B.08.03 01 50 00 MODOT permit.pdf

Form No. M-460 ( Rev. 09-13)

MISSOURI HIGHWAYS AND TRANSPORTATION COMMISSION

PERMIT TO WORK ON RIGHT OF WAY

NON-LOCAL GOVERNMENT PROJECTS

13- MISC./OTHER

28- TRF CONTROL / DETOUR

Inspector

Phone

RMS

Speed Limit

Location of work on State Highway right of way along the

Permit No.

Route

City

Log Points

GPS Begins

GPS Ends

County side. 1,444.00 Feet from mph

ISD ft.

ISD ft.

Released

Expires

Issued

PLATTE

NATHAN JULIANA

DELORIS GOETZ

12.2490

MO 45600 NORTHEAST COLBERN RD

LEE'S SUMMIT, MO 64086

NW Farley Hampton Rd.

EAST

NORTH

N

N

W

W

39.273951

39.275159

-94.826732

-94.828118

(State highway, County road, City street or County Line)

NB EB

SB WB

(Type of Work)

KANSAS CITY DISTRICT

Intersection/Stopping Sight Distance

Northbound/Eastbound

Southbound/Westbound SSD ft.

SSD ft.

Outside City Limits

816 607-2185 12.3610

NA

NA

NA

NA

By signing this form the applicant agrees to all provisions of this form, including the General Provisions attached hereto and incorporated by reference.

(Email Address)

(Telephone Number)

(City State Zip-code)

(Address)

(Applicant)

(Print or Type Name)

(Signature) (Date)

23105 Oberdiek Ln

Platte City MO 64079 swfulk@aol.com

Farley Beverly Drainage District

Steve Fulk

816 877-4865

(Email Address)

(Telephone Number)

(City State Zip-code)

(Address)

(Applicant's Contractor)

(Print or Type Name)

(Signature) (Date)

Date: ___________________________ By: ___________________________________ For Office use only

Make check payable to: Director of Revenue Credit Road FundTransmittal Number þ , bond # , check # amountSurety deposit required. None

Permission for the Farley, Beverly Drainage District to have their contractor access an existing levee entrance off of MO 45 approximately 1444 feet north of NW Farley Hampton Rd. in order to make repairs to the levee along the Platte River as directed by the Core of Engineers. The Drainage District has permission to have their contractor flag traffic during the construction at this location and will be directing the dump trucks to enter from the north and exit the site to the north. The

Drainage District also has permission to temporarily overburden the right of way at this location on the north side MO 45 within the back portion of the right furthest from the roadway with material while reconstructing the levee. MO 45 shall be kept free of all debris during the time period of this project. All material that is not needed at the end of the project shall be removed from the right of way and the right of way restored to its original or better condition. A video of the shoulder of MO 45 along this area should be taken both prior and after for referencing in the event that any damage is thought to have occurred from this project.

Contractor / applicant shall contact MO ONE CALL and complete a Notice of Intent three business days prior to starting work on right of way. All lane closures shall be submitted with traffic control plans for review and approval two business days prior to starting work on right of way. Contractor is responsible for verifying right of way in the field.

A copy of the permit and traffic control plan (if applicable) shall be available on site at all times. In addition, the following needs to be completed prior to any work being done on the Missouri Department of Transportation right of way:

1. Applicant and/or Contractor shall contact the established Missouri One-Call System to identify and locate all utilities prior to beginning work on state right of way.

2. Applicant and/or Contractor shall complete the "Notice of Intent to Perform Work" form on-line a minimum of two working days in advance of activity.

https://www.modot.org/notice-intent

3. Applicant and/or Contractor shall provide "Temporary Traffic Control" that is in accordance with the minimums set forth in the Manual on Uniform Traffic Control Devices (MUTCD) - Current Edition. Typical temporary traffic control applications can be accessed in our "Traffic Control for Field Operations" manual.

http://epg.modot.org/index.php/616.8_Typical_Applications_(MUTCD_6H)#Listing_of_Typical_Applications_for_Maintenance

4. Applicant and/or Contractor shall seek approval from the Missouri Department of Transportation for any lane closures on state routes. The lane closure request and temporary traffic control plan shall be submitted for review, two working days notice is required.

5. Applicant and/or Contractor shall contact me prior to working on Missouri Department of Transportation right of way.

6. Applicant and/or Contractor can access Missouri Department of Transportation "Standard Plans for Highway Construction" for necessary details of construction within the right of way limits.

7. A survey may be needed to accurately determine the right and utility corridor along this route, if no Right of Way markers are available. If plan sheets are needed for right of way, then a request should be made by submitting the following information to kcmicrofilm@modot.mo.gov ; county, route, town or city, township, section, and range, and nearest cross streets.

