RW_Use_Permit_Application_Form.pdf

RIGHT OF WAY USE PERMIT

City of Plant City | Engineering Department 302 W. Reynolds St.

Plant City, FL 33563 Phone: 813-659-4200 E-mail: engineering@plantcitygov.com

Website: www.plantcitygov.com

TYPES OF ACTIVITIES WHICH NORMALLY REQUIRE THE APPLICATION FOR THIS PERMIT WOULD INCLUDE THE PLACEMENT OR REPAIR OF ANY OBJECT, STRUCTURE OR FACILITY WITHIN A PUBLIC DEDICATED RIGHT-OF-WAY OR EASEMENT, CITY OWNED PROPERTY, WHETHER ABOVE GROUND OR UNDERGROUND AND ROAD CLOSURES.

Date: _________________

APPLICANT Name: __________________________________ Company: _____________________________________

Address: _________________________________________ Telephone No.: _________________________________

_________________________________________ E-mail Address: _________________________________

Emergency Phone No. 24 Hrs./7 days a week: ( ) __________________ Fax: ( ) _____________________

OWNER name: ___________________________________

Address/Job Site: _________________________________ Telephone No. ___________________________________

_________________________________ E-mail Address: ___________________________________

WILL THE PROJECT REQUIRE A ROADWAY CLOSURE? YES □ NO □

For City Use Only

CITY WILL DETERMINE MEANS OF NOTIFICATION TO RESIDENTS OR BUSINESSES.

DOOR HANGER ARE TO BE POSTED AT EACH ADDRESS WITHIN THE LIMITS OF THE ROAD BEING CLOSED. YES □ NO

VARIABLE MESSAGE BOARDS INSTALLED AT LEAST ONE (1) WEEK IN ADVANCE. YES □ NO □

IF YES, A DETOUR MUST BE APPROVED AND WARNING SIGNS AND IN CERTAIN CASES VARIABLE MESSAGE BOARDS INTALLED AT LEAST ONE (1)

WEEK IN ADVANCE.,

Check all that apply: Nature of Work

Utilities: □ Potable Water □ Sanitary Sewer (Gravity) □ Sanitary Sewer (Force Main)

□ Sewage Lift Station □ Reclaimed Water □ Gas

□ Telephone □ Cable TV □ Buried Electric

□ Overhead Electric □ Jack & Bore □ Horizontal Directional Bore

Drainage: □ Culverts □ Drainage Structures □ Ditches/Swales

□ Sidewalks □ Curb & Gutter □ Concrete Driveways

□ Asphalt Repair □ Flowable Fill □ Other: __________________________

Road Closure: □

Capital Project: ________________________________________________________________________________ City Projects Only

All work and maintenance of traffic shall be carried out according to the plans attached in this application and the FDOT INDEX Series 600. Any exceptions must be approved by the City Engineer.

ROW Permit #

Approved By:

Permit Issue Date

Expiration Date

Inspection Required Yes ____ No _____

MOT Required Yes ____ No _____

Road Closures will be approved with no less than five (5) business days’ notice. City Departments, Hillsborough County Agenc ies and property owners must have no less than five (5) business days’ notice to time of closure. The following agencies will be notified by e-mail prior to any road closure and proof of notification included in the permit application.

Agencies to be Notified for Road Closures

Department E-mail Address Phone Number

CITY MANAGER billmcdl@plantcitygov.com 813 659-4200, ext. 4157 Assistant City Manager mperez@plantcitygov.com 813 659-4200, ext. 4271 Assistant City Manager jholland@plantcitygov.com 813 659-4200, ext. 4250 City Manager’s Office jnavarro@plantcitygov.com 813 659-4200, ext. 4157 Community Services dmcDaniel@plantcitygov.com 813 659-4200, ext. 4209 Fire Department tmossgrove@plantcitygov.com 813 757-9131, ext. 4028 Police Department police@plantcitygov.com 813 757-9200 Utilities Maintenance loquendo@plantcitygov.com 813 757-9288, ext. 4730 Stormwater/Traffic cshiver@plantcitygov.com 813 707-7200, ext. 4506 Building Department rproctor@plantcitygov.com 813 659-4200, ext. 4211 Planning & Zoning planning@plantcitygov.com 813 659-4200, ext. 4159 Hillsborough County Sheriff’s Department jloy@teamhcso.com 813 247-8555 Hillsborough County EMS EDCSupervisorsGroup@hillsboroughcounty.org 813 272-6600 Hillsborough County EMS PradoJF@hillsboroughcounty.org 813 272-6600 Hillsborough County School Board Christine.Hughes@hcps.net 813 707-7318 Plant City Observer michelle@plantcityobserver.com 813 704-6850

