6-Right-of-way Permit Authorization Form

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General Requirements Page 2 of 2 April 2024 PERMIT NO. CITY OF LAKE ELMO 3880 Laverne Avenue North Lake Elmo, Minnesota 55042 Phone: 651.747.3900 GENERAL REQUIREMENTS (Office Use Only) 1.Permit Required: All work within City right-of-way and/or easements requires the appropriate City permit be obtained. Five copies of detailed scaled drawings showing the planned installation must accompany the permit application along with accurate Right-of-Way and topographic information. If color drawings are submitted, all five (5) copies must be in color. 2.Notification Required: Please notify the City Public Works Department at 651.747.3941, a minimum of 24 hours in advance of beginning this work, and again upon completion of the work. 3.Permit Display: The permit issued by the City for this work shall be conspicuously displayed at all times at the indicated work site and shall be available for inspection by the City. 4.Supplementary Application: No work may be completed in the Right-of-Way (including patching and restoration) beyond the dates specified in this permit, or outside of the Right-of-Way area covered by this permit, unless a Supplementary Application has been submitted prior to the expiration of this permit, and a new permit or permit extension is granted. 5.Protection of Property: Existing utilities and street surfaces shall be protected. Contractor shall not drive over curbs, sidewalks, or along trails. Any damage caused to existing facilities shall be immediately replaced or repaired in a manner approved by the City Engineer. 6.Safety: Safety shall be the responsibility of the Contractor performing work. 7.Traffic Control: The permittee must implement traffic control measures in the area of the work and shall use traffic control procedures in accordance with the most recent manuals on uniform traffic control, traffic control devices and traffic zone layouts published by the State of Minnesota. Excavations shall be properly protected and identified by barricades and warning devices accordingly. Traffic flow shall be maintained at all times along City streets unless Right-of-Way closure is explicitly allowed for by this permit. Private driveway access shall also be maintained. 8.U.S. Mail service shall be maintained without interruption. 9.Restoration of Property: Any disturbed turf areas shall be backfilled, leveled and restored to an equal or better condition with quality lawn sod. Seed restoration will not be allowed in residential areas. Final topsoil placement must be 6-inches. Final grade must be flush and even with the existing ground surface. Settlement within two years of the completion date shall be restored to its original condition by the permit holder. 10.Delay Penalties and Diligence in Performing Work: Once work in the Right-of-Way has started, the Contractor must work diligently in an expeditious manner until the work is fully competed, including Patching and Restoration. Work shall be well coordinated, shall not begin unless all necessary parts and equipment are available, and mobilizing restoration work immediately after the installation is completed. The City may impose delay penalties in accordance with the Right-of-Way Ordinance, for work completed beyond the permitted completion date and for work not progressing diligently. 11.As-Built Drawings: Certified mapping, “As-built”, showing utility locations must be provided to the City within 90-days upon completion, indicating location of installation with respect to existing physical features, (i.e. back of curb, edge of bituminous, etc.). 12.Revocation of Permit: The City reserves the right to revoke this permit, without a fee refund, if there is a substantial breach of the terms and conditions of any statute, rule or regulation, or any material condition of this permit. 13.Approval of this permit in no way implies or expresses the City of Lake Elmo will guarantee said work.