HomeMy Public PortalAbout1983-039Member
and moved its adoption:
introduced the following Resolution
CITY OF iV1EDINA
RESOLU`1'ION NC). ff3-- � y
PERMIT/ RESOLUTION FOR puBLIC UTILITY INSTALLATION
IN CITY RICK T OF WAY
WHEREAS
utility licensed to do business in
to the City for the installation of
located at
within the City of !�lcr�ina;
-n , a public
e City of Medina, has made application
NC)kk►, '1'lih:lil':FoltE, lil? l'1' 10:SOLVI:1) that said application
in accordance with the plans and specifications submitted, subject
following conditions:
1. Street and Right of Way shall be restored their
•� to
original condition upon completition of installation
and Applicant shall be liable for settlement or other
damage caused by said installation for a period of
one year following conirletiun.
'.. Cmlipiction 1 Vile:
:. Performance Bond in the Amount of:
1)eptii of Conduit:
City Clerk
Pvlayo►•
be granted
to the
The motion for the adoption ��i the foregoing li 5� ution is duly
seconded by Member fi ,e,,.0 .+� anti ups n vote being taken
thereon the following voted ilk favor thereof: /
and tilt' fcritm inn v(pti.d against.� U
kon• •i•uptni ;ili1 1.;0:;(dil n,n 11:iS det'1;i►'ed nassod Lind nd,,l)ted,
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by the City c'I�;rh this
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66.14-4.61
.- /71-3
CITY OF
Permit No
Job P4-4.5
APPLICATION FOR PERMIT FOR INSTALLATION OF UTILITIES
OR FOR PLACING UNDERGROUND CONSTRUCTION
Name of Party or Organization performing work MINNEGASCO, INC.
Address 201 South Seventh Street
1. Nature of Work
Installation of gas service main
Telephone No.
Type of Surface to be Disturbed
(Check type) (Gravel)
(Bituminous)
(Concrete) (Boulevard)
2. Location
Street, Avenue and House number
(Additional information attached when necessary)
3. Size and kind of pipe, conduit or cable
Depth from Surface 2.5 feet ±
Dimensions of Excavation
4. Method of Installation or Construction (including method of compaction and excavation)
In accordance with procedures as described in Minnegasco Distribution Department Operations Manual,
Section 500, "Excavating, Back filling and Surfacing", the most recent edition on file with the permitting authority.
Machine Excavation: Yes x
5. Work to start within
6. Will detouring of traffic be necessary?
No
days and completed with 1 ? - ? l - 4
No If so, describe routing:
days thereafter.
For MINNEGASCO, INC.
(Applicant)
Signed By t
117
Dated
The date when work is completed must be reported to the person designated by municipality.
AUTHORIZATION OF PERMIT
Upon payment of permit fee in the amount of $ and in consideration of the agreement to comply
in all respects with the Street or Alley excavation ordinances and regulations applicable covering such operations,
permission is hereby granted for the work to be done as described in the above application, said work to be done in
accordance with special precautions required, as hereby stated:
It is expressly understood that this permit is conditioned upon replacement or restoration of the road surface to its proper
condition in accordance with the appropriate rules and regulations. It is further understood that this permit is subject
to revocation within ten (10) days of receipt of copy of application by the County Engineer when the permit is for work
on a County Road.
APPROVED
DATE
All requirements shown on reverse side to be complied with.
White copy to applicant, yellow to Municipality Engineer, blue to Municipality Street Superintendent.
Form 16 R3/82
RULES PERTAINING TO STREET AND ALLEY EXCAVATIONS
SAFETY
1. Excavations shall be properly protected and identified by barricades and flags in the daytime, and flares, red
lanterns or flashing signals at night, to protect persons and traffic at all times.
2. Barricades to be erected in a manner which will provide suitable visibility in all directions.
3. Excavations must be cribbed when necessary, depending upon type of soil, in order to prevent cave-ins.
4. No guys or stays to be attached to trees on Right of Way.
5. Underground construction must be so constructed as not to harm or unnecessarily destroy the root growth of
sightly or ornamental trees.
ROADWAY
1. Installation of pipe under concrete or high type of bituminous pavements to be done by jacking or boring unless
otherwise authorized by Engineer. When an installation is made by jacking or boring a pipe three inches or larger
in diameter, a casing of larger dimension must be used to encase the service pipe.
2. All back -filling must be placed in 6-inch layers and thoroughly tamped, and material must be flush and even
with the road surface when finally in place, unless Engineer authorizes alternate method of construction.
3. Finished surface, base, and sub -base of road after excavation and back -fill, shall be at least equal in stability
to finished surface, base, and sub -base prior to excavation.
4. Concrete pavement to be replaced according to specifications which will be provided by the Engineer.
5. If settlement or excavation caves in within one year from completion date so that replaced materials settle
( ,ituminous mat or concrete base), same shall be restored to its original condition by the holder of this permit.
6. No pole anchors, anchors, braces, or other construction to be put on roadway shoulder except by special
authorization.
7. No driving onto highway from ditch or driving on shoulders except when authorized by the Engineer, and if
damage occurs, permit holder will make proper repairs.
8. No machine excavation shall be permitted except when noted in application for permit.
9. Excavations greater than four feet in width at top of trench will not be generally permitted and may be made
only when expressly provided for on the permit.
10. Streets may not be closed to traffic unless expressly authorized by the permit.
LIMITATIONS
1. No lugs shall be used on equipment traversing road which will damage the road surface.
2. Roadside shall be cleaned up after work is completed.
3. No work shall be done which will create a nuisance.
4. Within 24 hours, (Saturdays, Sundays and legal holidays excluded) the permit holder shall notify the municipality
issuing the permit and, when applicable, the County Engineer, that such work has been completed and is ready
for final inspection.
5. Within ten days after receipt of a copy of the permit application the County Engineer shall notify the applicant
of any objection the County may have to the application.