HomeMy WebLinkAboutEXCAVATION PERMIT - 22-00644 - 325 E 1st N - REPARING EXISTING SEWER LINEa-uubgq
Excavation Permit Application��wa= =n crTY.Of
Public Works REXBURG
35 North 1st East keithd®rexburg_org Phone: 208.359.3020 x2320 amtdrss t8mtlrf�W
Rexburg. ID 83440 www.rexburg.org Fax: 208.359.3022
Applicant:
DR Heating and Plumbing
Date: 8/26/22
Mailing address:
418 N 4014 E ste#4 Rigby ID, 83442
Contact phone:
208-356-9331
Eman: info@drheatingandphanbing.com
Refund recipient name (if different from applicant):
Contractor:
DR Heating and Plumbing
Phone:
Utility company:
Phone:
Excavation address:
325E 1stN Rexburg ID 83440
Exr- date: N/A
Describe area of excavation right of way: I Edge of house out to the main sewer line
Purpose of excavation:
I Repairing existing line
Location of excavation:
treet ❑ Alley ❑ Sidewalk ❑ Undeveloped/Landscape Area
CONDITIONS OF PE T:
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 completed. (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.
5. The public right of way fee is $1,000 for any work that will disturb less than 30 square yards of asphalt surfacing. A $100 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 must 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 as required 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 must 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 must be completed within 10 calendar days of the initial excavation.
18. No excavation permits will be approved from November 10 — 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 10.
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. /� // �/ • ,
-4"l" � 8/26/22
Applicant Signature Date
*Applicant will be notifred ofpermit application approval and request for a deposit to be submitted before excavation can begin.
Revised 10/7/2019
(Attachment A)
Acceptance of Surface Repairs
K August 22 sar
On this 2626 _ day of � 20_ I, ritt Gray ,the parcel owner of the property located at
325 E 1st N in Rexburg, Idaho, approve surface repairs to my property completed by the noted contractor.
Krystal Gray K-11 6Ua �Aug26,20209 Mn*) Aug 26, 2022 8018676171
11
Printed Property Owner Name Signature Date Contact Number
On this _ day of
Acceptance of Surface Repairs
201,
the parcel owner of the property located at
in Rexburg, Idaho, approve surface repairs to my property completed by the noted contractor.
Printed Property Owner Name Signature Date Contact Number
On this _ day of
Acceptance of Surface Repairs
the parcel owner of the property located at
in Rexburg, Idaho, approve surface repairs to my property completed by the noted contractor.
Printed Property Owner Name Siguature Date Contact Number
Revised 10/7/2019
Excavation Permit (Revised
Final Audit Report
Created: 2022-08-26
10-7-19)
2022-08-26
By: DR Heating and Plumbing (info@drheatingandplumbing.mm)
Status: Signed
Transaction ID: CBJCHBCAASAAjl4Bl5evcGmezS_Q7DK5Z7PHHvD"FB
"Excavation Permit (Revised 10-7-19)rr History
Document created by DR Heating and Plumbing (info@drheatingandplumbing.com)
2022-08-26 - 3:26:49 PM GMT- IP address: 192.225.189.6
C• Document emailed to kjgray75@yahoo.com for signature
2022-08-26 - 3:27:39 PM GMT
Email viewed by kjgray75@yahoo.com
2022-08-26 - 3:46:45 PM GMT- IP address: 104.28.85.157
bo Signer kjgray75@yahoo.com entered name at signing as Krystal Gray
2022-08-26 - 3:51:21 PM GMT- IP address: 107.77.227.169
6o Document e -signed by Krystal Gray (kjgray75@yahoo.com)
Signature Date: 2022-08-26 - 3:51:23 PM GMT - Time Source: server- IP address: 107.77.227.169
O Agreement completed.
2022-08-26 - 3:51:23 PM GMT
,a.- Adobe Acrobat Sign