HomeMy Public PortalAboutPERMIT APPLICATION: Excavation
City of Riverdale, Iowa
110 Manor Drive, Riverdale, Iowa 52722 (563) 355-2511 www.riverdaleia.org
CITY OF RIVERDALE, IOWA
EXCAVATION PERMIT FORM
CONTRACTOR INFORMATION
Name
Phone
Email
License Number
Construction Site Supervisor Name
24 Hour Phone #
APPLICANT INFORMATION (leave blank if same as contractor)
Name
Phone
Email
PROJECT INFORMATION
Project Address
(street address & lot #)
Property Type ☐ Commercial ☐ Residential Construction Value $
Type of Excavation ☐ New ☐Repair ☐ Replacement ☐ Removal
Purpose of Excavation ☐ Gas ☐ Electric ☐ Water ☐ Sewer ☐ Sump Pump ☐ Mailbox
☐ Trees ☐ Pavement ☐ Sidewalk ☐ Telecommunications ☐ Other
Description of Work
to be Performed
Total Project Area (ft2) Number of Sidewalk Panels
Street Closure ☐ Yes ☐ No Sidewalk Closure ☐ Yes ☐ No
Street Cut Area (ft2) Work Begin Date
Style of Mailbox Work End Date
City of Riverdale, Iowa
110 Manor Drive, Riverdale, Iowa 52722 (563) 355-2511 www.riverdaleia.org
APPLICANT CHECKLIST
☐ Construction documents (drawings, traffic control, GIS plans, etc.)
☐ Read the City Code of Ordinances for a comprehensive list of requirements and indemnification.
Ordinances can be found at https://codelibrary.amlegal.com/, and Riverdale, Iowa's ordinance regarding
excavations is ordinance number 135.09. Excavators should be familiar with all aspects of Riverdale's
ordinance. ☐ Ordinance 135.09.4 Bond Required: The applicant shall post with the City a penal bond in the minimum
sum of one thousand dollars ($1,000.00) issued by a surety company authorized to issue such bonds in the
State. The bond shall guarantee the permittee’s payment for any damage done to the City or to public
property, and payment of all costs incurred by the City in the course of administration of this section. In lieu
of a surety bond, a cash deposit of one thousand dollars ($1,000.00) may be filed with the City.
☐ Ordinance 135.09.5 Insurance Required: For the duration of a contract, the applicant must obtain and
maintain $500,000.00 public liability and property damage/auto insurance in the minimum amount of $100,000.00 for each occurrence of property damage and $500,000.00 for each occurrence of personal injury or bodily harm.
☐ Attached payment in the amount of $100.00.
CERTIFICATION
A permit must be issued prior to the commencement of work. Applicant must provide a minimum of 48
business hours' notice with application before work begins. Call (563) 949-0464 for inspections on any street
or right-of-way work. All work is to be done under the provisions of the ordinances of the City of Riverdale
and the undersigned agrees to comply with all requirements. Along with City of Riverdale ordinances,
owners must ensure mailboxes are compliant with USPS regulations and ASHTO standards.
Signature
Date
Submit this form and attachments to:
Operations Manager, Public Works Department
City of Riverdale, Iowa
110 Manor Drive, Riverdale, IA 52722
operations@riverdaleia.org
(563) 949-0464
FOR OFFICE USE ONLY
Construction Documents Received ☐ Yes ☐ No
Bond Received ☐ Yes ☐ No
Insurance Received ☐ Yes ☐ No
Fee Received ☐ Yes ☐ No
City of Riverdale, Iowa
110 Manor Drive, Riverdale, Iowa 52722 (563) 355-2511 www.riverdaleia.org
Permit Issued ☐ Yes ☐ No
Permit Number Processed By