Appendix B - Traffic Permits.pdf
PDF 2 MB Posted
- Attached to
- BID NO. 256112 LARGE DIAMETER SEWER INSPECTION
- Solicitation number
- S-KS0043-00016029
- Issued by
- Marion County, Oregon
About this file
This file comprises multiple permit application forms and traffic control documents for work in right-of-way projects across the City of Salem and Marion County, Oregon. The documents are designed to regulate and authorize construction activities, utility work, and special events within public roadways and right-of-way areas under the jurisdiction of the City of Salem, Marion County Land Development Engineering & Permits (LDEP), and the Oregon Department of Transportation (ODOT). The City of Salem requires three full business days' notice for traffic permits, with applications submitted to the City Project Manager. Work permits are classified as Type A (valid for 30 days) covering sidewalk closures and local right-of-way work, or Type B (valid for 10 closure days within a 30-day period) covering arterial and collector lane closures. Arterial and collector daytime work hours are restricted to 8:30 a.m. to 3:30 p.m. unless otherwise approved. Marion County LDEP applications require submission of site plans via email to MCLDEP@co.marion.or.us, with fees ranging from $50 to $1,000 depending on permit type, plus additional plan check fees calculated as percentages of engineer's estimates for major construction projects.
Applicants must provide contractor certificates of insurance with additional insured endorsements, construction plans, proposed work schedules, cost estimates, traffic control plans, and erosion prevention and sediment control plans where applicable. Marion County requires financial guarantees ranging from 100 to 125 percent of the engineer's estimate depending on rural or urban classifications. For work affecting state highways, ODOT approval is required via a separate application form (OAR 734-055), with applicants required to notify the District Representative at least 48 hours before beginning work and comply with Oregon Utility Notification Center rules by calling 1-800-332-2344. All work must conform to applicable federal, state, and local laws, the Manual on Uniform Traffic Control Devices (MUTCD), and the Oregon Temporary Traffic Control Handbook. Contractors performing full street closures that restrict emergency services must notify the City of Salem Public Works Dispatch Center at 503-588-6311, the school district at 503-399-3100, and the transit district at 503-588-5468 at least 24 hours in advance.
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Text version
Appendix B
Traffic Control Permits
City of Salem
Capital Improvement Projects Work in Right-of-Way Permit Application
PLEASE COMPLETE SECTION 1 OF THIS DOCUMENT.
Notice of three full business days is required (weekends and holidays excluded). Send the completed application to radkins@cityofsalem.net .
SECTION 1: GENERAL INFORMATION
Type A (Valid for 30 days) Closure of sidewalk Closure of local right-of-way, lane, alley, or street Work in collector or arterial, maintaining all travel lanes
Type B (Valid for 10 closure days within a 30-day period)
Closure of one arterial lane Closure of one collector lane Closure of two or more arterial lanes Closure of two or more collector lanes
Site Address_ ________________________________________________________________________ Work Location________________________________________________________________________
Name of Applicant_____________________________________________________________________
Address______________________________________________________________________________
Day Phone________________________________ Evening Phone_______________________________
Email____________________________________________________ Fax________________________
Is applicant the contractor? Yes No If no, provide the contractor’s contact information.
Name of Contractor’s Contact Person_ ___________________________________________________
Day Phone _______________________________ Evening Phone_______________________________
Email____________________________________________________ Fax________________________
Description of Work to Be Done_ ________________________________________________________
City Project Manager________________________________________ City Project Number___________
ARTERIAL AND COLLECTOR DAYTIME WORK HOURS ARE 8:30 A.M. TO 3:30 P.M.
Requested Start Date_ ______________________ Time_____________________ a.m. p.m.
Requested End Date________________________ Time_____________________ a.m. p.m.
Signature of Applicant_____________________________________ Date_______________________
OFFICE USE ONLY
Revised Date _ _______________
Int _____________Date ________
Revised Date _ _______________
Int _____________Date ________
Revised Date _ _______________
Int______________Date ________
For Office Use Only
Traffic Permit #
AMANDA Permit #
Expedited Yes No
AEdelman Text Box
AEdelman Rectangle mailto:radkins@cityofsalem.net mailto:developmentservices%40cityofsalem.net?subject= mailto:developmentservices%40cityofsalem.net?subject= mailto:radkins@cityofsalem.net mailto:radkins@cityofsalem.net mailto:radkins@cityofsalem.net dtps\…\work-in-right-of-way-permit-app-2024-07-01.indd Page 2 of 2
SECTION 2: PERMIT CONDITIONS—TO BE FILLED OUT BY CITY STAFF
Arterial and collector daytime work hours are 8:30 a.m. to 3:30 p.m. unless otherwise required or approved by the City Traffic Engineer.
