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HomeMy WebLinkAboutENC2014-00084 I9aAnit&L sg4) t(P NriuditNt-LaApac- � � � c�'G� t- r �1C�k�4 (1 Print Form Permit No `^ V —4)0C)CITY OF CAMPBELL ENCROACHMENT PERMIT `� '�7 / DEPT.OF PUBLIC WORKS (for working within the public X-Ref.File 70 North First Street ri I��i.ht-of-way) Application Date Campbell,CA 95008 Application Expiration Date • Ph. (408)866-2150 Issued APN l ` ZhLk0 Fx. (408)376-0958 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.) J� A. Work Address or Tract No.: C aej . cti)ny\c/de Utility Trench Location: n5 and c] (/)f 7 ','?(Ii B. Nature of Work: PO() Afianceck Cif v'C,Z©I ..Y C. Attach four(4)copies of an engineered plan showing the location and ext t of the work,and four(4)c ies 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. .—9 Lill U /J - Name of Applicant: l�/�r.�/,1 gtArna4A,, Telephone: 1406 L/ 1 0-271,Address: at?-(4e ` ({ ng3.t le Alfe. E-Mail Address: 24-HOUR EMERGENCY PHONE NUMBER: Is this work being done by the property owners at their own residence? r 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 dla g s ari ing out of the condition of any private improvements in the public right-of-way. Accept*I: bv' (Applicant Permittee) (sign) Dat AANc �It( of 114 (Contractor) (Print Name) Date SPECIAL PROVISIONS: 1. Street shall not be open cut for underground installations. Minimum cuts may 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. SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT NO. , PERMIT APPLICATION FEE $ c - 25-2 '1OL/ PLAN CHECK DEPOSIT $ SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $ CONSTRUCTION CASH DEPOSIT $ PLAN CHECK&INSPECTION FEE $ EMERGENCY PERMIT FEE C- r - $ 3 e ( ES q0.2, APPROVED FOR ISSUANCE Yl�! /491 (- /'4V/ For City Engineer Date Permit Expires 12 Months After Date of Issuance 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. Applicant Date: 6 KA `') Lt -( 1 Contractor (Print Name) Date: J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf Rev.02/14 PUBLIC WORKS DEPARTMENT UTILITY ENCROACHMENT,TRAFFIC & MISCELLANEOUS RECEIPT Effective July '1, 2013 TO: City Clerk ��ZQ'1- -Q�a�� PUBLIC WORKS FILE NO. PROPERTY ADDRESS 41 Please collect & receipt for the following monies: AMOUNT ACCT. ITEM ENCROACHMENT PERMIT 4722 Utility Encroachment Permit Application Fee $377.00 R-1 Encroachment Permit N/C Emergency Permits $107.00 Plan Check&Inspection Fee Minimum Charge Per Location $377.00 Conduits/Pipelines up to 500 Feet $2.50/ft Above 500 Linear Feet $1.55/ft ManholesNaults/Etc. $165.00/ea Pole Set/Removal $165.00/ea 4760 Storage Container Permit $153.00 4760 Project Plans &Specifications Project No. 4760 Standard Specifications & Details $1/Pg$15 50/Bk 4760 Engineering Maps&Plans Aerial Plot 24"x 36" $60.00 Aerial Print 8 1/2"x 11" $28.00 Map Research (includes max of two 