SOW App 008 Dig Permit Fillable Template.pdf

BASE CIVIL ENGINEER WORK CLEARANCE REQUEST Permit Number:

1. Clearance is requested to proceed with work at on Work Order No.

Contract No. involving excavation or utility disturbance per attached sketch.

2. Description of Work: Particularly describe in detail all ground penetrations. Provide length, width, and depth of all excavations and clearly indicate location on attached drawing. At the excavation site, mark the outlines of the proposed excavation in white paint or markings IAW the American Public Works Association Uniform Color Code.

INSTRUCTIONS:3.

This BCE Work Clearance Request is required for any work that disturbs the ground surface by any means, including vaccuum excavation, or may disrupt aircraft or vehicular traffic flow, base utility services, fire protection, intrusion alarm systems, air quality, water quality, stormwater flow, biovents/monitoring wells, recreations trails/activities, wetlands, vegetation or routine activities of the installation. Work must be coordinated in order to minimize customer inconvenience and ensure the safety of contract workers and base personnel. This request must be processed prior to start of work. If work is not started within 15 days of the approval date or it is suspected that job site conditions have changed, this request must be reprocessed by all shops and validated by the approving officer. Further guidance concerning utilities can be found in 673 ABWI 32-1007.

A map showing the location of the proposed work, building numbers, and street names must be submitted with the clearance request.

Shops/sections in Blocks 7B to 7H are only at building 5327 from 0800-1000 Tues and Thurs from 1 Apr-30 Sept. Coordination of work requests from 1 Oct-31 Mar must be made at each individual shop from 0800-1100 or 1300-1600 Mon-Fri (Excluding Federal holidays). Submit completed form with all signatures/coordination to 773 CES/CEOER in Building 6326 (Front Entrance) for processing.

4. Requester's Name: 5. 6.Phone Number: (Must be local Anchorage/JBER number, not long distance)

Organization:

JBER-E

ORGANIZATION

LOCATION/PHONE NUMBER

Locate Date Printed Name and Signature

Remarks Use Block 20 for additional

B.

Steam/Heat Distr Lines-HVAC In -Floor Heat/Snowmelt Systems Bldg

5327 (JBER E) 552-8131/8948

Water, Sewer, Fire Suppression

Bldg 5327 (JBER E) 552-3024

D.

Security/ Fire Alarm Shop

552-4046/4037

E.

Electrical Distr/Airfield Lighting

Bldg 5329 (JBER E) 552-4280/4061

F.

POL Distribution/Cathodic Protection

Bldg 8306 (JBER E) 552-3334

G.

H.

Drainage, Pavmts, Grounds, RIDS

Bldg 9361 (JBER E) 552-2994/2995

7. A.

C. Environmental Restoration

Bldg 54 Basement (JBER R) 384-2984

673ABW Form 3, 20200423; Prescribed by: 673ABWI32-1007 PREVIOUS EDITION IS OBSOLETE

Utilities in Area

Yes No

J.

K.

GEOBASE

Bldg 6326 Rm 166 (JBER E) 552-0050

C I V I L

E N G I N E E R I N G or

Air Force Project Manager

Cable TV (GCI), DOYON, Natural Gas (ENSTAR), AWWU, Commerical Telephone (ACS), ALASCOM Communications

Alaska DIGLINE 278-3121

Locate Number: Call the DIGLINE or fax your request to 278-0696. Attach the DIGLINE response (e-mail or fax copy)

Base Comm Cable Maintenance

Bldg 7265 (JBER E) 552-8541

Traffic Control Sys Bldg 5337 (JBER E)

I. Environmental Quality Bldg 724 2nd Floor (JBER R)

384-2440/6224 See additional remarks, Block 20

THIS FORM MUST BE SAFEGARDED WHEN FILLED IN

JBER

ORGANIZATION

LOCATION/PHONE NUMBER

Utilities in Area

Yes No Locate Date

Printed Name and Signature

Remarks Use Block 19 for additional

8.

9.

10.

11.

Bldg 656 2nd Floor (JBER R) 384-0812

12.

13.

Excavations on JBER E ONLY Bldg 11369 (JBER E) 552-2107

14.

15.

16.

Bldg 10441 3rd Floor 552-6850

Aurora Housing

Bldg 6350 (JBER E) 753-1023

Additional Remarks:

Approved Disapproved

22. Work Must Start Prior To:

21. Clearance request

23. Signature of Approving Officer: (Operations Flight Commander or Designee)

24. Approval Date:

Work Clearance is not valid until a permit number is assigned. Permit numbers are assigned in the 773d CES/CEOER office (Bldg 6326, Front Entrance) after the approving officer has signed. Approved work is limited to the description in Block 2 and attached drawings. Excavation work must start within 15 days of approval date.

(Reverse)673 ABW Form 3, 20200423; Prescribed by: 673ABWI32-1007

Bldg 11550 3rd Floor 552-6855

18.

Security Forces - SFO

17.

Doyon Utilities

Bldg 36010 (JBER-R) 338-3600

Bryant Airfield Manager

HANGAR 1 Bldg 47430 Bryant Field (JBER R)

-7252/7241

Construction Management

Bldg 730 (JBER R) 384-3081

Last Signature Before Block 23.

Airfield Management

Excavations on JBER R ONLY. Must be signed in addition to Block 7A before signature in block 23.

Excavations on JBER R ONLY.

Required if within close proximity of Bryant airfield boundary

19.

Secondary Electric on JBER-R

Wolf Creek Federal Services North End Bldg 700 (JBER R)

(907) 903-2837

Excavations on JBER R ONLY.

673 ABW Ground Safety

(JBER E)

3 WG Weapons Safety

(JBER E)

Range Control (JBER R)

Bldg 59004 (JBER R)

384-6231/384-6230

All excavations on JBER R Ranges

ONLY.

20.

PREVIOUS EDITION IS OBSOLETE

Fire Department

Bldg 724 Second Floor (JBER R)

North East Corner 384-5555

Generators (Power Production) Bldg10306 (JBER-E) 552-2715

**If any artifacts, structural remains, or bones are encountered during ground disturbance, stop all work in the area and contact the JBER Cultural Resource Manager, 384-3467 and/or the Conservation Law Enforcement Officers, 552-8609 immediately.**

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