1. All work shall be done in accordance with all applicable provisions of federal, state, and local laws, ordinances, and administrative rules.
2. All work in public right-of-way and all work which is connected, directly or indirectly, to City of Salem water, sanitary sewer, or storm sewer lines shall be constructed in accordance with applicable City of Salem Standard Construction Specifications.
3. Any full street closure that restricts emergency services requires the contractor to call the City of Salem Public Works Dispatch Center at 503-588-6311 to notify of closures and re-openings.
4. Permittee shall indemnify, defend, and save harmless the City of Salem, its officers, employees, and agents from any and all claims arising out of or in connection with any work done under this permit.
5. The City Traffic Engineer, or their designee, reserves the right to deny or modify the submitted traffic control plan. Should a problem arise as a result of the approved traffic control, additional traffic control may be required at the permittee’s expense.
6. This permit may be revoked at any time by the Public Works Director or their designee.
Approved Date of Closure________________________________________________________________
Approved Time of Closure________________________________________________________________
ADDITIONAL CONDITIONS OF PERMIT
Contractor shall contact these agencies 24 hours in advance of work:
City of Salem Public Works Dispatch Center 503-588-6311 for full street closure and re-openings that restricts emergency services.
School district 503-399-3100
Transit district 503-588-5468
Traffic signal shall be turned off to flag at intersections. Please contact your inspector at least 5 full business days prior to the start of work.
All traffic control shall be in accordance with the Manual on Uniform Traffic Control Devices (MUTCD), the Oregon Temporary Traffic Control Handbook, and to the satisfaction of the City Traffic Engineer. The traffic control indicated is approved subject to the following conditions:
Approved By_ ____________________________________________ Date_______________________
City of Keizer
Marion County https://pw.intra.co.marion.or.us/Engineering/LDEP/Forms/Application/LDEP Application Cover Sheet.docx Page 1 of 1 Last Revised: 2/17/23
Marion County LDEP Application Cover
Sheet
OREGON
Public Works Land Development Engineering & Permits 5155 Silverton Rd NE Salem, OR 97305
(503) 584-7714 http://co.marion.or.us/PW/Engineering/
Marion County Land Development Engineering & Permits (LDEP) Application Cover Sheet
Permit Applying for Minimum Sections
Required Fee
Work in Right-of-Way 1, 2, 3, 5, 6, 7 $100.00
Major Construction 1, 2, 3, 5, 6, 7 1% of Engineer’s Estimate + Pre-Review Plan Check of 0.5% of Engineer’s Estimate + Post-Review Plan Check of 0.25% of
Engineer’s Estimate
Erosion Prevention and Sediment Control
1, 2, 3, 6, 8 $150.00
Access (Driveway) 1, 2, 3, 6, 9 $50.00
On-site Stormwater 1, 2, 3, 6, 10 $100.00
Event and/or Road Closure 1, 2, 3, 6, 11 Social Activity/Road Closure $150.00
Commercial Activity – Up to 2 Days $500.00
Commercial Activity – 2 Days or More $1,000.00
PUC Work in Right-of-Way 1, 2, 3, 6, 12 $0
Annual Blanket 1, 2, 3, 5, 6, possibly 7 $100.00, $0 for Public Utility Company
Plan Review ONLY 1, 2, 3, 6 0.5% of Engineer’s Estimate
Application Instructions:
• Sections 1, 2, 3, and 6 are required for all applications. Section 4 is only needed if applicable.
• Sections 5, 7, 8, 9, 10, 11, and/or 12 are to be completed as instructed by Section 6.
• Signature and date are required on the last page, complete the fee summary table if applicable.
• Email digital applications and site plans to MCLDEP@co.marion.or.us Note: A site plan is required for all applications (except Annual Blanket applications).
mailto:MCLDEP@co.marion.or.us https://pw.intra.co.marion.or.us/Engineering/LDEP/Forms/Application/General Application 08.25.23.docx Page 1 of 4 Updated 8/25/23
For Internal Use Only
Record Number: ___________________________
Date App Received: _________________________
Instructions:
• Sections 1, 2, 3, and 6 are required for all applications. Section 4 is only needed if applicable.