Failure to comply with these provisions could result in a temporary suspension of the permit. If you have any questions regarding the permit specifications or specific requirements in this email, feel free to give me a call or visit our D4 Permits

Website for additional information.

No lanes closures will be allowed during Holidays such as Thanksgiving, Christmas, etc. Holiday working hour restrictions include the working day prior to the Holiday starting at 12PM to the working day following at 9AM. One lane of traffic shall be maintained at all times during hours of construction. Proper traffic control shall be in place at all times during construction, and

Certified Flaggers shall be used when a flagging operation is needed. Contact Nathan Juliana at 816-835-5612 prior to starting work and upon completing work for right of way inspections.

No equipment or material shall be left on state right of way during non-construction hours unless authorized by a MODOT representative. If allowed to be left on state right of way then the following shall be observed; 1) All materials and/or equipment shall be placed out of the 30 foot clear zone,2) All materials and equipment shall be properly protected and identifiable as specified by a state representative.

Description of Work

During construction hours, all equipment, material and vehicles will only be permitted on shoulders, medians or pavements where the locations are closed to traffic, properly signed and occupied by ongoing construction operations, unless otherwise approved by the said MODOT representative.

Damage to MoDOT Facilities

Damage to MoDOT facilities within the area of work caused by the contractor will be deemed by MoDOT as either

�non-emergency� or �emergency� upon notification of the damages. Repair to damages will be performed as follows:

� Non-Emergency: The contractor will have 4 hours to propose a repair plan to MoDOT for a complete repair within 3 business days.

� Emergency: Upon notification of the damage, the contractor must immediately submit a repair plan which will take no more than 4 hours to respond on-site and complete repairs within 48 hours of notification of damage.

In either case, if the proposed plan is unacceptable for any reason to MoDOT, repairs will be made by MoDOT with all costs billed to the contractor. The applicant�s permit deposit or bond will be held until all costs are reimbursed to MoDOT per

Section 12 of the Permit For Work on Right of Way General Provisions.

Safety Apparel

MoDOT�s safety apparel guidelines are found in EPG 616.4.3 Worker Safety Considerations.

All workers within highway right of way shall wear approved ANSI/ISEA 107 Performance Class 2 or 3 safety apparel and more specifically as follows:

Daytime Flagger: During daytime activities, flaggers shall wear a high visibility hard hat, safety glasses, a Performance Class

3 top OR a Performance Class 2 top, and safety footwear. Hard hats other than high visibility orange or green shall be covered with a high visibility covering.

Daytime Worker: During daytime activities, workers shall wear a hard hat, safety glasses, a Performance Class 3 top OR a

Performance Class 2 top, and safety footwear.

Nighttime Flagger: During nighttime activities, flaggers shall wear a high visibility/reflective hard hat, safety glasses, a

Performance Class 3 top AND Class E bottoms, OR Performance Class 2 top AND Class E bottoms, and safety footwear.

Hard hats shall be reflective or covered with a high visibility covering.

Nighttime Worker: During nighttime activities, workers shall wear a hard hat, safety glasses, a Performance Class 3 top OR

Performance Class 2 top AND Class E bottoms, and safety footwear.

See also EPG 616.5.2 High-Visibility Safety Apparel.

TRAFFIC CONTROL ONLY

1. All materials & procedures must conform to current MoDOT Standards and Traffic Control for Field Operations, as well as current MUTCD Guidelines.

2. Applicant and/or Contractor must possess a copy of this permit and permit approved plans on the job site at all times.

3. Keep roadway and shoulders clear of dirt, mud, debris, equipment and materials at all times.

4. Roadway ditches, culverts and other such devices used to carry surface run-off will be kept open, free and clear at all times.

5. Dress all disturbed earth areas; seed and mulch with straw and/or sod.

6. UTILITY LOCATES � CONTACT MO ONE-CALL 1-800-344-7483 FOR LOCATION OF UNDERGROUND FACILITIES.

7. All MoDOT property or facilities (including roadway and shoulder pavement) disturbed or damaged during the scope of work allowed by this permit must be restored or replaced in accordance to current MoDOT Standards to meet or exceed the original existing condition as directed by MoDOT.

8. Steel Plate Ahead signs shall be displayed for all lanes of traffic while being used on the roadway.

Utility Work Related To New Facility Placement

In the event that the underground location of the Applicant's utility facilities is marked within an area of Commission right-of-way proposed for project excavation, the Applicant agrees: (1) to perform non-invasive digging methods (hand/soft digging, pot holing, vacuum methods, pressurized air/water, pneumatic hand tools, etc.), at the Applicant's own cost and expense, to confirm the horizontal and vertical location of said facilities; (2) to pay the Commission an up-front lump-sum for the estimated costs of performing non-invasive digging methods, under the terms of a separate written agreement, to confirm the horizontal and vertical location of said facilities; or (3) to relocate said facilities, at the Applicant's own cost and expense, to an area of right-of-way as designated by the Commission. Should non-invasive digging methods reveal that the location of the Applicant's utility facilities interferes with the Commission's proposed project excavation, relocation of those facilities by the Applicant will be required.

