TE A-04_Excavation Clearance Request - Digging Permit-Digging Example.pdf

Permit number: ___________ Expiration Date: ____________

Digging Permit Form 17 Mar 2022 fillable

CONTRACTOR’S

EXCAVATION PERMIT

USAG STUTTGART-DPW, GERMANY

CONTRACT/PROJECT NUMBER:

NAME OF CONTRACTING FIRM:

AUTHORIZED CONTRACTOR’S

REPRESENTATIVE (Printed):

CONSTRUCTION SITE:

WORK TO BE PERFORMED:

(Also see attached drawing)

DATES: STARTING: ________________________ ENDING: __________________________

The above named contractor’s representative was informed of the location of all known underground communication lines within the project site by providing him with copies of available drawings. He was given the following name and telephone number to call should a communication line be cut during excavation. (Patch

Barracks, Bldg.2368, Rm 3, phone 0711-680-4080/4300/7139/8557).

n d S

IG

POC: PHONE: 0711-680 - 4080 or 0711-680-4300 or 0711-680-7139 or 0711-680-8557

SIGNATURE: DATE:

DSN: 430-4080 / 4300 / 7139 / 8557

(52ND SIG BN Representative)

A review of the utility drawings was conducted with the contractor’s representative and all known changes were annotated. The following POC’s were provided in case a utility line is damaged. (Kelley Barracks, Bldg. 3318, room 201 and 202 and Patch Barracks, Bldg. 2311, basement).

O

M

-U ti lit ie s B ra n c h

POC:

SIGNATURE: DATE:

PHONE: 09641-70596-6256

or 0711-680-8292 or 0711-680-8294

(DPW-O&M-Utilities Branch, Electrical Representative)

POC:

SIGNATURE: DATE:

PHONE:

09641-70-596-6268 or

09641-70596-6275

(DPW-O&M-Utilities Branch, Mechanical Representative)

1526590780.ln Sticky Note

EN

This is the work order number (DA FORM 4283). The number will be assigned by the project manager or by a designated person from your section/unit/division. He or she must be stationed at USAG Stuttgart.

(Temporarily erected tents do not necessarily require a work order.)

DE

Dies ist die "work order number" (DA FORM 4283). Diese Nummer wird von dem/der Projektmanager/-in, welche/-r aus der US Army Garrison sein muss, vergeben.

(Temporär aufgestellte Zelte bedürfen nicht zwingend einer Work Order.)

1526590780.ln Sticky Note

EN

Name of company/organization/section/unit who is performing the digging.

DE

Name der Firma, Organisation, Abteilung oder Einheit welche die Grabungen durchführt.

1526590780.ln Sticky Note

EN

The POC (Point of Contact) for that company performing the digging.

DE

Vollständiger Name des Ansprechpartners der Firma welche die Grabung durchführt.

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EN

Where is the work taking place?

e.g. Patch Barracks, near BLDG 2300.

DE

Wo wird gegraben?

Z.B. Patch Barracks, near Bldg. 2300

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EN

Short explanation of what needs to be done.

(Please attach a sketch)

DE

Kurze Schilderung was gemacht werden muss. Vorzugsweise auf English (eine Lageplanskizze ist beizufügen)

1526590780.ln Sticky Note

EN

When is the start and the approximate finish date of the work?

DE

Wann soll die Arbeit beginnen und wann soll sie voraussichtlich abgeschlossen sein?

1526590780.ln Sticky Note Unmarked set by 1526590780.ln

1526590780.ln Sticky Note

EN

For contact details, see "DP contact list"

DE

Siehe "DP contact list" fuer Kontaktdaten

I certify that I have personally contacted the above US Army personnel and that I am aware of all known on-site utility and communication lines. I certify that I will contact the appropriate POC identified above should there be any damage to a utility or communication line. My firm accepts responsibility for any damage, in accordance with governing statutes and regulations. The US Forces and the Federal Republic of Germany have no liability, financial or otherwise, for damages caused by my firm.

I also understand that the "as-built" drawing must be turned in to DPW Master Planning Division within 90 days after completion of the project.

After the completion of the work the contractor will restore all affected areas to their original or better condition.

Furthermore I have contacted Telekom (06321-455324, Fax 0391-580219745, email:

planauskunft.suedwest@telekom.de ), TKS (0631-3522-265, Fax 0631-3522-113) and EnBW Netzgebiet Stuttgart (0711-289-47962, email: leitungsauskunft-stuttgart@netze-bw.de ) or EnBW Netzgebiet Mitte (0711-289-53650, Fax 07219-142-1369, email: leitungsauskunft-mitte@netze-bw.de ) and am aware of the location of their lines.

