Alamosa Drainage Project - Advertisement - Appendix N - Right of Way Permit.pdf

Page 1 of 10 Rev 2020 B.Maestas

Application for Right of Way Access

Name of Applicant: Name of Contractor:

Phone Number: Cell Phone Number: Phone Number:

Current Mailing Address: Person of Contact: Cell Phone Number:

Physical Address: Address:

City: State: Zip: City: State: Zip:

Email: Email:

Job Location w/ nearest cross street: Job Contact (Name and Phone):

Job Dates From: To: Job Contact Email:

Use Space Below or attach Sketch Project:

(Please include roads and dimensions of proposed project)

Latitude ____________________________________ Longitude ________________________________________

Work Description Work Type

Traffic Control (Check all that apply & attach plan)

Cut Info (Check all that apply)

Type of Backfill (Check all that Apply)

Install Water Manhole Flaggers Asphalt Asphalt Repair Sewer Culvert One lane closure Concrete Flowable Fill

Abandon

Electric Ditch Road closure Curb & Gutter Road Base

Encroach

Gas Storm drain

Parking restriction change

Gravel Excavated Material

Bore/Plow

Telephone/ Commutations

Sidewalk Special ROW usage Native material

Native material

Cable Right of Way

Speed limit reduction

Other:

Other:

Fiber Other: Other:

Road and Bridge • 8663 County Road 109 • Alamosa, CO 81101 Phone: 719-589-6262 • Fax: 719-589-6063•

Page 2 of 10 Rev 2020 B.Maestas

Permit Fee: $250

Additional Fees:

Improved Roadway $50

Appurtenances: $25 Ea.

(Power Pole, Phone Pedestal, Hand Hole, Man Hole, Pot Holes, ETC.)

HDD Drilling: $25 Per Run

HDD Boring and Plowing: 0-25 Ft $0.25 Per Ft 26-200 Ft $0.15 Per Ft

Over 201 Ft $0.10 Per Ft

Fine Fees: Please refer to the Condition and Regulations Fine can only be waived by the degression of the director

I have reviewed all the Conditions and Regulations and agree to comply with all of Alamosa County Stipulations.

Applicant Print Name: _________________________________________________________________

Applicant Signature: ___________________________________________Date:___________________

Do not write below – Office Use Only

Quanty Unit Cost Total 250.00$ $

50.00$ $

25.00$ $

25.00$ $

0.25$ $ 0.15$ $ 0.10$ $

Total

Documents check-list Proof of Insurance Site Plan (if not drawn) Proof of Payment

Traffic Plan (if needed) Notification of Road Work to Dispatch

Please note amount and material removed or excavated Asphalt/Material Concrete Curb & Gutter

Dimensions (sq ft) (LxWxD) Dimensions (sq ft) (LxWxD) Dimensions (sq ft) (LxWxD)

Special Instructions: Special Instructions: Special Instructions:

Initial Inspection (if needed)

Final Inspections (Required)

Date Date

Pass Fail-Reason: Pass Fail-Reason:

Inspector Inspector

Notes/ Inspections Required Notes

Page 3 of 10 Rev 2020 B.Maestas

Alamosa County Road and Bridge PERMIT #:_________

8663 County Rd 109 S EXPIRES: _________ Alamosa, CO 81101

(719) 589-6262

ROW PERMIT

APPLICANT INFORMATION

CONTRACTOR INFORMATION

PROJECT DESCRIPTION

Applicant:

Phone:

Email:

Mailing:

City, State Zip:

Contractor:

Phone:

Email:

Mailing:

City, State, Zip:

Type of Project:

Linear Footage:

NOTICE: READ BEFORE SIGNING

All inspection requests require a minimum 24-hour notice. Inspection cancellations must be received before

9:00 A.M. the day of the inspection. If the inspection proceeds and you are not prepared, you will be charged a $50 re-inspection fee. Harassment of Inspectors will not be tolerated. If there is inappropriate conduct, verbal abuse, or unwanted physical contact, the inspector reserves the right to cancel the inspection and $50 re-inspection fee will be assessed.

I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinance governing this type of work will be complied with whether specified herein or not. The granting of a permit does not give authority to violate or cancel the provision of any other state or local law.