ITS Facilities in Area

In the instance of damage to MoDOT owned freeway and arterial management facilities, the MoDOT Engineer will have the option of issuing a work order for MoDOT�s On-Call ITS Maintenance Contractor to make necessary repairs, if it is the engineer�s opinion that the contractor creating the damage will not be able to make or arrange for the repairs to be performed in a timely manner [4 hours to respond and being repairs, in the instance MoDOT deems the damage to be an �emergency�

(i.e. critical device outage or significant network outage). If the damage is not causing a significant outage (i.e. broken pull box, minor conduit damage), and deemed a "non-emergency", repairs may be completed within 5 business days.]. The ITS

Maintenance Contractor will then bill the contractor causing the damage directly. Notice of full payment shall be provided to the MoDOT Engineer for approval of compliance to this specification.

If the contractor creating the damage is sub-contracted by the applicant who applied for the Missouri Highways and

Transportation Commission Permit For Work on Right of Way, it will be the responsibility of the applicant to ensure the bill for the ITS Maintenance Contractor is paid in full, prior to project completion. If this bill is not paid, then the applicant�s permit deposit or bond will be held, until this specification is satisfied, per Section 12 of the Permit For Work on Right of Way

General Provisions.

(Rev. 10-15)

GENERAL PROVISIONS

Section 1. The signing of this form binds the applicant to the terms of this permit. If signed by Applicant�s contractor or that contractor�s authorized representative, the contractor and any subcontractors will be held jointly responsible for all of the requirements of this permit until it is released by the District Engineer or the District Engineer�s representative. Applicant agrees to keep a copy of the permit and an approved plan on the job site.

Section 2. Construction material and equipment may be on the right of way only during the period of actual construction providing it is not on the roadway shoulders, in the ditch or blocking sight distance. Roadway ditches, culverts and other such devices used to carry surface run-off will be kept open, free and clear at all times.

Section 3. Applicant agrees that construction inspection will be provided by Applicant to assure compliance with the permit.

Section 4. Applicant shall provide adequate preliminary engineering including planning, and coordination with all concerned parties to:

(a) Confirm their contractor knows the rules and limitations for installations on highway right of way.

(b) Provide preinstallation meetings to all parties on major installations.

(c) Designate a point of contact who shall be available 24 hours per day, 7 days per week while the permittee is present on state highway rights of way and shall be capable of correcting any deficiencies in accordance with Missouri Standard Specifications for

Highway

Construction including, but not limited to Section 616.

(d) Include the name and telephone numbers of the design engineer and construction manager, as well as the dimension of the facility from the right of way line on the permit.

Section 5. Prior to beginning work, the applicant will request from the established Missouri One-Call System, the location of all utilities on the right of way.

Section 6. Applicant will contact MoDOT 48 hrs prior to any lane closure or 14 calendar days prior to the imposition of height, width, and weight restrictions. Lane closure dates may be rescheduled and/or land closure times may be shifted to off-peak and/or nighttime hours to minimize traffic backups. Schedule multiple tasks in a single work zone if possible.

Section 7. All work covered under this permit is to be in accordance with the Missouri Standard Specifications for Highway Construction, Missouri

Standard Plans for Highway Construction, and The Manual on Uniform Traffic Control Devices (MUTCD current edition) where applicable.

All utility facilities will be installed and located and all other work performed in accordance with the Code of State Regulations, Title 7, Division 10, Chapter 3, Utility and Private Line Location and Relocation and other policies of the Missouri Department of Transportation.

Section 8. No advertising signs or display material of an advertising nature is to be placed on or to extend over onto the right of way as covered in

Section 227.220 R.S.Mo.

Section 9. Except for the negligence of the Commission, its officers, employees and agents, the Applicant agrees to hold harmless the

Commission, its officers and employees from all liability, judgments, costs, expenses and claims growing out of damages of any nature whatsoever, to any person or property arising out of performance or non-performance of said work, or existence of said improvements from permit issuance until released as dated hereon.

Section 10. All costs incurred due to the issuance of this permit shall be borne by the Applicant, the Applicant�s successors, and assigns.

Section 11. It is understood that in granting this permit the Commission waives none of its power or rights to direct the removal, relocation, and/or proper maintenance in the future of anything within the right of way of the state highway at no cost to the Commission.

Section 12. The Applicant�s deposit or bond may be held until the work has been completed and has been approved by the District Engineer or the

District Engineer�s representative. The Applicant agrees that the Commission may, after the expiration date of this permit or extension thereof, use as much