• Sections 5, 7, 8, 9, 10, 11, and/or 12 are to be completed as instructed by Section 6.
• Signature and date are required on the last page, complete the fee summary table if applicable.
• Email digital applications and site plans to MCLDEP@co.marion.or.us
Note: A site plan is required for all applications (except Annual Blanket applications).
1. Project/Event Information (Required) Project/Event Name:
Detailed Description of Work/Event:
Worksite/Event Address:
Affected/Fronting Parcel or Tax lot #:
Notes:
• Parcel or Tax lot numbers appear like 072W08D000300. Refer to the Marion County GIS Program for assistance.
• A matching parcel number and address is required as a matter of permit traceability, even for work exclusively in public right-of-way.
• If multiple locations are involved identify a primary and list only ONE parcel number and address per application.
Associated Land Use Case(s) – If Applicable:
2. Property Owner Information (Required)
• For work exclusively within right-of-way provide the information of the affected/fronting property owner.
• Enter Customer’s information if work is for a customer and is connecting to private property.
First and Last Name:
Mailing Address:
E-mail:
Primary Phone:
3. Applicant Information (Required) – If PUC enter PUC info ☐Check if same as Owner First and Last Name:
Organization Name:
Mailing Address:
E-mail:
Primary Phone:
4. Agent for Applicant Information (If Applicable)
• An “Agent” is an Applicant’s designated representative
☐Check if same as Owner
☐Check if same as Professional (Section 5)
First and Last Name:
Organization Name:
Mailing Address:
E-mail:
Primary Phone:
Marion County
General Land Development and
Event Permit Application
OREGON
Public Works Land Development Engineering & Permits 5155 Silverton Rd NE Salem, OR 97305
(503) 584-7714 http://co.marion.or.us/PW/Engineering/ mailto:MCLDEP@co.marion.or.us https://gis-marioncounty.opendata.arcgis.com/apps/b41e1f1b340a448682a2cc47fff41b31/explore https://pw.intra.co.marion.or.us/Engineering/LDEP/Forms/Application/General Application 08.25.23.docx Page 2 of 4
5. Licensed Professional Information (If Applicable) Note for PUCs: If using subcontractor, enter subcontractor info. If not, enter PUC info.
If more than one contractor will be used, complete the form linked below and include it with your application:
☐ Licensed Professional Information for Projects with Multiple Contractors Attached.
License Type: Business Name:
License #: E-mail:
First and Last Name: Emergency Phone:
Mailing Address:
Contractor Certificate of Insurance and Additional Insured Endorsement Required. See Marion County Insurance Requirements.
6. General Information (Required) – Check all that apply ☐ Includes Working in the Right-of-Way Complete Section 7 Below and Section 5 Above
• Includes Sidewalk/Roadcuts, Stormwater Drainage, Private Utility work, Major Construction
• Check if applying for Annual Blanket Work in Right-of-Way Permit
☐ Includes Erosion/Sediment Control Complete Section 8 Below
• Includes Erosion Prevention and Sediment Control in area(s) under County jurisdiction
☐ Includes Access (Driveway) Work Complete Section 9 Below
• Rural: Typically includes any access work within the first 20’ of edge of roadway
• Urban: Typically includes any access work between road and back of sidewalk
☐ Includes On-site Stormwater Complete Section 10 Below ☐ Is for an Event and/or Road Closure Complete Section 11 Below ☐ Is Public Utility Company (PUC) Work Complete Section 12 Below and Section 5 Above ☐ Plan Check ONLY No additional sections required. Fee: 0.5% of Engineer’s Estimate
7. Work in the Right-of-Way Application Specific Information Required if “Includes Working in the Right-of-Way” is Checked in Section 6
As applicable to the proposed work, these items may be required for an application to be deemed “Complete”.
Note: Not all applications will require all these items.
☐Construction Plans ☐Proposed Work Schedule ☐Cost Estimate ☐Contractor Certificate of Insurance and Endorsement ☐Traffic Control Plan ☐Proposed After Hours Site Safety Plan
Additional Major Construction Application Specific Information ☐Financial Guarantee Rural: 125% of Eng’s Est. Amount: Type: Urban: 100% of Eng’s Est.
