HomeMy WebLinkAboutDangerTree Removal Permit No. 05-106-002 - OT General - 7/25/2005 Washington State
Department of Transportation Application for General Permit
Permit No. F5 - 106 - 002
Applicant- Please print or type all information
Application is Hereby Made For: ®General Permit(No Fee)
ā¯‘General Permit $2.50(Subject to RCW 47.12.140(2)) Reimb.Acct.
Intended Use of State Right of Way is to Construct, Operate, and Maintain a:
Cut and remove danger trees on and adincent to WSDOT right-of-way. These trees were identified to he removed
during a site inspection by Larry Deemer, WSDOT Supervisor- and Greg Jones, professional forester from Forest Pro,
Inc.
on a portion of State Route 106 (at/from)MilePost 8.4 to Mile Post in Mason County,
to begin in the SW 1/4 of SW 1/4 Section 34 Township 22 North: Range 3W West/East W.M.
and end in the W 1/2 of SW 1/4 Section 35 Township 22 North: Range 3W West/East W.M.
Fees in the amount of$ are paid to defray the basic administrative expense incident to the processing of this
application according to RCW 47.12.140(2)and amendments.The applicant further promises to pay additional costs
incurred by the Department on the behalf of the applicant.
Checks or Money Orders are to be made payable to"Washington State Department of Transportation."
Jerry Vermillion
Applicant(Referred to as Grantee) Apo i nt Autho ed Signature
8371 Hwy. 106 Jerry Vermillion
Address Print or Type Name
Union WA 98502 Owner
City State Zip Code Title
360-898-8234 Dated this 18 day of July 2005
Telephone
Applicant Reference(WO)Number Federal Tax ID Number or Social Security Number
Authorization to Occupy Only If Approved Below
The Washington State Department of Transportation referred to as the"Department,"hereby grants this Permit subject to the terms and
conditions stated in the General Provisions,Special Provisions,and Exhibits attached hereto and by this reference made a part hereof:
Construction facilities proposed under this application shall begin within one year and must be completed within three years from date of approval.
For Department Use Only
Exhibits Attached Department Approval
1. General Provisions
2. Special Provisions for Veg Management on Hwy R/W By:
3. Signed permit must be on jobsite while work is in progress CA
4. All personnel working on WSDOT right-of-way must wear Clay Wilcox
approved personal protective equipment Title: Assistant Superintendent
5. Appropriate traffic control measures, per the MUTCD, are to
be taken while work is being performed on the R/W to ensure
the safety of the traveling public Date:
6. All debris shall be removed from the R/W.
7. Work to be performed by a Washington State licensed and
bonded contractor. Expiration Date: December 31,2005
DOT Forth 224.698 EF
3/97
General Provisions
1. The Grantee, its successors and assigns, agrees to protect the State of Washington, its officers and employees and save them
harmless from all claims, actions or damages of every kind and description which may accrue to or be suffered by any person,
persons, or property by reason of the acts or omissions of the Grantee, its assigns, agents, contractors, licensees,employees
or any person whomsoever, in connection with Grantee's, its assigns', agents',contractors', licensees'or employees'
construction, installation, maintenance, operation, use or occupancy of the right of way or in the exercise of this permit. In case
any suit or action is brought against the State of Washington, its officers and employees, arising out of or by reason of any of the
above causes,the Grantee, its successors or assigns will, upon notice of such action,defend the same at its sole cost and
expense and satisfy any judgment against the State of Washington, its officers, or employees: PROVIDED,that if the claims or
damages are caused by or result from the concurrent negligence of(a)the State of Washington's agents or employees and
(b)the Grantee or Grantee's agents or employees,this indemnity provision shall be valid and enforceable only to the extent of
the negligence of the Grantee or the Grantee's agents or employees.
The Grantee, and on behalf of its assigns, agents, licensees,contractors and employees agrees to waive any claims for losses,
expenses,damages or lost revenues incurred by it or its agents, contractors, licensees,employees or customers in connection with
Grantee's, its assigns', agents', contractors', licensees'or employees'construction, installation, maintenance, operation, use or
occupancy of the right of way or in the exercise of this permit against the State of Washington, its agents or employees except the
reasonable costs of repair to property resulting from the negligent injury or damage to Grantee's property by the State of
Washington, its agents, contractors or employees.
2. During the progress of the work, such barriers shall be erected and maintained as may be necessary or as may be directed for the
protection of the traveling public;the barriers shall be properly lighted at night.
3. Except as herein authorized, no excavation shall be made or obstacle placed within the limits of the State highway in such a manner
as to interfere with the travel over said road.
4. If the work done under this permit interferes in any way with the drainage of the State highway,the Grantee shall wholly and at its
own expense make such provision as the Department may direct to take care of said drainage.
5. On completion of said work herein contemplated, all rubbish and debris shall be immediately removed and the roadway and roadside
shall be left neat and presentable and satisfactory to the Department.
6. All of the work herein contemplated shall be done to the satisfaction of the Department, and all costs incurred by the Department shall be
reimbursed by the Grantee.
7. The Department hereby reserves the right to order the change of location or the removal of any structure or structures authorized
by this permit at any time, said change or removal to be made at the sole expense of the party or parties to whom this permit is issued,
or their successors and assigns.
8. All such changes, reconstruction,or relocation by the Grantee shall be done in such manner as will cause the least interference with
any of the Department's work, and the Department shall in no wise be held liable for any damage to the Grantee by reason of any such
work by the Department, its agents or representatives, or by the exercise of any rights by the Department upon roads, streets, public
places, or structures in question.
9. This permit or privilege shall not be deemed or held to be an exclusive one and shall not prohibit the Department from granting other
permits or franchise rights of like or other nature to other public or private companies or individuals, nor shall it prevent the Department
from using any of its roads, streets, or public places, or affect its right to full supervision and control over all or any part of them, none of
which is hereby surrendered.
10.The Department may revoke, amend, or cancel this permit or any of the provisions thereof at any time by giving written notice to the
Grantee.The Grantee shall immediately remove all facilities from the right of way.Any facilities remaining upon the right of way 30
days after written notice of cancellation shall be removed by the Department at the expense of the Grantee.
11.The party or parties to whom this permit is issued shall maintain at its or their sole expense the structure or object for which this
permit is granted in a condition satisfactory to the Department.
12. Upon approval of this permit the Grantee shall diligently proceed with the work and comply with all provisions herein.
13.This permit is subject to all applicable provisions of RCW 47.32, RCW 47.40 and/or RCW 47.12.140(2)and
amendments thereto
14.The Grantee hereby certifies that the facilities described in this permit are in compliance with the Control Zone Guidelines.
DOT Form 224-698 EF
3/97