NNK16552269R_J-10_Tech_Reference_006_Utility_Locate_Excavation_Permit_KSC26-312.pdf

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Utility Locate / Excavation Permit Request KSC FORM 26-312 NS 09/12 (1.0) PREVIOUS EDITIONS ARE OBSOLETE. Validate prior to use.

NRRS 8/23.5.A.11

Page of Instructions KSC FORM 26-312 NS 09/12 (1.0) PREVIOUS EDITIONS ARE OBSOLETE. Validate prior to use.

NRRS 8/23.5.A.11

Instruction Page of

5. Check One MAP / SKETCH, WITH AREA TO BE LOCATED / EXCAVATED CLEARLY MARKED, IS ATTACHED (REQUIRED) See next page for completion and process instructions.

Please complete as many fields as possible.

NOTE: ALL FIELDS INDICATING "(REQUIRED)" MUST PROVIDE INFORMATION.

Block 1 Date submitted. Block 2-4 Provide related Site Plan, PCN or Work Order Numbers. Block 5 Check one. If you are NOT going to dig, but need an underground utility locate, check "Locate Only". Block 6-18 Enter the name, email address, phone, fax number, company name, and address of the person who will be receiving this permit including KSC NASA Contact for Project. Block 19-20 Enter the building number where work will be performed (or closest building number). Block 21 Enter additional information as necessary. Block 22 Enter the date excavation is expected to begin. Block 23 Enter the date excavation is expected to be complete. Permit will be closed on this date. End date may not be longer than one year from the start date. Block 24 If excavation is of an emergency nature and requires priority, enter justification. Block 25 Enter a description of why this permit is being requested, i.e., what work will be performed and why.

REQUIRED: ATTACH A MAP/SKETCH WITH AREA TO BE LOCATED/EXCAVATED CLEARLY MARKED.

Email, fax or hand-carry this request, along with a map, drawing or sketch to the Excavation Permit Request (EPR) Administrator using the contact information below.You may contact the EPR Administrator using the contact information below if you have any questions on the dig permit process.To schedule an appointment with the Excavation Permit Inspectors to locate underground utilities and/or obtain an approval signature on this permit to dig, Requester should phone the Excavation Permit Inspectors' Office (321-861-3375/6869 or 321-749-4840 or 321-289-2372) at least 72 hours prior to digging.Requester should notify the EPR Administrator when excavation is complete.Permits may be extended for up to one year by calling the EPR Administrator, but all permits will be closed upon expiration unless notified.

ERP Administrator Location KSC Headquarters, M6-0399, Room 3145 Mail Code

ISC-4026

Phone

(321) 867-2406 Fax

(321) 867-1175 Email KSC-ISC-DIGPERMIT@mail.nasa.gov ***Emergency requests will be processed on a real time basis*** through the ISC Duty Office 861-5050, Fax (861-1627) or Email - KSC-ISC-DutyOffice@mail.nasa.gov 11.0.0.20130303.1.892433.887364

UTILITY LOCATE/EXCAVATION PERMIT REQUEST

KSC FORM 26-312 Rev 09/12, Created 04/15 Version 1.0 04/15 KSC Forms

UTILITY LOCATE/EXCAVATION PERMIT REQUEST

09/12 1.0