HomeMy WebLinkAboutEXCAVATION PERMIT APPLICATION - 21-00811 - 132 N CENTER STREET - REPAIR BREAK IN SEWER LINEClick to Submit I z' _ DDS I
Excavation Permit Application OCT* 3 (° 1 t oil
Public Works RE City Of ReURG
35 North Isi East keithdQrexburg.org Phone: 208.359.3020 x2320
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3022
Applicant / Cont
Mailing Address:
Application Date:
Primary Phone (❑ Home 14 Work ❑ Cell): z0a %yS9yU(e —Email—_
Alternate Phone (❑ Home ❑ Work X Cell): 20$ -2(,pZ _Zyc5 0
Approximate address of excavation: /3
Describe area of excavation in right of way:
Purpose of excavation: V pei)ir LSreAU& 5Quyer- Imt
Location of excavation: Street ❑ Alley ❑ Sidewalk ❑ Undeveloped/Landscape Area
Date to begin planned excavation: 71
Refund Name (if different from above):
Refund Mailing Address (if different from above):
CONDITIONS OF PERMIT:
Phone Number:
1. No excavation shall be made in any city street or right of way without first obtaining an excavation permit and paying the required fees.
2. This permit is good for 30 calendar days after issuance.
3. Contractor is to carry a minimum of $500,000 in general liability insurance to cover possible damages that may be caused by the
excavation or any accident caused by the work.
4. The permit fee within the public right of way is $1000 for any excavation that will disturb less than 30 square yards of asphalt surfacing. A
fee of $100 will be retained from the permit fee to cover city inspection costs.
5. For excavations that will disturb more than 30 square yards of asphalt surfacing, the permit fee will be determined by the city on an
individual basis.
6. The contractor is to notify the city prior to placing backfill material and final asphalt placement. If these conditions are acceptable to the
city engineer, $900 of the permit fee will be refunded within 30 calendar days ofcompletion.
7. If stated conditions are not met, the city may hold the permit fee for one year from final asphalt placement. In the event repairs are needed,
the contractor will be responsible for the repairs. If contractor'fails to make the repairs within 7 days, the city may do the repairs and retain
the permit fee and permit holder is responsible for any cost overruns.
8. The contractor is to notify Dig Line at 1-800-342-1585, at least two (2) business days in advance of an excavation.
9. The contractor shall furnish and maintain all barricades, signs, and flagmen as required by the Manual on Uniform Traffic Control Devices
(MUTCD).
10. Existing asphalt pavement shall be saw cut to provide a vertical surface.
11. Excavation and backfill work shall be completed in accordance with the requirements of Sections 300 and 800 of the ISPWC (Idaho
Standards for Public Works Construction). See summary attached.
12. All excavated material shall be stockpiled for re -use or immediately removed from the site if it is unacceptable for re -use as backfill. Keep
excavated material safely away from the trench and from the traveled roadway.
13. Excavations made in all streets shall be backfilled with 3 feet of flowable fill, 4 inches of 3/4 inch crashed aggregate road base, and 2'/r
inch minimum thickness of plant mix pavement surface or equal to the existing material thickness, whichever is greater, unless otherwise
approved by the city public works director.
14. Existing asphalt pavement shall be "tacked" prior to new asphalt placement.
15. Final repair of asphalt surfaces is to be completed within 10 calendar days of the initial excavation.
16. In the winter months (Nov 1 -Mar 31), no excavation permits will be approved, except in the case of emergency as deemed necessary by the
city public works director. If winter excavation allowed, a temporary cold mix paving must be placed and maintained by the contractor
until final paving is completed as soon as weather permits in the spring.
In making applicati n for this permit, I hereby agree to the above conditions ofthepermit and applicable City Ordinances.
Signature: Print Name: RAte�twQ` Twl�
Signed Date: �d 13-21
*Applicant will be notified ofpermit application approval and request for deposit to be submitted before excavation can begin,
0e��� Revised 7/19/2018