Loading...
HomeMy WebLinkAboutSpecial Provisions for Permit or Franchise - OT General - 7/7/1997 'R` Washington State Application for Permit or Franchise ' ♦/ Department of Transportation Request to Occupy State DOT Right of Way Applicant- Please print or type atl information Application Is Hereby Made: Category 1 Category 2 �ategvry-3-- x'Permit Fee $500 Fee$300 Fee $150 ❑Franchise p Consolidation ❑ Renewal O Amendment ❑ General Permit Fee $300 Fee $250 No Fee Intended Use of State Right of Way is to Construct, Operate, and Maintain a: State Route Number County At Mile Mile Post , O From Mile Post To Mile Post Beginning in The 114 of the 1d4-ef Section Township North:Range West/East W.M. -W ZZ Z Ending in The 114 of the 1/4 of Section Township North:Range West/East W.M. Fees in the amount of$ are paid to defray the basic administrative expense incident to the processing of this application according to WAC 468-34 and/or RCW 47.32 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." Applicant Field Review ontact erson Name: Authorization to Occupy Only If Approved Below Phone: The Washington State Department of Transportation referred to as the "Department,"hereby grants this document 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: Exhibits Attached (Department Use Only) Applicant (Reforreq to as Grantee UC- Exhibit"A"-Speeiatl Prapvitions>3or Permits and Frmw2tiM.. �32D r k 1, 3 Address Exhibit"B"-Utility Facility Description,Page 1 Exhibit"C"-Plan showing details,Page I Exhibit"D"-Traffic control plan,Pate I Cityi,State,zip CI ��O Exhibit"E"-Underground encroachment detail,Page 1 Telephone Construction of facilities proposed under this application shall begin w� within one year and must be completed within three years from the date Applican Aulborized Signature of approval_ Otherwise, this document shall become null and void. Approval Prin or T r pe N Department of Transportation W r Title By: ` , elo —Federal Tax ID Number or Social Security Number Title: Date: 7 7 9 7 Dated this day of — Grantee Reference Permit Number Explratlon Date — (W.O.) Number Franchise Number Amendment Number State Route _iO6 DOT Fo,m 224-69e 9 os Washington State Special Provisions for � vI/ Department of Transportation Permits and Franchises Permit/Ffaffo4isa No. U97-95 Applicable provisions are denoted by ( © ) ® 1. No work provided for herein shall be performed until the Utility is authorized by the following Department representative: Joyce Komac Area Maintenance Superintrndent 8293 Spring Creek Road SE Port Orchard,WA 983 66-96 1 3 Telephone(425)599-7255 2 A copy of Ue permit or franchise must be on the job site,and protected from tte elements,at aN times durirq any of the Construction authorized by said permit franchise, ® 3, In the event any milepost,ngft of way marker,fence or guard rail is located within the limits of this protect",And be disturbed during construction,these Reins will be rarefuity renwved prior to construction and reset or replaced at Ure conclusion of construction to the satisfaction of the Depertrrrert,AN signs and traffic control devices must be maintained in operation during construction. 4. prior to construction,the Utility shall contact the Department's representatrve(listed under Special Provision Number 1)to ascertain the location of survey control monuments within the project Nmils.In the event any monuments will be alill damaged or destroyed by the project,appropriate action v,d be taken by the Department.prior to construction,to reference or reset the rnorwnents.Any monuments altered,damaged a destroyed by the Utidty'a operation will be reset or replaced by the Department at the sole expense of the Utility. ❑ 5. During the construction and or maintenance of this facility,the Utility shall comply with the Marxral on Uniform Traffic Control Devices for Street*and Highways.If oetermined necessary by the Department,the Utility shall submit a signing and traffic control plan to the Department's representative for approval prior to construction or maintenance operations. 