Loading...
HomeMy WebLinkAboutENC2014-00034 3o9 '72213 6 ► # RECEIVED ENCROACHMENT PERMIT Permit No ENO-�o\4 co Gay CITY OF CAMPBELL DEPT.OF PUBLIC WORKSr•C CB 0 6 2014 (for working within the public X-Ref.File 70 North First Street r right-of-way) Application Date Campbell,CA 95008 3125 114 Application Expiration Date 7'ks I tk Ph. (408)866-215gublic Works Administri� APN {-4631 S 1]'\ Fx. (408)376-095 3125 {5 Permit Expiration Date APPLICATION Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code,Section 11.04. (Application expires in six (6) months if the permit is not issued. Application Fee is non-refundable.) A. Work Address or Tract No.: A60 U TT' PI-A L t') )) $ ) ,I330 T -7 / \IENVjg Utility Trench Location: C,01— 03 AS S - of '/1 or" -�•�-A C�{�J� Ow-G1 B. Nature of Work: �(1 v r 1s 1 / 1a c<x C, Attach four(4)copies of an engineered plan showing the location and extent of the work,and four(4)copies of the preliminary Engineer's Estimate of work.The plans shall show the relation of the proposed work to existing surface and underground improvements.When approved by the City Engineer,said plan becomes a part of this permit. D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction;the General Permit Conditions listed on the reverse side;and the Special Provisions for this permit,listed below. Failure to abide by these conditions and provisions may result in job shutdown and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.) E. The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before starting work. Notice must be given to Public Works at least 24 hours before restarting any work. Name of Applicant: 7 c, -y-E- SACK fc42‘. Telephone: 1Z S — 27 0-- Address: E-Mail Address: nn 2 p 13 � .1 �.�.•.. L.dN\ 24-HOUR EMERGENCY PHONE NUMBER: 8°0 " 7 y3 Is this work being done by the property owners at their own residence? I"i YES NO The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell,its officers,agents,and employees free,safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The Applicant/Permittee hereby acknowledges that they have read and understand both the front and back of this permit,and they will inform their contractor(s) of the information. Applicant Is advised that upon Issuance of this permit, property owner, or property owner's successors, shall be responsible for any and all damagesarising out of the condition of any private improvements in the public right-of-way. Accepted: r c- G -C /34-, 2'' O - 2-O 1 (Applicant Permittee) (sign) Date (Contractor) (Print Name) Date SPECIAL PROVISIONS; 1. Street shall not be open cut for underground installations. Minimum cuts m be allowed for connections or exploration holes. Such cuts may be specifically approved by the inspector prior to cutting. 2. Pavement may be cut for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method "A",unless otherwise approved by the Engineer. 3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two(2)copies of the cut sheets sent to the Public Works Department before starting work. 4. Per Section 4216 of the Government Code this permit Is not valid for excavations until Underground Service Alert(USA)has been notified and the inquiry identification number has been entered hereon. USA Phone: 1-800-227-2600. USA TICKET NO. 5. Prior to any work,the property owner shall execute an Agreement for Private improvements in the Public Right-of-Way,which shall be recorded. 