SIGNATURE OF

OWNER/CONTRACTOR______________________________________DATE_____________

SIGNATURE OF

DEPARTMENT STAFF________________________________________DATE_____________

Page 4 of 10 Rev 2020 B.Maestas

Road and Bridge 8686 County Road 10 South Alamosa, CO

REQUEST FOR INSPECTION NUMBER: 719-589-6262

ROW INSPECTION RECORD

Applicants:

Address:

Projects:

Contractor:

Expires:

ALL BOXES CHECKED MUST REQUIRE

AN INSPECTION and SIGNATURE of official

Initial Inspection

Mid - Culver Setting inspecting (Needs to be called in before covered)

Mid - Asphalt Replacement

Mid - Concrete Replacement

Mid - Utility inspection (Needs to be called in before covered)

Final Inspection

Other (Please Specify) ____________________________

Notes

THIS INSPECTION RECORD CARD MUST BE POSTED ON THE JOB SITE AND AVAILABLE FOR

INSPECTOR(S) TO SIGN.

SHOULD THIS CARD NOT BE POSTED AND AVAILABLE FOR THE INSPECTORS, THEY WILL REFUSE THE

INSPECTION AND A RE-INSPECTION FEE OF $50.00 WILL BE

ASSESSED AND PAID BEFORE THE NEXT INSPECTION.

Approved Failed

Page 5 of 10 Rev 2020 B.Maestas

Alamosa County Right-of-Way Access Conditions and Requirements

The following requirements must be met for all and/or work being done within Alamosa County Right-of-Way (ROW).

1. CALL BEFORE YOU DIG. All utilities must be located prior to any engagement of work within the right of way with at least 48 hours’ notice in advance of starting. Call the Utility Notification Center at 811 or 800-922-1987 for locates.

2. A permit fee of $250.00 + Additional costs must be paid to Alamosa County before a permit will be Processed. The submittal of application for permit must include all proper documentation to start Approval Process. Once Approved, Applicant will be notified of Approval.

3. Contractors must have proof of insurance and active insurance bonds provided by a federally certified bonding for company prior to the permit being issued.

4. The permittee shall perform any other requirements deemed necessary by the Director of Road and Bridge or Designated Representative for the particular circumstances of the project and so specified hereon.

5. Contractor agrees to guarantee all work under this Permit for a period of Two (2) years from the date of final acceptance by Alamosa County.

6. Work must only be done pursuant to the Permit Monday through Friday between 7 A.M. and 7 P.M. Any work done outside of these hours is a violation of this Permit and will be assessed a $100 fine per day. Arrangements can be discussed if need be.

7. No cleated or tracked Equipment shall work on any pavement surface without mats or other appliances adequate to prevent damage to such surface without permission from the Director of Alamosa County Road and Bridge or Designated Representative.

8. All work must be completed by the dates(s) on the permit. If an extension is required, the Road and Bridge Department must be notified prior to the expiration of the permit in order to ensure emergency services are notified in a timely manner.

9. Traffic Control Plans are required in all cases 24 hours in advance. The Traffic Control Plans should include a drawing of the county road where the work zone will be located along with the nearest intersection noted as well. Road names, north arrows, type of traffic control devices, distances between, and location of approved work in the Right of Way should also be noted. A minimum of one lane must remain open at all times, unless an alternate reasonable route approved in advance by the Road and Bridge Director or

Page 6 of 10 Rev 2020 B.Maestas

Designated Representative is available for traffic. A certified Flagger may be required to facilitate traffic flow safely through a construction zone. The Contractor shall adhere to the Manual on Uniform Traffic Control Devices (MUTCD) for all traffic control plans. Any equipment or other obstructions left on ROW after sunset must be to as far off road surface as possible and barricaded with lighted barricades. Inadequate traffic control or improper equipment barricading will result in a $100 fine per day.

10. Project Sketch - The Contractor can draw or provide a sketch of the work to be done, including road names, and any structures in work area (if appropriate), approximate locations of all utilities in relation to the work being done, the type and location of work being done, a north arrow, and other pertinent information. If the Contractor is unable to install the proposed utility where it is shown in this sketch, the Contractor shall submit an additional sketch to show the actual work location.

10. Any new installation crossing perpendicularly, or running parallel to and within four

(4) feet horizontally of ANY County owned facility shall be made beneath the level of the County owned improvement so as not to impede or otherwise constrain the county’s ability to maintain infrastructure.

11. Linear installations to any section of the Right-of-Way will be determent by the linear foot plus base fee. This rate will apply to underground (bore) or plowed installations.

12. Excavations impacting less than 4 square feet of surface area shall be considered and shall be backfilled with flowable fill concrete meeting the requirements specified in Section 15 of this permit. All potholes shall be patched with HMA (Hot Mix Asphalt) when available, or with approved cold patch when hot mix is not available. If cold patch is used to patch the pothole, the Contractor is required to remove the cold patch and install HMA as soon as HMA is available.

