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HomeMy WebLinkAboutEXCAVATION PERMIT - 22-00507 - 4TH S 1S W PLACE ELECTRICAL POWER CABINET21 2022 Excgf4t16riit Application aF�,>°°4 C1 r Y OF Public Works 35 North Ist East keithd@rexburg.org Phone: 208.36:3020 x2320 AmMaaF%1M*0mlmvMiY Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3022 AppllcantlContractor: 2947 a Forthill rd Mailing Address: LightLink Communications Primary Phone ( ❑Home ❑Work []Cell) 6014561093 Excavation Address: 4th South 1 st West Description: We are looking to doing a directional bore and place fdt vaults for fiber Date: 6/22/2022 City: Eagle Mountain state: UT Zip. 84005 Email. maclain.drake@firstdigital.com service to customer. Location of Excavation: 0 Street ❑ Alley ❑ Sidewalk ❑ Undeveloped/Landscape Area Purpose of Excavation: Place Electrical power cabinet Exc. Date: Refund Recipient Name (if different from above): Refund Recipient Address: CONDITIONS OF PERMIT: City: Phone 4: 8014561093 State: Zip: 1. No excavation within city right of way limits shall take place prior to the issuance of an excavation permit. 2. Property owners must be made aware of work happening adjacent to their parcels. An "Acceptance of Surface Repairs" form must be signed by the property owner(s) prior to the excavation work being signed off by the City. (See Attachment A) 3. This permit expires 30 days after the issue date. Any work started and not completed within 30 days will be assessed a $100 weekly inspection fee until work finalized. 4. The contractor is responsible for carrying a minimum of $500,000 general liability insurance coverage for possible damages during excavation or other accidents. A certificate of liability is required and must be submitted via email at customerservices@rexbura.org 5. The public right of way fee is $1,200 for any work that will disturb less than 30 square yards of asphalt surfacing. A $200 portion of this fee will be retained by the city for initial inspection costs. 6. Excavation work which disturbs more than 30 square yards of asphalt surfacing must be individually assessed by the city for additional fees. 7. All utilities most be placed a minimum of 4 feet below the finished grade unless specifically authorized otherwise in writing. 8. The contractor is responsible for contacting the city prior to placing backfill material and/or asphalt in city street locations. A city representative will then assess and, if acceptable, the excavation fee less inspection costs will be refunded within 30 calendar days of completion. 9. If permit conditions are not met the city will hold fees for 1 year from final asphalt placement If repairs are required, the contractor will be responsible for completing all repairs. If repairs are not made within 7 days, the city will complete repairs. The permit fee will be retained and any additional costs will be the responsibility of the permit holder. 10. The contractor must notify Dig Line at 1-800-342-1585 at least two (2) business days in advance of the excavation date. 11. The contractor is responsible for furnishing and maintaining all barricades, signs, and flagmen asrequired by the Manual on Uniform Traffic Control Devices (MUTCD). 12. Existing asphalt pavement shall be saw cut prior to placement of asphalt to provide a vertical surface. 13. Excavation and backfill work is to be completed in accordance with the requirements of Sections 300 and 800 of the Idaho Standards for Public Works Construction (ISPWC). (See Attachment B.) 14. All excavated material, if acceptable for re -use shall be stockpiled or if not acceptable be immediately removed from the site. Excavated material needs to be kept a safe distance from trenches or traveled roadways. 