6. Public Notification Requirements: 7. $EE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT NO. PERMIT APPLICATION FEE $ 37 7 Q PLAN CHECK DEPOSIT $ SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $ CONSTRUCTION CASH DEPOSIT $ PLAN CHECK&INSPECTION FEE $ 1�t (� - 30 EMERGENCY PERMIT FEE $ APPROVED FOR ISSUANCE 3/15/I'-,t For City Engineer Date Permit Expires 12 Months After Date of Issuance CL*C L > (-5OO Le of 2.5o/04-(( 46 IF x 15 F5514) _ 1I474 "3`' GENERAL PERMIT CONDITIONS 1. A Construction Cash Deposit is required. Charges will be made against this deposit if there is an emergency call-out,overtime inspection or when City ordered barricading is required. Any such costs in excess of the deposit will be billed to the Permittee. 2. A one-year maintenance period and surety are required.Such period will begin on date of written acceptance by the City. 3. Refund or the cash deposit balance and refund or cancellation of the Faithful Performance Surety will be Initiated by the written acceptance of the work by the City. 4. Submit project schedule 10(ten)days prior to proposed start of work.Special provisions may be required for work within City facilities and downtown Campbell. 5. The Permittee must request in writing a final inspection and acceptance of the work upon completion.Acceptance by the City will be made in writing to the Permittee. 6. Maintain safe pedestrian and vehicular crossings and free access to private driveways,bus stops,fire hydrants,and water valves. 7. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures,detours,and street closures.This plan must be reviewed and approved prior to any lane closures. • 8. A Construction Traffic Control Plan shall conform to the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones,dated 1990,available at Caltrans.Traffic control equipment shall include Type II flashing arrow signs If required. 9. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and Specifications at the sole expense of the Permittee. 10. Sawcut for all PCC or AC removals. All PCC removals shall be to the nearest scoremark and shall be doweled to existing improvements. 11. Prior approval of inspector is required for any work done after normal working hours,on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 12. Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading may result in the City's providing signing and barricades and charging the cost(including all labor and materials)against the cash deposit. 13. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer. 14. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during construction. Contractor or Permittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m.to 4:00 p.m. 15. No storage of materials or equipment will be allowed near the edge of pavement,the traveled way,or within the shoulderline which would create a hazardous condition to the public. 16. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other work for which a separate permit may be required,nor does it relieve the Permittee of any obligation to obtain any other permit required by law. 17. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 18. This permit is not transferable.Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 19. Call back(call out)due to emeregencies regarding this permit shall be at the current overtime rate with a three(3)hour minimum charge per occurrence. 20. Pursuant to Chapter 14.02 of the Campbell Municipal Code,applicant shall not cause to be discharged any material into the municipal storm drain system other than storm water.Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff Pollution Prevention Program. 21. If the public interest requires a modification of,or a departure from the plans and specifications,the City shall have the authority to require or approve any modification or departure and to specify the manner in which the same is to be made for City-owned or maintained facilities. 22. Permitttee must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by the City prior to distribution and include dates of work and a contact name and phone number. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware and understand all of the above conditions. a-'A lam. 2 6- 2ody Applicant Date: Contractor (Print Name) Date: I J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf Rev.02/14._ • • SIGNS BEING USED & 48X48" W14 z N W ROAD AHOEAD 48X48" W20-1 F- W E O CO N SPECIAL W20-1 °e3" m HHOM l KEEP odoa ` S �a Y RIGHT `� � 4 c;Q n1 AVENUE /cA`, {c 11.4 NTR0L PERSON ITO MAINTTIONAL AIN CLOSURE FFIC ASSIST a('� >-• 7 "` TMON VT AV ENU` BICYCLE,PEDESTRIAN AND DRIVE �,�.:- , a �E� 36X48 WAY TRAFFIC SHOULD NEED ARISE r ----- 5, STREET WIDE ENOUGH STOPPING TRAFFIC IS W 1-4 lit!Di, NOT REQUIRED BUT TRAFFIC CONTROL PERSON lit, moo WILL ASSIST HOMEOWNERS IN AND OUT OF THEIR ° ° NOT TO SCALE DRIVEWAYS AS NEEDED. . TAPER 125' N 1 PLACED AT EACH W20-1 Q ROAD WORK WORK AEA - r KEEP 2 5 • { RIGHT MPH KEEP I � : ; BUFFER so' ,� ��� �. 8 R30 24X24" BARRICADE RIGHT „,..„1.....) ' . ;.. �� 'S����; MOUNTED, PLACED ON -__ - BOTH SIDES OF STREET ►�+��""'a'-'�' " \ 20'APART 72HR PRIOR TOW-AWAY TO START OF WORK yC0 cs^ L E C co ZONE 0 ___\,/ MAX CONE SPACINGS 28" 101 b SPEED MIN TAPER TAPER TANGENT -.O `r° 4 25 125 25 50 LOC 803 r �3°=p SEE SPEC SHEET 2 FOR ADDITIONAL m 30 180 30 60 -TRAFFIC CONTROL STIPIJI .ATIONS 35 245 35 70 40 320 40 80 FOR TCP QUESTIONS CALL: 45 540 45 90 ROBERT @ 209-200-3351 ALL BUFFER ZONES SHALL BE A MIN OF 60' ALL SIGN SPACINGS_SHA LL BE A MIN OF 125' PEDESTRIAN AND BICYCLE ACCESS co Owner CITY OF CAMPBELL TO REMAIN OPEN AT A L L TIMES ° Pt Name Abbott Project NDmbe Abbott Ave&westmontAve. Campbell ,California WORK SHALL NOT EXCEED 12 H RS Prime Contractor Traffic Control Contrado PG&E ED SAFETY INC MIN 12' CLEARANCE FOR TRAFFIC Z Phone 209-333-0807 SPs""-2�r 12/1/2013 PM 30972273 MIN SIGN SPACING 125' m Prepared By ED SAFETY SERVICES, INC HOURS OF WORK SHALL BE DETERMINED BY THE CITY OF CAMPBELL 0 • SIGNS BEING USED W20-1 °"3H x", °voa 48X48" W1 -4 z N W ROAD WORK AHEAD 48X48" W20-1 . ` � N W E W1-4 � . 0 0 SPECIALC0 m KEEP a il ooh S RIGHT r 3< ADDITIONAL TRAFFIC CONTROL PERSON TO MAINTAIN CLOSURE ASSIST WESTM1NT AVENUE BICYCLE,PEDESTRIAN AND DRIVE ,,. 36X48 WAY TRAFFIC SHOULD NEED ARISE I.._...- ----" „`, s STREET WIDE ENOUGH STOPPING TRAFFIC IS NOT REQUIRED BUT TRAFFIC CONTROL PERSON Zoo TAPER 125' WILL ASSIST HOMEOWNERS IN AND OUT OF THEIR oxb 1 \,, KEEP DRIVEWAYS AS NEEDED. \ RIGHT N BUFFER 60' / NOT TO SCALE 7 PLACED AT EACH W20-1 .. / ROAD WORK WORK AREA 25 .„ MPH R30 24X24" BARRICADE •7fiz��� MOUNTED, PLACED ONiii •�fi�mor. BOTH SIDES OF STREET 20'TO APART OF72HRW PRIOR ELEC TOW-AWAY TO START OF WORK � Zoo m xa ZONE 28" 10I b 0 MAX CONE SPACINGS -o N SPEED MIN TAPER TAPER TANGENT LOC 801 ♦ 25 125 25 50 rn SEE SPEC SHEET 2 FOR ADDITIONAL 30 180 30 CO TRAFFIC CONTROL STIPULATIONS 35 245 35 70 - 40 320 40 80 FOR TCP QUESTIONS CALL: 45 540 45 90 ROBERT h, 209-200-3351 ALL BUFFER ZONES SHALL BE A MIN OF 60' ALL SIGN SPACINGS SHALL BE A MIN OF 125' PEDESTRIAN AND BICYCLE ACCESS o Owner CITY OF CAMPBELL TO REMAIN OPEN AT ALL TIMES Project Name Project Number Abbott Ave&Westmont Ave. Campbell ,California WORK SHALL NOT EXCEED 12 H RS Prime ContractorTraffic Control Contractor C PG&E ED SAFETY INC MIN 12' CLEARANCE FOR TRAFFIC Phone 209-333-0807 Sheet Number Data 12/1/2013 PM 30972273 MIN SIGN SPACING 125' C Prepared By t ED SAFETY SERVICES, INC HOURS OF WORK SHALL BE DETERMINED BY THE CITY OF CAMPBELL YINNOdll*/Q 1138dPWO 3f1N3AV 11Q8Bb lSLL h „ src a anva wo aaxo>s vax .�o ''p 3Qvld uoeav _ g .,. .. oN,tvi vie No is�a nlnun ®Jg11� NOINOH '2!'0 W3.I� Sg W swoisi�3a 9N©1YDVIO L ONIMV8O NQIIOIi JSNOO 01810313 m a T _ yg@g a a 11 fit INil l, RI!1 c" 11 1 P H / r - 1jiJJi I > v e ( i lily I � ` 0. � ra'1 volt latftl Pf 3f3� # s� # #qd# azl Axaa zvan