new_dig_permit_page_2.docx

Instructions The BCE work clearance request is used for work ( contract or in house ) that may disrupt aircraft or vehicle flow, base utility services, protection provided by fire and intrusion alarm system, or routine activities of the installation. This form is used to coordinate the required work with key base activities and keep customer inconvenience to a minimum. It is also used to identify potentially hazardous work conditions in an attempt to prevent accidents. The work clearance request is processed just prior to the start of work. If delays are encountered and the conditions at the job site change this work clearance request must be reprocessed.

I understand that I must contact all required organizations as indicated on the clearance review remarks ( ONE CALL ). I understand that the utilities and other conditions as indicated in the contract plans and specifications are approximate locations and that I will excavate and do other required work carefully, and by hand when required, to protect them and to determine their exact locations as needed to perform the required work. I will revalidate this permit every 30 days by calling the person who issued the permit. I understand that failure to do this every 30 days will void the permit. I also understand that I will be liable to repair any damages caused by my failure to comply with the above requirements.

Contractor Representative ( Print Name & Company ):

Contractor Signature:__________________________________________ Date_______________ THIS PERMIT WILL NOT BE ACCEPTED WITHOUT A SKETCH DRAWN TO SCALE, ATTACHED OR PASTED BELOW.