24"x36"copies) $28.00 Maps and Plans 24"x 36" $14.00 4722 Penalties: Failure to restore public improvements $100/Calendar Day(Muni Code Sec. 11.34.010) 4722 Penalties: Failure to correct unsafe conditions $100/Calendar Day 4722 Work Without Permits 4 Times Applicable Fee TRAFFIC 4728 Traffic Flow Map (Daily Traffic Volumes) $35.00 4728 Signal Timing Information 73 4271 Truck Permits $16.00 per trip 4728 No Parking_Signs $1 each or$25/100 MISCELLANEOUS 511.7424 Postage Other(Please Specify) TOTAL O NAME OF APPL►CANTTN C NAME OF PAYOR PHONE (pg- A -0+. ADDRESS L n e ZIP FOR RECEIVED By1 - -__ CITY CLERK d ONLY Date Receipt# _ I .:11 Y OF CAMli-bt U CITY OF CAMPBELL RECVD BY: CASHIER 01000252902 RAYOR: GREG B MUSSALLEM TODAY'S I;ATE: 04/07/14 REGISTER DATE: 04/07/14 TIME: 13:11 DESCRIPTION AMOUNT ENGR & SUBDIV FILING F $377.00 CUST ID: 226 SUNNYSIDE 14-084 ENGR R SUBDIV FILING F $377.00 CUST ID: 226 SUNNYSIDE 14-084 TOTAL DUE: $754.00 CHECK PAID: $754.00 CHECK NO: 1052 TENDERED: $754.00 CHANGE: $.00 W., APPLICANT CHECKLIST »..., . H„,„„, �..... r.u�, F. . ,. ■ CONTACT UNDERGROUND SERVICE ALERT "USA" AT 1-800-227-2600 (OR "811" BY LANOLINE), AT LEAST 2 BUSINESS DAYS BEFORE EXCAVATION, TO HAVE EXISTING UNDERGROUND UTILITIEDS MARKED IN FIELD I. • OBTAIN CITY/COUNTY EXCAVATION PERMIT (IF APPLICANT TO TRENCH) ■ FOLLOW TRENCH INSTRUCTIONS (IF APPLICANT TO TRENCH) ❑ THE TOTAL NUMBER OF SWEEPS (BENDS) IN ANY ONE CONDUIT RUN NOT TO EXCEED 300', INCLUDING THE SWEEP AT THE FEED-IN LOCATION. • APPLICANT TO BACKFILL IMMEDIATELY AFTER INSTALL. MINIMUM OF 4" OF SAND AND 8" OF NATIVE SOIL DAY OF CONSTRUCTION. • HAVE SUFFICIENT SAND ONSITE PRIOR TO FINAL INSPECTION, REFER TO GREENBOOK SECTION 2.3.4 • MAINTAIN 3' MINIMUM PARALLEL SEPARATION FROM WET FACILITIEDS (I.E. WATER, SEWER, STORM), REFER TO UO STANDARD S5453, EXHIBIT B • TRENCH MUST MEET PG&E STANDARDS (SHOWN BELOW) AND HAVE 2" OF PG&E APPROVED SAND ON BOTTOM OF TRENCH BEFORE FINAL INSPECTION. ■ COORDINATE INSTALLATION OF TELEPHONE AND CABLE TV FACILITIES PER THEIR CONSTRUCTION REQUIREMENTS • CALL (408) 725-2202 OR FAX (408) 725-7773 FOR PG&E TRENCH INSPECTION - AT LEAST 2 BUSINESS DAYS ADVANCE NOTICE • PLUMB GAS HOUSELINE TO NEW LOCATION AND HAVE MUNICIPALITY NOTIFY PG&E THAT GAS HOUSELINE HAS PASSED INSPECTION ❑ GAS METER GUARDS PER GAS STANDARDS AND SPECIFICATIONS MANUAL SECTION J-95 • PAYMENT MUST BE RECEIVED BY PG&E, BEFORE CONSTRUCTION WORK CAN BE SCHEDULED 1 TYPICAL JOINT TYPICAL MINIMUM SEPARATION AND s SERVICE TRENCH GAS ONLY TRENCH \ \ CLEARANCE REQUIREMENTS IN o ?Z¢ ,_-12'-' G T T C S P MINIMUM COVER MIN. ¢W MIN. w¢ G GAS — 12" 12" 12" 6" 12" 24"; 30" in street N BACKFILL °~M�• _q Z i LJ> T TELEPHONE 12" — 1" 1" 12" 12" 24"; 30" in street �; 39' MIN. W T TELEPHONE (DB) 12" 1" — 1" 12" 12" 24"; 30" in street a 51' MIN. C T 3' 28' MIN. BACKFILL Q o C CAN 12" 1" 1" — 12" 12" 