6. The amity shall notify the Department's representative upon completion of Ux work under this permlUfranoNse so that a final inspection can be made and shall Immediately furnish to the District Utilities Engineer a revised franchise or pentad plan of the final location or relocation of its facilities If the original permd/franchise plans have been revised during the course of construction. �] 7. Prior to the beginning of construction,a preconstruction conference shad be held at which the Department and the Utility and utilitys engineer, contractor,and inspector steal+be present 8 Should the Ut;lily choose to perform the worts outlined herein with other than its own forces,a representative of the Utility shall be present at all times, unless othervvise agreed to by the District representative.All contact between ttw Department and the Utildyys contractor shall be through fM representative of the Utility.Where the Utility chooses to perform the work with its own faces,it may elect to appoint one of its own employees engaged in the construction as its representative.Failure to comply with this provision snail be grounds for restricting any further work by the Utility within the State nght of way until said requirement is met The Utility,at its own expense,shall adequately police and supervise all work on the above described project by itself,its contractor,subcontractor,agent,and others,so as rot to endanger or injure any person or property_ g, The Utlity agrees to schedule the work herein referred to and perform said work in such a manner as not to de ay the Department's contractor in the performanoe of his contract. 10 Work within the right of way shad be restricted to between the tours of 8:00 AM and 4 30 PM and no work stall be allowed on the ngM of way Saturday,Sunday.or holidays,u niess authorized by the Department.Any lane closures must be submitted for approval in advance of use The hours of permitted closure may differ from the above rated hours 11, If determined necessary by the Department,any or all of the excavated material shall be removed and replaced with suitable material as specified by the Department 12 Wherever deemed necessary by the Washington State Department of Labor and Industries ar4or the Department for the safety of the workers and the protection of the highway pavement,the sides of the trench(or excavation)shall be adequately supported to reduce the hazard to workers and prevent any damage by cracks,settlement,etc.,to the pavement,No other work in the trench or excavation area will be allowed until this requirement is met. [ 13 Trenches shall be backfitted as soon as possible bet"the laying of pipe or cable.No open trenches stall be left overnight.This includes borhp or jacking pits which shall be covered with material of sufficient strength to wtietand the load of highway traffe if the pit Is not to be backftded with material each night. DOT F 224-OWU Page 1 Exhibit "A" ® 14. AN slopes,slope treatment,top soli,ditches,pipes,etc.,dWu(bed by this operation shell be restored to their or%#*cross section and condition.AN open trenches shall be merked by warning sign»,barricades,lights are If necessary,flagmen shal be empOyed for fine purpose of protecting the traveling public. Roadside operations may be specified by the Department's represent". ® 15. Where applicable,markers shall be placed at each right of way litre for all crossings and placed every 5W feet for longitudinal fines to Include: company name,pipeline or cable identfticatlon,telephone rxxrnbw for contact,and the distance from the marker 10 the Mine in feet.Markers stall be placed so as to minimize interference with maintenance operations.Marlene shall also be placed at all changes in offset distance from right of way we or cantertne of highway, ® 16. The tdlllty shah Install detector tape or cable approxiirrately 12 inches above the underground facility.The tie shall conform to the standards of the American Public Works Association Uniform Color Code. 17. In the event that construction and maintenance of the highway facility within the proximity of the%Hilly,installation becomes necessary durkog the period which this Utility will occupy a portion of the right of way,it is expressly understood that,upon request