13. Excavations that undermine the surface material adjacent to the excavation in the opinion of Director of Alamosa County Road and Bridge or Designated Representative shall be backfilled with flowable fill concrete meeting the requirements specified in Section 19 of this permit.

14. Compaction testing of subgrade and road base backfills is required in all excavations in county ROW. Subgrade soil backfills shall be compacted to a minimum of 95% of the Standard Proctor Density at +/-2% of optimum moisture. Road base backfills shall be compacted to a minimum of 95% of the Modified Proctor Density at +/- 2% of the optimum moisture. The use of an approved flowable fill concrete negates compaction testing requirements. HMA (Hot Mix Asphalt) and concrete may be applied directly over the top of the flowable fill. Testing frequency and additional requirements may be discussed with the Director of Alamosa County Road and Bridge or Designated Representative.

Failed compaction tests shall require re-excavation, re-compaction and additional testing at the Contractor’s expense.

15. Flowable fill concrete is an acceptable backfill material as long as it is designed within the range of 50 to 200 PSI maximum strength at 28 days. However, the roadway must be open for traffic at the end of the working day. If flowable fill concrete backfill has not adequately set up by the end of the working day, steel plates will be required over the trench to allow traffic flows. A temporary HMA or cold patch ramp shall be installed along

Page 7 of 10 Rev 2020 B.Maestas each edge of the steel plate to make a smooth transition for vehicles travelling over the trench.

16. All roadways shall be patched within 72 hours of cutting, or within 24 hours of completion of underground and backfill work, unless prohibited by cold or inclement weather. Prior to patching, the contractor shall monitor the condition of the cut area weekly and immediately repair all potholes and bumps in the temporary surface. If weather does not allow asphalt placement within 72 hours, cold mix shall be placed in the street cut for the interim period until hot mix can be placed. If cold mix is used, the Contractor shall return to the site bi-weekly to monitor surface condition and perform needed maintenance.

17. After completion of the work necessitating an excavation, the excavated area shall be refilled and returned as near as possible to its condition prior to the excavation, including all pavement, cement and other surface material, within five (5) days. Applicant shall restore all slopes and drainage ditches to original condition prior to the permitted work.

All surfaces not completed within this time frame are subject to replacement by the Alamosa County at a cost of $150.00 per hour pulse materials to be billed to the contractor.

18. Asphalt shall be saw-cut for a clean straight edge prior to new asphalt placement.

Asphalt thickness shall be matched to existing conditions plus (1) one inch. Placement shall be done in lifts not to exceed 3 inches. A minimum thickness of 3 inches of asphalt is required. The minimum patch dimensions shall be 2 ft. by 2 ft.

19. Open hole limits - all trenches shall conform to appropriate federal, state and local safety regulations. Every effort shall be made to guard the safety of the general public.

OSHA regulations for trench safety shall be adhered to. Open trenches are not allowed overnight without prior approval of the Director of Alamosa County Road and Bridge or Designated Representative.

20. If within twenty-four hours after the County gives the Contractor notice of a defect, failure or abnormality of the work and the Contractor neglects to make, or undertake with due diligence to make the necessary repairs or adjustments, Alamosa County is hereby authorized to make repairs or adjustments or order the work to be done by a third party.

The cost of the work plus 15% shall be paid by the Contractor.

21. Contractor must give Director of Alamosa County Road and Bridge or Designated Representative 24 hours’ notice before proceeding with work (719-589-6262).

22. Any contractor installing utility conduits via a boring method, either crossing or longitudinal to County Sewer System infrastructure, that may or may not be located in easement, tract, or rights of way, shall provide CCTV video documentation of the sewer main line and service line condition along the alignment of utility conduit installation. The CCTV documentation shall be conducted immediately after completing the new utility conduit installation. A video copy of the documentation with a plan view schematic showing orientation of the sewer system and utility conduit alignment shall be provided to the county for review prior to approval of the work.

23. The Required Inspections on this permit form details the two inspections that are required in order to obtain final sign off on this permit by Director of Alamosa County Road and Bridge or Designated Representative. Different types of jobs will require

Page 8 of 10 Rev 2020 B.Maestas different inspections. Which will be noted in the notes; therefore, some permits may require more or less inspection work than others. Failure to obtain a sign off by Director of Alamosa County Road and Bridge or Designated Representative in any of the indicated areas will prevent final sign off of this permit. Refer to the latest copy of the Failure to obtain a final inspection by will result in the county notifying the contractors bonding company.