☐Utility Coordination Verification Additional Private Utility Application Specific Information O.U.N.C. District Code Number:
8. Erosion/Sediment Control Application Specific Information Required if “Includes Erosion/Sediment Control” is Checked in Section 6
Required for application to be deemed “Complete”:
☐Erosion Prevention and Sediment Control Plan ☐Proposed Work Schedule
Area to be Disturbed (square feet):
Building Permit # - If Applicable:
https://www.co.marion.or.us/PW/Engineering/permit/Documents/Licensed%20Professional%20Information%20for%20Projects%20with%20Multiple%20Contractors.pdf https://www.co.marion.or.us/PW/Engineering/permit/Documents/COI%20Insurance%20Requirements.pdf https://pw.intra.co.marion.or.us/Engineering/LDEP/Forms/Application/General Application 08.25.23.docx Page 3 of 4
9. Access (Driveway) Application Specific Information Required if “Includes Access (Driveway) Work” is Checked in Section 6 Required for application to be deemed “Complete”: ☐Site Plan or Sketch
Proposed Use of Access: ☐Residential ☐Commercial ☐ Field ☐Farming ☐Other, explain:
Access is to Be (Check all that apply):
☐Constructed (new) ☐Modified (existing, extending culvert, paving, etc.)
☐Change in Use (existing) from ☐Residential ☐Commercial ☐Farming ☐Other, explain:
to ☐Residential ☐Commercial ☐Farming ☐Other, explain:
☐Other (Hardships, etc.):
Type of Surface Proposed: ☐ Concrete (curbed street) ☐ Asphalt ☐ Gravel
10. On-site Stormwater Application Specific Information Required if “Includes On-site Stormwater” is Checked in Section 6 Required for application to be deemed “Complete”: ☐Construction Plans Building Inspection Plumbing Permit # - If Applicable:
Building Inspection Structural Permit # - If Applicable:
11. Event and/or Road Closure Application Specific Information Required if “Is for an Event and/or Road Closure” is Checked in Section 6
Required for application to be deemed “Complete”: ☐Certificate of Insurance and Additional Insured Endorsement Attached
Start Date: End Date:
Start Time: End Time:
Start Location: End Location:
Additional Road Closure Application Specific Information
Required for application to be deemed “Complete”:
☐Traffic Control & Signing Plan ☐Detour Plan
Additional Event Application Specific Information
☐ New Event, never been held in Marion County ☐ Repeat Event, has been permitted previously
Do you want a Pre-Plan Meeting? ☐Yes ☐No Pre-planning meeting with Marion County recommended for new events.
Required for application to be deemed “Complete”:
☐Proposed Traffic Control ☐Proposed Route Map:
Route Map shall show planned route or course, direction of travel, beginning and ending stations, all rest stops, proposed signing/traffic control plan.
☐Proposed Route Map Turn by Turn List ☐Proposed Detour Route Map (if required)
Type of Event:
(Select all that apply)
☐Banner ☐Bicycle ☐Block Party* ☐Filming ☐Pedestrian ☐Parade ☐Other, explain:
Timed Event (ex: bike race)? ☐Yes ☐No *Block Party Event Applications are required to submit proof of notification to all affected neighbors in the form of signatures. See Event Permit FAQ for more information.
Est # of Participants: Est # of Support Vehicles:
Will any Public Agencies Assist? ☐Yes ☐No If yes, list the Contact Info here:
https://www.co.marion.or.us/PW/Engineering/permit/Documents/Event%20Permit%20FAQ.pdf https://pw.intra.co.marion.or.us/Engineering/LDEP/Forms/Application/General Application 08.25.23.docx Page 4 of 4
12. Utility Work Application Specific Information Required if “Is for Public Utility Company (PUC) Work” is Checked in Section 6
Required for application to be deemed “Complete”: ☐ Construction Site Plans Structure Data
If more than 5 structures will be affected by this project, attach the form below in lieu of filling out this section:
☐ Structure Data for Projects Affecting More than 5 Structures Attached
Structure Number:
NJUNS Number (PUC’s Only):
Width of Right-of-Way (if known): ft ft ft ft ft Width of Road: ft ft ft ft ft Edge of Road to Center of Structure: ft ft ft ft ft Structure Type:
Note: This application is not an approved permit and does not authorize the start of work. The Permit will be valid only for those specified roads and right-of-ways under Marion County jurisdiction.