24"; 30" in street SAND 12' M¢ S ELECTRIC SECONDARY 6" 12" 12" 12" — 3" 24"; 30" in street z 4' COVER MIN. P ELECTRIC PRIMARY 12" 12" 12" 12" 3" — 30"; 36" in street S 6' MIN. . G \4' SAND SAND 2' ® —2' SL STREETLIGHT 6" 12" 12" 12" 1" 3" 24"; 30" in street GREENBOOK PG. 2-11\ GREENBOOK PG. 2 8 •SAND 2' PER UO STANDARD S5453, EXHIBIT B 30' MIN. TO BUILDING CORNER THE MINMUM CLEARANCES DO NOT APPLY TO FIXED WINDOWS THAT LENGTH /� A 6' MIN. TO INSIDE ARE NOT DESIGNED TO OPEN. !, BUILDING CORNER /, EXISTING PIPE ELECTRIC / ,� l2' MIN. TO OUTSIDE o' METER / %�, BUILDING CORNER 3 ELECTRIC 36' 36' SERVICE TEE 1 / METER 10' 10' MIN. MIN.O HOUSELINE 5' LENGTH X 4' WIDTH STEEL PIPE. , MIN. MIN. BUILDING 4' LENGTH X 4' WIDTH PLASTIC PIPE. COMMUNICATIONS VENT 36' V 36' ENCLOSURE 75' MAX MIN. MIN. I A 66' PREFERRED i�■ (�","� 48' MIN. ■ 4; T SERVICE = ��iL�jeee 26' TEE/HOUSELINE J EXISTING PIPE Ns ,` 9' �� °C FINISHED GRADE VENT METER BUILDING J 26' REGULATOR FINISH 18" UNDER STEEL PIPE. VENT GAS RISER GAS VENT GAS RISER GRADE 12" UNDER PLASTIC PIPE. GREENBOOK PG. 2-29 ELECTRIC SERVICE RACEWAY GREENBOOK PG. 2-30 GREENBOOK PG. 2-8 COMBUSTION 36' MIN. 36' MIN. k8,- COMBUSTION EXHAUST FAN EXHAUST FAN Noj f PAD-MOUNTED TRANSFORMERS,. i °N_ ALL ELECTRIC EQUIP. AND GAS REGULATOR 26• WIRING (E.G., CENTRAL AIR, COMBUSTION EXHAUST FAN) COMBUSTION AIR-INTAKE VENTS VENT 9'4_ AIR-INTAKE VENTS 8' MIN. - METER SERVICE TEE/HOUSELINE f, GREENBOOK PG. 2-31 '-'=` E 8' MIN. / EST: J. MANNINA JR. CO: ADE: J. GAMBUCCI Applicant Trenching Checklist SD: SUPV: E. STRAUB 226 SUNNYSIDE AVE. CAMPBELL NOTIF: 106885653 REP: C. MANNINA OTHER: PLNR: Applicant and PG&E Inspector Copy SHT: SHEETS SCALE: DATE: Meter Set Separation Dimensions and Clearances PM: REV. NONE 12/11/13 ' PACIFIC GAS AND ELECTRIC COMPANY 31036183 LEGEND W -� = PG&E TO INSTALL 4/0 AXL TPX (600V) SERVICE CABLE �J _ W IN (1) 3" PVC CONDUIT BY APPLICANT. I AF N —s = PG&E TO INSTALL 4/O AXL TPX (600V) SECONDARY CABLE IN (1) 3" PVC CONDUIT BY APPLICANT. ro [2] = APPLICANT TO INSTALL 17" X 30" X 26" (IVT) SECONDARY BOX. I 0 0 NOTES : 000 (..> N Z O N d 1. APPLICANT TO TRENCH JOINT WITH ELECTRIC, PHONE, & CATV. N 2. APPLICANT TO PROVIDE ALL ELECTRIC SUBSTRUCTURES AS SHOWN. N Z 3. APPLICANT TO PROVIDE MULE TAPE IN ALL ELECTRIC CONDUITS. N Q 4. APPLICANT "TO PROVIDE MANDREL" AND PROVING OF EX N CL- ALL ELECTRIC CONDUIT FACILITIES WITH PG&E INSPECTOR STANDBY. r 5. THE TOTAL NUMBER OF BENDS INSTALLED IN ANY PRIMARY DUCT RUN SHALL NOT U EXCEED 300 DEGREES. THE TOTAL NUMBER OF BENDS IN ANY SECONDARY DUCT RUN COORDINATE # 0o , IN EXCESS OF 200 FEET SHALL NOT EXCEED 300 DEGREES. ANY SECONDARY DUCT RUN LOADING DISTRICT 3157978 288R A C.)