24. Applicant or his agent shall present a copy of this permit for inspection on demand by any member of the Alamosa County Government, upon proper identification being shown.

25. Applicant assumes full responsibility for any and all damages or claims resulting from the performance of work for which the Permit was issued. Applicant agrees to indemnify and hold the County of Alamosa harmless from any and all claims, demands and suits, including County attorneys’ fees, arising from or related in any way to the performance of work for which the Permit was issued.

26. No work shall be performed without current permit or out of perimeters. Such as amount of linear feet, number of Appurtenances installed or preformed. Work cannot be performed out of the start and finish date. In Doing so, could result in a fine of $500.00 per day unless arrangements have been made with the Director of Alamosa County Road and Bridge or Designated Representative. Installing or preforming Appurtenances without permit or out of permit perimeters could results in an additional $10 per appurtenances along with currently appurtenances permit fee.

27. Applicant represents to the Alamosa County that its employees, agents and subcontractors who will perform the work for the Permit has been issued will be fully covered by Worker’s compensation insurance when performing the work.

28. These fees in no way release the applicant from restoring roadways to original or better condition. The linear footage fees are in addition to the base fee. All fees are cumulative.

29. Fees can be asked to be waived for utility relocations for county projects but a permit must be issued to track the quality of the work that is performed.

30. Fees will not be charged to governmental agencies, tax-based agencies or utility districts, and however a permit must still be issued to track the quality of the work that is performed.

Protection of County Utilities

38. The Contractor shall at all times take proper precautions and be responsible for the protection of all County owned Utilities (water mains & service lines, sanitary sewer mains & service lines).

39. The Contractor shall “Pot Hole” County owned utilities when work is anticipated within a 5-foot radius or crossing at any depth to check for correct location and depth of all City owned utilities before work commences.

40. The Contractor shall “Pot Hole” at all additional locations as directed by the County.

Page 9 of 10 Rev 2020 B.Maestas

41. All utilities installed parallel to County owned utilities by boring or open trench will maintain a 4-foot radial distance from any County owned utility and never to be installed on or above any County owned utility including mains, service lines, or laterals.

42. All private telecommunications shall submit engineered plans sealed by a professional engineer registered with the State of Colorado with the excavation permit. These documents are to be reviewed and approved by the County before work commences.

43. All private telecommunications installations are to follow the stamped engineered plans unless otherwise directed by the County.

44. All private telecommunication installations will keep open trench and boring logs that include placement location and depth of line installation. A copy of these logs will be readily available for review during installation work and an as built copy of logs will be turned into the County once work is complete on a particular boring or trench installation.

These logs are to be submitted within 72 hours of the closing of the trench or de-mobilization of the boring equipment.

45. All Telecommunication installations in the County owned ROW shall be placed behind the curb & gutter (outside the pavement section). If the street is constructed without a curb & gutter telecommunication installation will be installed in the back slope of the ditch.

46. Plowing of utilities will only be allowed in special cases and upon review by the Public Works Director. Schedule of Fees Any Contractor or Person that causes damage to any County owned utility will be subject to the following schedule of costs: Please See (pg 10) Fines.

Please Submit an AS-BUILT upon completion of work…

Page 10 of 10 Rev 2020 B.Maestas

Fines/ Fees

• Supervisory personnel mobilization and assessment of damages. $500.00 (five hundred) dollars.

• Isolation of damaged utility segment (closing valves in the waste water system or installation of plugs and pumps in a sewer system) $1,000.00 (one thousand dollars)

• Excavation to and repair of main line $2,000.00 (two thousand dollars) minim for a minor repair.

For a major repair in addition the Contractor will be billed on time and materials basis.

• Working without Permit. $500.00 Per Day

• Working out of Hours $100.00 Per Day

• ROW Restored by County due to incompletion of Permit. $150.00 Per Hour of billable work plus Material plus 15%

• ROW not opened out of working hours $150.00 Per day

• Appurtenances preformed or Installed without permit: $10.00 per Appurtenance plus $25.00 permit fee

• Re-inspection Fee. $50.00 (Needs to be paid before next inspection)

• Permit Renewal. Half the cost of original Permit Fee.

Permit Fee: $250

Additional Fees:

Improved Roadway $50

Appurtenances: $25 Ea.

(Power Pole, Phone Pedestal, Hand Hole, Man Hole, Pot Holes, ETC.)

HDD Drilling Runs: $25 Per Run

HDD Drilling and Plowing: 0-25 Ft $0.25 Per Ft

26-200 Ft $0.15 Per Ft

Over 201 Ft $0.10 Per Ft