Applicant is responsible for contacting other controlling jurisdictions.
Signature of Applicant Date
Check if
Applies Applying For Amount Fees Due
☐ Work in Right-of-Way $100 $
☐ Major Construction 1% of Engineer’s Estimate $
☐ Pre-Review Plan Check 0.5% of Engineer’s Estimate $
☐ Post-Review Plan Check 0.25% Engineer’s Estimate (Due at permit issuance) $
☐ Erosion/Sediment Control $150 $
☐ Driveway/Access $50 $
☐ On-site Stormwater $100 $
☐ Event/Road Closure See Marion County Event Permit Fees Table on Cover Sheet $
Total $ https://www.co.marion.or.us/PW/Engineering/permit/Documents/Structure%20Data%20for%20Projects%20Affecting%20More%20than%205%20Structures%20-%20FORM.pdf
ODOT
FOR ODOT USE ONLY
APPLICATION AND PERMIT TO OCCUPY OR
PERFORM OPERATIONS UPON A STATE HIGHWAY
See Oregon Administrative Rule, Chapter 734, Division 55
GENERAL LOCATION PURPOSE OF APPLICATION
(TO CONSTRUCT/OPERATE/MAINTAIN)
NO
NO
INSURANCE REQUIRED
BOND REQUIRED
BETWEEN OR NEAR LANDMARKS
HIGHWAY NUMBER COUNTY
DESIGNATED FREEWAY
TYPEPOLE
LINE
BURIED
CABLE
PIPE
LINE
TYPE
TYPE
IN U.S. FOREST
YES NO
HWY. REFERENCE MAP
APPLICANT NAME AND ADDRESS
NO NON-COMMERCIAL SIGN AS DESCRIBED BELOW
YES
YES
REFERENCE:
OAR 734-055
-0035(2)
REFERENCE:
OAR 734-055
-0035(1)
AMOUNT OF BOND
SPECIFIED COMP. DATE
DETAIL LOCATION OF FACILITY (For more space attach additional sheets)
YES
HIGHWAY NAME AND ROUTE NUMBER MIN. VERT. CLEARANCE
COMMENTS (FOR ODOT USE ONLY)
MILE
POINT
MILE
POINT TO
ENGINEERS
STATION TO
ENGINEERS
STATION
SIDE OF HWY OR
ANGLE OF CROSSING
DISTANCE FROM
CENTER OF PVMT R/W LINE
BURIED CABLE OR PIPE SPAN
LENGTHDEPTH/VERT. SIZE AND KIND
CLASS :
PERMIT NUMBER
KEY#
734-3457 (2/2021)
LOCAL GOVERNMENT OFFICIAL SIGNATURE
X
APPLICATION DATE
TITLE
TITLE
When this application is approved by the Department, the applicant is subject to, accepts and approves the terms and provisions contained and attached: and the terms of Oregon Administrative Rules, Chapter 734, Division 55, which is by this reference made a part of this permit.
DISTRICT MANAGER OR REPRESENTATIVE
X
APPLICANT SIGNATURE
X
APPROVAL DATE
DATE
TELEPHONE NO.
IF THE PROPOSED APPLICATION WILL AFFECT THE LOCAL GOVERNMENT, THE APPLICANT SHALL ACQUIRE THE LOCAL GOVERNMENT
OFFICIAL'S SIGNATURE BEFORE ACQUIRING THE DISTRICT MANAGER'S SIGNATURE.
AT LEAST 48 HOURS BEFORE BEGINNING WORK, THE APPLICANT OR HIS CONTRACTOR SHALL NOTIFY THE DISTRICT REPRESENTATIVE______________________________________AT PHONE NO.:___________________________ OR EMAIL OR FAX THIS PAGE TO THE DISTRICT OFFICE AT:_______________________________________________________. SPECIFY TIME AND DATE WORK IS TO OCCUR.
A COPY OF THIS PERMIT AND ALL ATTACHMENTS SHALL BE AVAILABLE AT THE WORK AREA DURING CONSTRUCTION.
ATTENTION: Oregon Law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0001 through OAR 952-001-0090. You may obtain copies of the rules by calling the center at (503) 232-1987.