from"Departments representative.the Utility will promptly identify and locate by auitable field markings any and all of their underground facilitlee so that ilia Department or its contractor an be fully apprised at all:Imes of its precise location. ® is. The shoulders,where disturbed shall be surfaced with crushed surfacing top course four inches mwtinxen compacted depth, or as directed by the Department's representative.The surface of the finished shoulder shall slope down from the edge of pavement at the rate of 0.02 rod per foot uNesa otherwise directed.The restored shoulder must root have any strips or sections less than 2 feet wide.The restored shoulder shall be surfaced with asphalt concrete pavement. ❑ 19. All crossings of roadways surfaced with oN,asphalt concrete pavement or cement concrete pavement shah be accomolished by jacking,boring,or aogenng the cable or pipe under the roadway,unless specifically provided for otherwise cruder special provision No.21. ® 20_ The cable or pipe shall be placed within a suitable encasement as sWified on the attactled eRnibts.Said encasement pipe anal be jacdtad,bored,or angered through Vie highway grade with a minimum depth of 5 fed from top of casing to finished road grade and a mirvnnam of 3'/i feet of depth from bottom of ditch to top of casing. atiowed at those locations Identified on the exhibits and/or listed on ❑ 21. Open trench construction mil be ony plan Ex nibil(s) ,with restoration to be performed as noted on the attached'Open Cut Detail;Exhibit ❑ 22. No routine maintenance of this facility wilt be allowed withm the limited access area. ❑ 23. Routine maintenance of ihia facility will not be permitted from the through traffic roadways or ramps of SR and all service to this facility will be by access from ❑ 24_ Bond coverage required to ensure proper compliance with all terms and conditions of said permit or franchise will be fumishxd by a Blanket Surety Bond held at Headquarters in Olympia. ® 25. The Utility shah provide to the Department to the arrount of$ 2,0W00 a surety bond written by a surety company authorized to do business in the State of Washington or an escrow account with a bank approved by the Department,prior to start of corstuctkon,to insure compliance with any and all of the terms and conditions of this permit or franchise.Said bond/account to remain in race for a period ending one year after date of completion of Construction_ ❑ 26. The utility agrees to bury the aerial lines covered by this franchise in Scenic Classes Wand'B',as defined on attached or line to be reconstnlCted a to Exhibit(3) ether at the time of ma' reconstruction of the Ass,for that , for Porten prior expiration of this franchise. ❑ 27. Utifity agrees to bury the aenal lines covered by this franchise In Scenic Class"W,WC,'B',and/or-WC,as defined on attached Exhibit(s) at the time the pole owner buries its facility. ❑ 28. The l)titity agrees to bury or relocate aerially the existing overhead lines in Scenic Classes"AX'and'13X7,as defined on attached Enhibil(s) ,to a location acceptable to the Department either at the time of map(reconstruction of the line,for the portion of line to be reconstructed,or prior to the expiratlon of this franchise.The edshN aerial lines may remain In Itroir preaent Iocatton if acoeptable to the Department. ® 29. The Utility agrees to be responsible for any construction deficiencies as a reach of the roadway irtstahatilon. ® 30. No lane closures shall be ailaved except as approved by the Depertrnent representative.Approvals may cause revision of special provisions,inckuding hours of operation. ® 31. The responsibility of the Utllty for proper performance,safe conduct,and adequate policing and supervision of the protect shall not be leasened or otherwise affected by Department approval of plans,specifications,or work or by the presence at tho work site of DeparUnerrt representatives,or by compliance by the Utility wth any requests a recommendations made by such representatkea. 