SIGNATURE OF CONTRACTOR’S REPRESENTATIVE:

SIGNATURE: DATE:

EMAIL: PHONE:

This excavation work is approved and any excavation may proceed. A copy of this excavation permit will remain on site at all times.

I certify that the excavation work is coordinated with the Installation Coordinator (IC) and the customers which are affected by this particular work.

PRINTED NAME AND SIGNATURE OF COR/ Project Manager/ Project Inspector:

SIGNATURE: DATE:

EMAIL: PHONE:

The above named contractor’s representative was informed of the location of all known underground utility lines within the project site by providing him with copies of available drawings.

With the following signatures the requested digging permit is approved.

SIGNATURE: DATE:

(CHIEF/ Master Planning Division, DPW) PHONE:

09641-70596-6241 DSN:

596-6241

SIGNATURE: DATE:

Director of Public Works / Deputy

Digging Permit Form 17 Mar 2022 fillable mailto:zentrale-planauskunft-Ti-NL-Sw@telekom.de 1526590780.ln Sticky Note

EN

Please note that by signing this permit, you have contacted local utility companies (e.g. EnBW, NetzeBW) and or communication companies (e.g.

Telekom, TKS) and have confirmed the location of their lines. The Stuttgart DPW does not maintain nor possess these plans in their archive.

DE

Bitte beachten Sie, dass Sie mit ihrer Unterschrift auch bestätigen, dass EnBW/NetzeBW, Telekom und TKS kontaktiert wurde. DPW verwaltet oder führt diese Pläne nicht im Archiv, daher müssen diese Informationen gesondert besorgt werden

Unexploded Ordnance Form - May19

Permit number:__________

CONTRACTOR’S

EXCAVATION PERMIT (PART 2)

PROCEDURES IN REPORTING UNEXPLODED ORDNANCE AT THE JOB

SITE

The Contractor is responsible for notifying authorities if unexploded ordnance is found at the job site. All work must ceased and notification process start immediately. The

Contractor will, in order, notify the following Units:

Courtesy Translation:

VERFAHREN BEIM AUFFINDEN SCHARFER MUNITION AUF DER

BAUSTELLE

Der Auftragnehmer ist verantwortlich, beim Auffinden von scharfer Munition die zuständigen Dienststellen zu benachrichtigen. Jegliche Arbeit ist einzustellen und die

Benachrichtigung hat unverzüglich zu erfolgen. Der Auftragnehmer hat folgende

Einheiten, in Reihenfolge, zu benachrichtigen:

1. Military Police @ 09641-70-596-3102 or 3095

2. DPW @ 09641-70-596-6101 + Project Manager

3. Corps Of Engineers @ 0611-9744-2828 or 2916

4. Bauamt @ 0711-21802-800

5. German disposal authorities @ 0711-904-40000 (Kampfmittelbeseitigungsdienst)

6. Safety Office @ 09641-70-596-3832 or 3134

SIGNATURE OF CONTRACTOR ___________________________ DATE _________

1276761419.ln Inserted Text

Permit number: __________

CONTRACTOR’S EXCAVATION PERMIT (PART 3)

Excavation work at USAG Stuttgart –

Archaeological/historical artifacts

Dear Customer, Contractor, If you encounter any archaeological or historical artifact while performing excavation on any area within USAG Stuttgart, especially on potentially undisturbed ground, the ranges and training areas, the artifact needs to be protected and preserved until proper coordination with Host Nation authorities can be initiated and concluded.

You are required to notify POC listed below immediately about the finding and the location for an assessment. Work can only be resumed when authorized by the

Environmental Division.

POC for USAG Stuttgart Environmental Division is Mr. Christoph Leiss, Tel.:

09641-70-596-6133, email: christoph.j.leiss.ln@army.mil.

Alternate POC for USAG Stuttgart Environmental Division is Ms. Anja Emmenecker, Tel: 09641-70-596-6131, email: anja.emmenecker.ln@army.mil.

SIGNATURE OF CONTRACTOR ___________________________ DATE _________

Archaeological Form 7feb2020 mailto:christoph.j.leiss.ln@mail.mil mailto:anja.emmenecker.ln@mail.mil

Equipment Operator Form 2dec2020

Permit number: __________

CONTRACTOR’S EXCAVATION PERMIT (PART 4)

Equipment Operator list

Operator name Operating Equipment Operating license No. Contractor

Operators of Equipment for any excavation/digging have to be listed here.

If there is any change in equipment operators during the duration of this project, I assure that this list will be updated and sent per email to the COR/Project Manager/Project Inspector prior to the operator performing any excavation.

All utility strikes will be immediately reported to the O&M Utilities Branch and the COR/Project

Manager/Project Inspector, to include the name of the operator involved.

SIGNATURE OF CONTRACTOR ___________________________ DATE:_______________