CALL BEFORE YOU DIG 1-800-332-2344
DESCRIPTION OF DESIRED USE
SPECIAL PROVISIONS (FOR ODOT USE ONLY)
TRAFFIC CONTROL REQUIRED OPEN CUTTING OF PAVED OR SURFACED AREAS ALLOWED
YES [OAR 734- 055- 0100(2)] NO [OAR 734-055-0100(1)]YES [OAR 734- 055- 0025(6)] NO
MISCELLANEOUS OPERATIONS AND/OR FACILITIES AS
DESCRIBED BELOW
MILE
POINT
MILE
POINT TO
ENGINEERS
STATION TO
ENGINEERS
STATION
SIDE OF HWY OR
ANGLE OF CROSSING
DISTANCE FROM
CENTER OF PVMT R/W LINE
BURIED CABLE OR PIPE SPAN
LENGTHDEPTH/VERT. SIZE AND KIND
| closure_type_a_sidewalk: Off |
| closure_type_a_local: Off |
| closure_type_a_collector-arterial: Off |
| closure_type_b_arterial_single: Off |
| closure_type_b_collector_single: Off |
| closure_type_b_arterial_multiple: Off |
| closure_type_b_collector_multiple: Off |
| site_address: |
| work_location: |
| applicant_name: |
| applicant_address: |
| applicant_phone_day: |
| applicant_phone_eve: |
| applicant_email: |
| applicant_fax: |
| applicant_contractor: Off |
| contractor_contact: |
| contractor_phone_day: |
| contractor_phone_eve: |
| contractor_email: |
| contractor_fax: |
| work_description: |
| city_project_manager: |
| city_project_number: |
| requested_start_date: |
| requested_start_time: |
| start_time: Off |
| requested_end_date: |
| requested_end_time: |
| end_time: Off |
| Signature of Applicant: |
| Applicant Date: |
| AMANDA Permit #: |
| Expedited: |
| Yes (1): |
| No: |
| Revised Date: |
| Revised Date (1): |
| Revised Date (2): |
| Int: |
| Date (1): |
| Int (1): |
| Date (2): |
| Date (3): |
| Int (2): |
| Approved Date of Closure: |
| Approved Time of Closure: |
| City of Salem Public Works Dispatch Center: |
| Transit district 503-588-5468: |
| Traffic signal shall be turned off to flag at: |
| School district 503-399-3100: |
| Text36: |
| Text37: |
| Text38: |
| Text39: |
| Approved By: |
| Date: |
| ProjectEvent Name: |
| Detailed Description of WorkEvent: |
| WorksiteEvent Address: |
| AffectedFronting Parcel or Tax lot: |
| Associated Land Use Cases If Applicable: |
| First and Last Name: |
| Mailing Address: |
| Email: |
| Primary Phone: |
| Check if same as Owner: Off |
| First and Last Name_2: |
| Organization Name: |
| Mailing Address_2: |
| Email_2: |
| Primary Phone_2: |
| Check if same: Off |
| Check if same as: Off |
| First and Last Name_3: |
| Organization Name_2: |
| Mailing Address_3: |
| Email_3: |
| Primary Phone_3: |
| Licensed Professional Information for Projects with Multiple Contractors Attached: Off |
| License Type: |
| Business Name: |
| License: |
| Email_4: |
| First and Last Name_4: |
| Emergency Phone: |
| Mailing Address_4: |
| Includes Working in the RightofWay Complete Section 7 Below and Section 5 Above: Off |
| Includes ErosionSediment Control Complete Section 8 Below: Off |
| Includes Access Driveway Work Complete Section 9 Below: Off |
| Includes Onsite Stormwater Complete Section 10 Below: Off |
| Is for an Event andor Road Closure Complete Section 11 Below: Off |
| Is Public Utility Company PUC Work Complete Section 12 Below and Section 5 Above: Off |
| Plan Check ONLY No additional sections required Fee 05 of Engineers Estimate: Off |
| Construction Plans: Off |
| Proposed Work Schedule: Off |
| Cost Estimate: Off |
| Contractor Certificate of Insurance and Endorsement: Off |
| Traffic Control Plan: Off |
| Proposed After Hours Site Safety Plan: Off |
| Financial Guarantee: Off |
| Amount: |
| Type: |
| undefined: Off |
| OUNC District Code Number: |