32. AN material and workmanship shall conform to the Washington State Department of Transportation Standard SpecMc&6ons for Road,E16dge and Municipal Constnfcdon,current edition,and amendments thereto,and shall be subject to Inspection by the Department. ® 33. Any changes or rrodifloations to the approved rranchlealpermit shall be subject to prior review and approval by the Department. DOT Fa n4Q O EF Page t Exhibit "A" MW D ra�� �i cicl zaa ,Al 500 644-P+ -ram .ter r rho 6� pu,nw ra�.rk d �' 1Ja6e.s: � wrtfi�n $o' c+r u.attr, x '1. Dn u 13LE Sr vP.�/e 7��rt - i ru orukL r 3. D&Z T"")L rorlllu l �prePcx.C� rnA Snd COa-ry 5 p,�DEL l- 3 -23d/oao 3 c rQQ 3 Tc-�cr�j '2Z r.�q 7-9,S EXHIBIT un» EI FOR 01`EI7AII(WS Dr 15 MINUTES OR LESS. of I sigr and chonnelizotion devices may be eliminated. FOR OPERAIIONS OF 60 MINUTES OR LESS, chonnelizolion devices ore required - signs are recommended. tINi1N I111 SS Rf IJO IIO IJO Jlo ))f 41 ou""WME•ORS wily MINCE .R 1111KIE •SN[lI IIK "[Feel S I A 110"AT wo"c IIISI / T/Re pJllP IRSIJI M000 1)• ROU AI440 SIOPIMG OISI/NCE )SSIA[S 2'ml n. $S►III% 110 w0 DRT PAVtifNI- Iw - MCOM1 11KII a a a o ® 1 ° o q O x X x T ARE L/3 `1 100' ROAD WORK SllallaA Soo'MAX. 0� SAD C�p GENERAL NOTES ND or reverse cone ROAD RORK toper to show end 1 . No encroachment on travelled lone. if of work area � =' encroachment is necessoryo lone must (;20 2A �� .W20-I SMOULDER W20-302 be closed. 48,,x4e" WORK 48"x48' 45"x24' Uj 8/0 D�0 2. Buffer vehicle recommended - Big (may be o work vehicle. ) r - M21-5 4e"x4B 0/0 Chonne I I z Ing MRAMUM TAPER LENG111 IL11N rtEI Sion Spacing ' x Device Spocing tFt.l Posted Speed Imphl -Toper on9enl 2S 30 35 40 45 SO $5 65 j 65 MPII 1500i- LEGENO Freeroysf H i000'►- ♦0 so r I 26S 450 500 550 or MUICD Port 6. foble YI- Do. RurolRoods ull q SIGN LOCATION Urban nugn Speedi 40/55 W11 500'•- 30 60 2+ 295 495 550 605 1 R I POD MOUNT `- 0 12 320 540 600 660 T80 a o a CIIANNELIIING DEVICES BUFFER VEHICLE - RECOMMENDED SIIOULOER CLOSURE - IIIGII SPEED 140 MPII or higher? Iroff;-c Engineer Requirements Involving 2 Underground Utility Encroachments R/1t Aeeepteb I e +elr Var i anee to Acceptable J** R/M ;., z ' z • 1 0'�_ N's N 'i rzcrne O Zonis s Zone A zone 6� Side TYPICAL LONGITUDINAL DETAIL CarwectIon a Shou I ders. a I 1 en Ln i fcrm a I i griment am traffic lanes grade as near as proctrcaDle ON a"I one to the right-oF way line'. Utility facilities shall be buried in accordance with the Provisions for Permits and Franchises. Zone A is the area Within the foreslooe and bacicslope where routine maintenance operations generally occur. This area is defined as five feet beyond the bottom of the ditch or 15 feet beyond edge of shoulder. whichever is further. Zone B is the area outside of the roadway and Zone A. _ Iz Nz hIZ • _ NOTES: Dro ins. H needed. should Corrler Ploe comet+ to a suitanle drainage course. Casing Pipes ehculd Of seciTYPICAL CROSSING DETAIL R,r1�nsf�neclulrea. Maren r4. 1910 Utilities Accommodation Policy Peps 2.1 May 1002 MVHjBR SIEn ASSIGNMENT OF ESCROW ACCOUNT This assignment is for the purpose of fulfilling the requirement of bonding collateral for Permit No. 97- The undersigned does hereby assign, transfer, and set over unto the State of Washington all right, title and interest in and to $2,000.D0 on 016-135652 SAv. /Account in the Aberdeen Branch The Bank of Grays Harb(Stink, in the name of Michael Hicks with full power and authority to demand, collect and receive said deposit and to give receipt and acquittance therefor for the uses and purposes prescribed above. It is understood and agreed that Aberdeen Branch.The Bank of Grays Harbol3ank holds the Certificate covering said account in its possession and agrees to hold$2,000.00 until a release of this assignment from the State of Washington Department of Transportation is received. The interest shall be payable to Michael Hicks. Signed and dated at AherdeepWashington this 30th day of May 1997 Lely2;_'Z24 Z_-_� Sign ture Signature PO Box 626 Address Aberdeen, WA 98520 City, State, Zip ACCEPTANCE The undersigned hereby accepts the foregoing Assignment of Escrow Certificate, Voucher Number in the amount of$2,000.00 this 30 th day of may , 19_�L. The Bank of Grays Harbor Bank PO Box 1826 300 E. Market St. Address Aberdeen, WA 98520 City, S t Zi 5 Ow fficer