`� C. EQUAL TO OR LESS THAN 200 FEET IN LENGTH MAY CONTAIN UP TO A TOTAL OF 315 SUMMER COASTAL i -5 o I- DEGREES IN BENDS. TX SIZE - 37.5 LCD CD' w 6. PG&E INSPECTOR'S PHONE# (408) 725-2202. FAX# (408) 725-7773 KVA LOAD-82 -' v w 7. APPLICANT IS RESPONSIBLE TO ENSURE TRENCHING AND SUBSTRUCTURE # CUST. - 22 ca as o INSTALLATION MEET PG&E GREENBOOK STANDARDS. GREENBOOKS ARE AVAILABLE PHASE -10 z AT YOUR LOCAL PG&E HEADQUARTERS OR CAN BE FOUND ON THE INTERNET c. _ x• o Q w ® WWW.PGE.COM/GREENBOOK o N in 8. A 3' SEPARATION IS REQUIRED BETWEEN JOINT TRENCH AND WET FACILITIES. g N 9. GAS TO BE IN SEPERATE TRENCH ON W/S OF HOUSE. z ao 1O. CABLE LENGTHS INCLUDE TAILS (OFFSITE, ONSITE, CABLE.) M E-I 250 S. FIRST ST. w o L� N N cn U SECONDARY IS ALE z Q OPEN HERE \ 37.5 / \ o O- � 25 sC I BOX 0 \ ' / a_m /4\ 4 7978-8837 EL UG SVC 1 7 8835 1 TAC •1/0 TAC 4 - :__.ro-- CZ � �5'PT30817 1A �--1 M 2/UR 12KV 1c, \-/n."��ate» ,,,,,,,o___, 4' SEC ` ter 4 I l ..,t .4 , ! S 2 > ' __ Nom.o» 4i R' ., c S'0 rn .p a \ Si 6 G"a s rTP,C1.> I c EIEv]OS s3 W W i - - - o RE-ROUTE INFO: ""' m-.... co ' CD • APPLICANT TO EXPOSE EXISTING UG ql s m r' 6 w Q N d N SERVICE TO 250 S. FIRST ST. p1._- "\ _ 3 U • APPLICANT TO PROVIDE ALL 3" CONDUIT FOR v ' i ;�++es' REROUTE OF EXISTING UG SERVICE. =auI:_ I" \ I r _ -; t -- • PG&E TO REROUTE EXISTING UG SERVICE I CABLES INTO NEW #2 SPLICE BOX. ,ems "`" • APPLICANT TO BACKFILL TRENCH AFTER PG&E g .moo„ REROUTES THE UG SERVICE INTO #2 BOX. "'•`"` 1 -� ,,' m - 2OO AMS � _- 12O/24OV DETAIL FOR REROUTE co ry `� 'I � 226 / �E 5�8 KVA "-o I VF= 2.8V Q 0\ A/C= tOOA w U J �-f J 4, 250 S. FIRST ST.I ; '- ZO ( m S PROJECT CONDITIONS C..� Q L) L 2 n��.�5'P130811-1A !i 1yPeNa�of�STAMP V1 U ® a4 z 1 i y 0 PG&E Maintenance & Construction N E--4 N cv N APPLICANT TO PROVIDE Project Conditions: MAP H1616 g .9 I i ALL CONDUIT FOR ®NONE APPARENT (if project design change,,ooataot p ADE) or CLASS :5 AREA "B" 'NSA DIST C-.)REROUTE ❑CONDIITON5 APPLY: RISER QUADRANT j ❑PERMITS ❑TdILBOARD ❑OTC 12KV A'ZEA SC cue additional information ea Line SUB: EL PATIO 1 1 17 DT, n SSD: FUSE 32769 aurvas.NANI.[coDPoaAa ID]... • • of z vE CALL:811 I �` ****APPLICANT NOTES**** R r AFETY * APPLICANT TO TRENCH AND BACKFILL ALL * EXCAVATE 4'X4'X 18" BELOW GAS MAIN TIE-IN HOLE"thtt,�• ��e I * TRENCH 30' OF 12"X36" GAS ONLY ""°` CALL 811 * SEE APPLICANT CHECKLIST FOR TRENCH DETAILS CALL TWO WORKING DAYS BEFORE YOU DIG TICKET NO DATE BY ( � V J 7W 1,-1— \ \ CFI— ( J 1 1r` 1. 1 --4- IL-/ 0 \ TL ./ QE \\ / - C.o //' - yp SJ, \. . 5UNNY5IDE AVE. ,6\9,12 t / VI t- f TIED 2" HP STL-3' 1969 L11 1 _.. T _.. ....._. PROPERTY-OWE 7 PROPERTY LINE 21'1 1 1/ 1 // 6—I f cm I l —I I , I #226 / / PM#31036183 MAP#3412-15 CPA#3412-27 / EMERG 5I0#1/ MLX-NONE 1%9 CAMPBELL EST: J. MANNINA JR. CO: ADE: J. GAMBUCCI Gas Trench Drawing SD: SUPV: E. STRAUB 226 SUNNYSIDE AVE. CAMPBELL NOTIF: 106885653 REP: C. MANNINA OTHER: Applicant and PG&E Inspector Copy SHT: SHEETS PLNR: SCALE: DATE: Di% PM: REV. 11/13 ' PACIFIC GAS AND ELECTRIC COMPANY 31036183 NE