| undefined_2: Off |
| undefined_3: Off |
| Area to be Disturbed square feet: |
| Building Permit If Applicable: |
| undefined_4: Off |
| Residential: Off |
| Commercial: Off |
| Field: Off |
| Farming: Off |
| Other explain: Off |
| Constructed new: Off |
| Modified existing extending culvert paving etc: Off |
| Change in Use existing: Off |
| Residential_2: Off |
| Commercial_2: Off |
| Farming_2: Off |
| Other explain_2: Off |
| Residential_3: Off |
| Commercial_3: Off |
| Farming_3: Off |
| Other explain_3: Off |
| Other Hardships etc: Off |
| undefined_5: Off |
| undefined_6: Off |
| undefined_7: Off |
| Construction Plans_2: Off |
| Construction PlansBuilding Inspection Plumbing Permit If Applicable: |
| Construction PlansBuilding Inspection Structural Permit If Applicable: |
| Certificate of Insurance and Additional Insured: Off |
| Start Date: |
| End Date: |
| Start Time: |
| End Time: |
| Start Location: |
| End Location: |
| undefined_8: Off |
| undefined_9: Off |
| Do you want a PrePlan Meeting: Off |
| New Event never been held in Marion County: Off |
| Repeat Event has been permitted previously: Off |
| Proposed Traffic Control: Off |
| Proposed Route Map: Off |
| Proposed Route Map Turn by Turn List: Off |
| Proposed Detour Route Map if required: Off |
| Banner: Off |
| Bicycle: Off |
| Block Party: Off |
| Filming: Off |
| Pedestrian: Off |
| Parade: Off |
| Other explain_4: Off |
| Est of Participants: |
| Est of Support Vehicles: |
| Will any Public Agencies Assist Yes No If yes list the Contact Info here: |
| undefined_12: Off |
| If more than 5 structures will be affected by this project attach the form below in lieu of filling out this section: Off |
| 1Structure Number: |
| 2Structure Number: |
| 3Structure Number: |
| 4Structure Number: |
| 5Structure Number: |
| 1NJUNS Number PUCs Only: |
| 2NJUNS Number PUCs Only: |
| 3NJUNS Number PUCs Only: |
| 4NJUNS Number PUCs Only: |
| 5NJUNS Number PUCs Only: |
| ftStructure Type: |
| ftStructure Type_2: |
| ftStructure Type_3: |
| ftStructure Type_4: |
| ftStructure Type_5: |
| fill_29: |
| fill_30: |
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| fill_33: |
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| Date1_af_date: |
| ROW1: |
| ROW2: |
| ROW3: |
| ROW4: |
| ROW5: |
| Road1: |
| Road2: |
| Road3: |
| Road4: |
| Road5: |
| EOR1: |
| EOR2: |
| EOR3: |
| EOR4: |
| EOR5: |
| CB1: Off |
| CB2: Off |
| CB3: Off |
| CB4: Off |
| CB5: Off |
| CB6: Off |
| CB7: Off |
| CB8: Off |
| Check Box1: Off |
| Check Box2: Off |
| Check Box3: Off |
| Check Box4: Off |
| vert: |
| pole: Off |
| landmks: |
| cable: Off |
| pipe: Off |
| noncommsign: Off |
| Radio Button5: Off |
| Radio Button6: Off |
| bond: |
| date: |
| address: |
| stn1: |
| stn2: |
| side: |
| center: |
| row: |
| pipesize: |
| miscdesc: |
| misc: Off |
| phone: |
| comments: |
| mp1: |
| mp2: |
| depth: |
| span: |
| permitno: |
| key1: |
| class1: |
| apptele: |
| Radio Button3: Off |
| hwyref: |
| hwynumber: |
| Reset: |
| HwyNameRouteNo: [ ] |
| County2: [ ] |
| PoleLine: [ ] |
| BuriedCable: [ ] |
| PipeLine: [ ] |
| OAR0256: Off |
| OAR1002: Off |
| County1: [ ] |
| Radio Button4: Off |
| Print: |
| mp2-2: |
| estn1-2: |
| estn2-2: |
| crossing-2: |
| pvmnt-2: |
| rw-2: |
| depth-2: |
| kind-2: |
| span-2: |
| appdate1: |
| title1: |
| title2: |
| approvedate: |
| appdate2: |
| mp1-2: |
| fax or email: |
| rep name: |
File details come from the government source that posted it. Updated .