoln, Minidoka, Twin Falls District 5 5151 S. 5th Ave. Pocatello, Idaho 83205-4700 (208) 239-3300 Counties served: Bannock, Bear Lake, Bingham, Caribou, Franklin, Oneida, Power District 6 206 N. Yellowstone Ave. Rigby, Idaho 83442-0097 (208) 745-7781 Counties served: Bonneville, Butte, Clark, Custer, Fremont, Jefferson, Lemhi, Madison, Teton 1. The form initially serves as an application to install a utility facility within the State’s right-of-way. If approved, the completed form becomes a permit. Applicant shall anticipate 30 days from submission of a completed application for ITD review and/or approval. An incomplete application will delay processing. 2. Please print (in ink), type, or complete the application electronically in Adobe Pro. The form must be signed by Applicant or an Authorized Representative. 3. Read and understand these instructions and all of the General Provisions on page 2 of the form. These requirements apply to all utility permits. Additional special provisions may be conditions of the final approved permit. 4. Complete each item in the shaded area of the form under “Applicant Information.” If you require any assistance, or additional information, please contact your area permit coordinator. 5. Include the following with your application:  $50 non-refundable application fee.  A vicinity sketch which includes north arrow, Section, Township and Range.  Plans or drawings showing proposed work, installation location with offsets from the centerline of the Highway, location of all existing utilities within the work area with offsets from the centerline of the Highway, trench details (24-inch minimum width). Applicant shall contact ITD for roadway alignment or highway project plans.  Traffic Control Plan - drawn and signed by a certified Traffic Control Supervisor, include certification number.  Standard Details or Shop Drawings if proposing to attach a facility to any structure(s) within the right-of-way. 6. Upon receipt of a complete application: A. ITD will review the application, discussing with appropriate staff. The application may be approved as submitted, approved with conditions, or denied. i. If application is approved, or approved with conditions, a copy of the permit will be transmitted to the Applicant electronically (unless Applicant elects to receive via “paper” on page 1 of application) along with any special provisions that must be adhered to. Applicant must notify the ITD Maintenance Foreman at least five (5) days prior to installation start date. Foreman will email the Applicant with an approved date to commence work. Afterwards, the Applicant may (if required) transmit their road/lane closure information to ITD’s 511 Traffic and Traveler Information contact person. ii. All work associated with the permit shall be completed within one year of Department’s approval date. Prior to expiration of permit, the Applicant may request a one-time 6-month extension. This request must be made in writing to the Permits Coordinator. iii. All permitted work shall be available for final inspection within thirty (30) days after construction is complete, unless otherwise stated in the special provisions of the permit. iv. Upon completion of work, Applicant shall contact and coordinate with the Foreman for a final inspection of the work. The contact information for the Foreman will be included in the permit documentation. v. Failure to complete all work in accordance with the requirements of the permit and receive final approval within the allotted time will render the permit invalid. B. If application is denied, notification will be made to the Applicant via US Certified Mail. Reason(s) for denial and the process for appeal will be outlined in the notification letter.