Contacts Revised: 8/26/2021

Road To Be Closed:

Between And:

Beginning Date: Time:

Ending Date: Time:

Cross Streets Affected: Closed: One Lane: Flagger: Other:

Cross Streets Affected: Closed: One Lane: Flagger: Other:

Type of Work:

Contractor: (Include name, address and emergency phone number)

Emergency phone number 24 hours a day/7 days a week ( ) _______________________________

Will The Road Be Completely Closed? Yes: No:

ALL WORK PERFORMED AS PART OF THIS PERMIT SHALL INCLUDE A “MAINTENANCE OF TRAFFIC PLAN” PREPARED BY A PERSON WHO HAS SATISFACTORILY COMPLETED THE “FDOT ADVANCED MAINENANCE OF TRAFFIC COURSE” AND HAS A CURRENT QUALIFICATION AND SHALL AT A MINIMUM BE CONSISTENT WITH FLORIDA DEPARTMENT OF TRANSPORTATION INDEX SERIES 600.

A copy of this sheet shall be e-mailed to all of the entities listed on Page 2 of 4, including a copy of the MOT and detour route. A copy of an e-mail with this page will serve as proof the agency was contacted. The applicant and/or owner is fully responsible to maintain liability insurance and indemnifies the City of Plant City for all work as authorized by this permit.

mailto:billmcdl@plantcitygov.com mailto:mperez@plantcitygov.com mailto:jholland@plantcitygov.com mailto:jnavarro@plantcitygov.com mailto:dmcDaniel@plantcitygov.com mailto:tmossgrove@plantcitygov.com mailto:police@plantcitygov.com mailto:loquendo@plantcitygov.com mailto:cshiver@plantcitygov.com mailto:rproctor@plantcitygov.com mailto:planning@plantcitygov.com mailto:jloy@teamhcso.com mailto:EDCSupervisorsGroup@hillsboroughcounty.

mailto:PradoJF@hillsboroughcounty.org mailto:Christine.Hughes@hcps.net mailto:michelle@plantcityobserver.com

GENERAL CONDITIONS

THE ENTITY OR COMPANY NAMED IN THIS PERMIT AS THE APPLICANT IS SUBJECT TO ALL OF THE FOLLOWING

GENERAL CONDITIONS:

1. The applicant certifies that prior to filling out this application that said applicant has ascertained the location of all existing utilities both aerial and underground and the accurate locations are shown on the plans. Contractor to verify location of all utilities. The applicant further certifies that each utility company, public and private within the rights-of-way have been contacted and a copy of their response has been attached as part of this permit application.

2. The construction and maintenance of such utility shall not interfere with the property and rights of a prior occupant.

3. All work shall be done in keeping with the standards approved by the City Engineer of the City of Plant City and under the supervision of said City Engineer or representative.

4. All materials & equipment shall be subject to inspection by said City Engineer or their representative.

5. All construction shall be performed in a manner meeting the approval of the City Engineer of the City of Plant City and Safety

Standards as prescribed by the Manual on Uniform Traffic Control Devices and FDOT Roadway and Bridge Design Standards.

The City of Plant City shall be relieved of all responsibility from damages of any nature arising from issuance of this permit.

6. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City’s right, title and interest in the land to be entered upon and used by the Permittee and the Permittee will, at all times, assume all risk of and indemnity, defend and save harmless the City from and against all loss, damage, cost or expense arising in any manner on account of the exercise or attempted exercises by said Permittee of the aforesaid rights & privileges.

7. The City requires photos of proposed location when applying for permit and post photo’s upon closing the permit.

8. All City of Plant City property and/or rights-of-way shall be restored to original condition as far as practicable and meeting the approval of the City Engineer or representative, this includes the removal of locating flags and resodding.

9. The Permittee shall maintain BMP’s and erosion control measures throughout the duration of the project. This shall include obtaining a Notice of Intent through the Florida Department of Environmental Protection for projects over one (1) acre. No dewatering shall be done as part of this permit without an approved dewatering plan. If dewatering is contemplated, a plan shall be submitted with the project plans.