15. All street excavations most be backfilled with 3 feet of flowable fill, 4 inches of % inch crushed aggregate road base, and 2'h. inches minimum thickness of plant mix pavement surface or equal to the existing material thickness, whichever is greater. No exceptions unless pre -approved by city public works director. 16. Existing asphalt pavement shall be `tacked" prior to new asphalt placement. 17. Final repair of asphalt surfaces most be completed within 10 calendar days of the initial excavation. 18. No excavation permits will be approved from November 1" —March 310 except in the case of an emergency which must be approved by the city public works director. Winter excavation requires a temporary cold mix paving to be placed and maintained by the contractor until the final paving is completed no later than May 1�. in completing this application for an excavation permit, I hereby agree to all the above conditions as well as all applicable,City of Rexburg ordinances. (/(,Y�^*,aQ�lt/1.tA� 794-- aro, � � 6/22/2022 _ i Applicant Signature Date ['�� �" *Applicant will be notified ofpermit application approval and request for a deposit to be submitted before excavation c n begin. Revised 12/2/2021 -y % K� C/b c 'sk tv it; cc: t - , Milo .9 LL p08 U'pf7W� 11 4 CERTIFICATE OF LIABILITY INSURANCE DAM (o2D zm 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(!") must have ADDITIONAL INSURED provisions or 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 The Buckner Company 6550 S Millrock, Suite #300 Salt Lake City UT 84121 CONTACT NAME: Mard Davis PN°NE , gp1.937.8843 PAX No AooREas: mdavi buckner.00m INSURER(S) AFFORDING COVERAGE NAN:E 11/28/2021 INSURERA: Atlantic Spectalty Insurance Company 27154 LicerIsSM, 92480 INSURED FIRSDI"2 INSURERS: FirstDigital Communications, LLC PERSONALBADVINJURY $1,000,000 357 South 670 West #300 INSURER c: INSURER D: Lindon UT 84042 BJSURER E: AUTOMOBILELIASILITY IxANYAUTO SJSURER F: COVERAGES CERTIFICATE NUMBER: IR' AWAIARn RFVICInM NIIMRFR• 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 13 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Wp TYPE OF INSURANCE ADDL J=SUB POLICY NUMBER PMIDWICFF PEXP LIMITS A X COMMERCIALGENERALLOSILrrY CLAIMSIAADE OCCUR X 1,000 711-01-7745000D 11/28/2021 11/28/2022 EACH OCCURRENCE $1,000,000 D ES e=uy a $1,000,000 MED EXP one on $15,000 PERSONALBADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT "PLIES PER POLICY [K]JEpT LOC OTHER GENERALAGGREGATE $2,000,000 PRODUCTS-COMP/OPAGG $2,000000 $ A AUTOMOBILELIASILITY IxANYAUTO OWNED AUTOSSCHEDEDBODILY AUTOS ONLY AUTOS X NONOWNED AU70S ONLY AUTOS ONLY 711-01-7745-0000 11/28/2021 11/282022 COMBINED SINGLE UNIT $1,000,000 EeactltleM BODILY INJURY(Perpe ) $ INJURY aracddent $ (P 1HIRED PROPERTY DAMAGE Per erCtleM $ A X I UMBRELLA LIAR EXCESS LVIB X OCCUR CLAIM54AADE 711-01-7745-0000 112812021 11282022 TACHOCCURRENCE $10,000,000 AGGREGATE $10,000,000 DED I I RETENTION $ A ANDEMPLOYERVLIABILTTY WORImRSCOMPENSATION YIN ANYPROPRIETOR/PARTNERIEXECUTNE OFFICERIMEMSEREXCLUDED7 (Mande ryln NH) If desaft uMer DESCRIPTION OF OPERATIONS Deb. NIA 408-0482-02-0000 10/1/2021 10/12022 TH- X ST oArTUTFT EL EACH ACCO]ENT 51,000,000 EL DISEASE -EA EMPLOYEE $1,000,000 EL DISEASE-POUCY LIMIT $1000,000 A ErrereB omaelone 760-01-0848-0000 11/282021 112612022 Umll:$5.000,000 DESCRPTION OF OPERATIONS / LOCATMNS I VEHICLES (ACOR0101, Atldltlonal Ramarka 5cbetlule, may be atlachetl Nmore apara Is requUelO CERTIFICATE HOLDER CANCFI I ATION ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Rexburg 35 N tat E AUTHORZEDREPRESENTATME Rexburg ID 83440 ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD