G - Dig Perm (AF 103).pdf

PDF 189 KB Posted

Attached to
100% WOSB-Design Build Construction, Repave C St East Full Depth Repair-JBSA Randolph
Solicitation number
FA301621R0056
Issued by

About this file

This document contains a form used by the Air Force Civil Engineering Center to coordinate excavation and utility work on military bases. The AF Form 103 requests clearance to proceed with excavation or utility disturbance work, providing details on the location, type of work, required and termination dates for clearance, and remarks. Reviewers from various base organizations involved in electrical, drainage, water, communications, and safety systems must sign off on the form to approve the requested clearance. The reverse side of the form provides a space to include a detailed sketch of the excavation work.

The related federal contract opportunity is a design-build project to reconstruct approximately 1,380 linear feet of C Street East on Joint Base San Antonio Randolph. The Woman Owned Small Business contractor will provide design and complete reconstruction, including roadway, curb and gutter, pavement marking, and associated repairs. The work must be completed by the date specified in the solicitation.

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Text version

Red = Shop Yellow= HG 62 BLUE=Customer Calls

AF FORM RAFB103 PREVIOUS EDITIONS ARE OBSOLETE (Located on O-drive, forms, digging clearance AF 103) Updated 19 May 2020

BASE CIVIL ENGINEERING WORK CLEARANCE REQUEST DATE PREPARED

1. Clearance is requested to proceed with work at: Building Name of Project ______________________________ Brief description of work _ ______________________________________________________________________ CE Work Order No.________________ Contract No. ___________ involving excavation or utility disturbance per Detailed Sketch on reverse side of form. Note: Pavement (streets/parking lots) will not be cut unless approved 502CES/ CE2. Requesting Official must call CEO 652-5555 when work is completed to schedule site visit to inspect for proper grounds restoration and to update base ongoing construction map.

The area involved Has Has not been staked or clearly marked

2. TYPE OF FACILITY/WORK INVOLVED

A. Pavements D. Fire Detection & Protection Systems G. Aircraft or Vehicular Traffic Flow

B. Drainage Systems E. Utility

Overhead Underground H. Security

C. Railroad Tracks F. Comm Overhead Underground I. Other Site Borings

3. DATE CLEARANCE REQUIRED

4. DATE CLEARANCE TERMINATED

5. CE CLEARANCE CONTROL NUMBER

8. ORGANIZATION

CLEARANCE REVIEW

ORGANIZATION REMARKS REVIEWER’S NAME AND INITIALS

9.

A. ELECTRICAL DISTRIBUTION

652-7616 (Red) Secondary Only

B A

B. STORM DRAINS

652-3310 (Green)

S E

C. WATER DISTRIBUTION

652-3310 (Blue)

C I

D. CATHODIC PROTECTION

652-7616 (Red)

V

E. IRRIGATION SPRINKLERS

652-3310 (Blue)

L

F. CHILL WATER LINES

652-3404 (Blue)

N G

G Other

N

H. Other

I. Environmental (CEV) 652-4668

HG-62

R

J. High/Grade School 859-1961 Approval required when digging at schools

10 K. GAS DISTRIBUTION

811 (Yellow) CPS

11. American Water: (Water Distribution)

Help Desk (210)‐965‐8574 awjbsaservicedesk@amwater.com

12. Base Communications 652-2881 (Orange) B-379

13. Wing Safety 652-1842 B-171

14. San Antonio River Authority (SARA) SANITARY SEWER (Green) 210-302-4200

15 ELECTRICAL DISTRIBUTION CPS

(811) All High Voltage Systems

16. Commercial telephone Company 1-800-344-8377 (Orange) (811)

17. Cable TV 1-800-344-8377 (811) (Orange)

18. Base Operations 652-2943 B-8

19. OTHER (SPECIFY)

20. Requested Clearance APPROVED DISAPPROVED

21. Typed Name and Signature of Approving Officer (Chief/Deputy of Operations Flight) 17a. Date Signed

Red = Shop Yellow= HG 62 BLUE=Customer Calls

INSTRUCTIONS: The BCE work clearance request is used for any work (contract or in-house) that may disrupt aircraft or vehicular traffic 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 before starting work. If delays are encountered and the conditions at the job site change (or may have changed) this work clearance must be reprocessed.

21. REMARKS. (This section must describe specific precautionary measure to be taken before and during work accomplishment concerning the approved method of excavation, hand or powered equipment should be included (Provide detailed sketch of excavation in space below)

FORM 103 (REVERSE), MS Word V6.0

File details come from the government source that posted it. Updated .