10. All overhead installations shall conform to clearance standards of the Florida Department of Transportation (FDOT), and all underground crossings installations shall be installed at a minimum depth of thirty-six (36”) under the road base and at least thirty-six (36”) under below ditch invert grade. Variations and exceptions may be made by authority from the City Engineer or representative.,

11. The attached sketch or sets of plans covering details of this installation shall be made a part of this permit. A copy of this permit must be on site at all times.

12. It is expressly stipulated that this permit is a license for permissive use only and that placing of facilities upon public property pursuant to this permit shall not operate to create or vest any property rights ibn said holder.

13. Whenever necessary for the construction, repair, improvement, alteration, relocation of any portion of a City facility as determined by the City Engineer, any or all poles, wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be removed from said right-of-way, or reset or relocated thereon as required by the City Engineer and shall be done at the expense of the holder. The minimum notice of the requirement for non-emergency removal is ten (10) days:

for emergency removal, the City reserves the right to remove improvements without notice.

14. It is agreed that in the event of relocation of said utility, facilities are scheduled to be done simultaneously with a City improvement project, the Permittee will coordinate with the City before proceeding, shall cooperate with the City’s contractor to arrange the sequence of work so as to not unnecessarily delay the work of the City’s contractor, defend any legal claims of the City’s contractor due to delays caused by the Permittee’s failure to comply with the approved scheduled and shall comply with all provisions of the law and Rule 14-46, Florida Administrative Code. The Permittee shall not be responsible for delays beyond its control. The Permittee shall furnish a relocation schedule if the work will fall into the time frame the capital project is under construction. The City shall be notified at least three (3) business days and not more than five (5) business days prior to starting construction at 813 659-4200, ext. 4123 after the permit is issued.

15. Notify Sunshine State One Call of Florida at 1-800-432-4770 at least two (2) full business days and not more than five (5) business days prior to starting construction.

16. Area of construction shall be marked in white paint and the locate flags removed during restoration.

17. Proposed work must be started within thirty (30) calendar days from the date of approval. The extension of said time may be extended through written request only.

18. Execute and return three (3) copies of this permit with the Permit Closure Section completed and Record Drawings to the

City stating that the job is completed in accordance with the permit and all changes have been noted in the Record Drawings.

19. At no time will this permit exceed one (1) year.

20. This permit may be terminated by the City of Plant City when the City has determined the Permittee has violated any provision contained herein and/or fails to promptly correct such violation within five (5) day of notice from the City.

21. Permittee is responsible for providing an emergency contact person and phone number for 24 hours a day/7 day a week.

Inability to make contact in the event of an emergency may result in the penalty such as revocation of permit and/or back charge as result of damages.

22. The City requires a $2,500.00 bond or 10% of the total cost of the project be submitted as security for this permit. Upon satisfactory completion of the work including removal of all signs and restoration of the work area, the bond will be released.

Upon request, the City reserves the right to waive the bond requirement.

23. Comments: ___________________________________________________________________________________________

24. Plant City Code of Ordinances, Sec. 30-27 – Noise Prohibited – Construction or repair of buildings, excavation of streets and highways. The construction, demolition, alteration or repair of any building or the excavation of streets and highways other than between the hours 7:00 a.m. and 800 p.m. Monday through Friday; 8:00 a.m. and 8:00 p.m. Saturday; and 10:00 a.m.

and 8:00 p.m. Sunday is prohibited by Plant City Code of Ordinances, Sec. 30-27 – Noise Prohibited.

This application shall, upon appropriate City signatures, become the permit. All work shall conform to City of Plant City Standards.

Permission is hereby granted to:

Permittee & Title (typed or printed): _________________________________________

Permittee Signature and Title: ______________________________________________

Address: ___________________________________

For the construction and maintenance of: __________________________________________________________________________

____________________________________________________________________________________________ see plans attached.

For City Use Only

Approved by: ___________________________________________________ Date: ____________________________ City Engineer or Designee

PERMITTEE COMPLETION OF WORK

I, the undersigned, do hereby attest that the construction approved by the subject Permit was installed in Accordance with the permit requirements and in accordance with the City’s Rights-of-Way Use Procedures and that all changes have been noted in the Record Drawings. If this section is not completed, the permittee is still responsible to maintain and/or repair any damages to sidewalks, yards, sod, roadways or any other City infrastructure until signed off by the City Inspector.

Signature: ____________________________________ Title: _______________________________________

Date: _________________

For City Use Only Accepted By:

City of Plant City: _______________________________________________ Signature, Title, Date

(Updated 09/06/2023)