mt120a.pdf

Please wait...

If this message is not eventually replaced by the proper contents of the document, your PDF viewer may not be able to display this type of document.

You can upgrade to the latest version of Adobe Reader for Windows®, Mac, or Linux® by visiting http://www.adobe.com/go/reader_download.

For more assistance with Adobe Reader visit http://www.adobe.com/go/acrreader.

Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc., registered in the United States and other countries. Linux is the registered trademark of Linus Torvalds in the U.S. and other countries.

Form MT-120A (08/2015)

NEW JERSEY DEPARTMENT OF TRANSPORTATION

APPLICATION FOR HIGHWAY OCCUPANCY

(DEPARTMENT USE ONLY)

COMPLETION INSTRUCTIONS ON PAGE 2.

SUBMIT IN DUPLICATE

Please print or type The required fee must accompany this application, either by money order or check payable to the "New Jersey Department of Transportation".

-CASH WILL NOT BE ACCEPTED-

Requests Permit for the Use and Occupancy of the Right -of-Way

ALL PLANS MUST BE SEQUENCED AND STAPLED IN SETS

If permit is granted that includes the installation or construction of items within State Right of Way, I /we agree to accept full maintenance responsibility for such items, which may include but not limited to: flower beds, trees, benches, trash receptacles, decorative curbing, lighting and sidewalks. A comprehensive list of items will be provided to the State along with a plan sheet identifying the items and their location/s. Said list of items and plan sheet/s will be attached hereto and become part of this Permit. Subject to the provisions of the New Jersey Tort Claims Act, N.J.S.A. 59:1-1 et seq., I /we will be responsible for personal injuries and property damage caused by the actions of ourselves, our agents, servants and employees which arise out of or which are claimed to arise out of this Permit. Any such claim for such personal injury or property damage must be filed in accordance with N.J.S.A.59:8-1 et seq.

The Department shall reserve the right to demand from the applicant, as a condition of any permit, a certified check in an amount sufficient to guarantee or insure proper maintenance or restoration of the area disturbed. If it becomes necessary that the Department forces, for any reason, are required to make repairs, the cost of such work shall be deducted from the principal and the remainder, if any, shall be returned after the project has been completed and accepted. If the amount of the guarantee is less than the cost for the additional work, the applicant shall be billed for the balance due.

* NOTE: SUBMIT TWO (2) COPIES OF THIS APPLICATION AND SIX (6) COPIES OF A DETAILED PLAN DRAWN TO SCALE SHOWING THE PROPOSED INSTALLATION AND WHATEVER DATA IS NECESSARY FOR A COMPLETE UNDERSTANDING OF THE REQUEST. A TRAFFIC SAFETY SETUP AS PER THE "MANUAL ON UNIFORM TRAFFIC CONTROL" IS REQUIRED WITH APPLICATION. THE DEPARTMENT WILL NOT BE RESPONSIBLE FOR ANY ERRORS OR MISINFORMATION GIVEN IN THE APPLICATION AND/OR ON THE ACCOMPANYING PLANS.

If a permit is granted, I /we agree to comply with the rules and regulations of the New Jersey Department of Transportation and the conditions included therein and on page 2 of this form. In addition, I/we understand that N.J.S.A. 27:7-44.1 makes any violation of the provisions of the permit subject to a fine and civil action for the costs of prosecution as well as civil action for trespass to remove any non-conforming use. No work in connection with this application will be started until the final permit is approved and issued.

I/we understand that no refunds will be made after an application has been filed.

INSTRUCTIONS TO APPLICANT FOR HIGHWAY PERMITS

An applicant requesting a permit to occupy a highway right of way must obtain and complete the proper application form listed below according to the type of work to be performed.

APPLICATION FIR BRIDGE ATTACHMENT

NJ 16:41

FORM MT-105A

APPLICATION FOR ACCESS DRIVEWAY

NJ 16:47

FORM MT-32A

APPLICATION FOR DRAINAGE

NJ 16:41

FORM MT-39A

APPLICATION FOR ERECTION OF POLE

NJ 16:41

FORM MT-33A

APPLICATION FOR UTILITY OPENING

NJ 16:41

FORM MT-17A

APPLICATION FOR HIGHWAY OCCUPANCY

NJ 16:41

FORM MT-120A

APPLICATION FOR CHARITABLE SOLICITATION

NJ 16:40

FORM MT-120A

INSTRUCTIONS FOR COMPLETING THIS FORM

Below is the schedule of fees and types of requests that may granted and are covered by completing this form. Be sure to indicate the type of permit that you are applying for on the application and submit the required fee.

CASH WILL NOT BE ACCEPTED - APPLICATION FEES ARE NON-REFUNFDABLE

DO NOT SUBMIT PERMIT FEE WITH APPLICATION

FEE SCHEDULE AND TYPES OF PERMITS THAT APPLY TO THIS FORM

TYPE OF REQUEST

NUMBER - UNIT

APPLICATION FEE

PERMIT FEE

EXTENSION

Automatic Traffic Counting Procedure $65.00 $35.00 $35.00 Banners, Decorations or Temporary Announcement or Guide Signs 1 to 5 $165.00 $35.00 $35.00 Banners, Decorations or Temporary Announcement or Guide Signs Greater than 5 $230.00 $65.00 $65.00 Bus Shelters or Benches $395.00 $130.00 $130.00 Charitable Solicitation $25.00 $10.00 (per day) For each day, or part thereof, of proposed solicitation N.J.A.C. 16:40-10.1 Crosswalks 1 to 4 $230.00 $65.00 $65.00 Crosswalks Greater than 4 $460.00 $165.00 $165.00 Curb, Sidewalk, Handicapped ramp 0-200 Linear Feet (LF) $395.00 $130.00 $130.00 Curb, Sidewalk, Handicapped ramp Greater than 200 Linear Feet (LF) $790.00 $265.00 $265.00 Detours on/off State Highway $395.00 $130.00 $130.00 Grading Unit $330.00 $100.00 $100.00 Guiderail 0-200 Linear Feet (LF) $395.00 $130.00 $130.00 Guiderail Greater than 200 Linear Feet (LF) $790.00 $265.00 $265.00 Landscaping, Tree Trim, Vegetation Control and Unclassified Landscaping Unit $395.00 $130.00 $130.00 Lane or Shoulder Closings on State Highway $230.00 $65.00 $65.00 Miscellaneous Unit $395.00 $130.00 $130.00 Monitoring Wells 1 to 5 $230.00 $65.00 $65.00 Monitoring Wells Greater than 5 $460.00 $165.00 $165.00 Parades or Gatherings $165.00 $35.00 $35.00 Pedestrian Overpass and/or Pedestrian Underpass 1 Unit $790.00 $265.00 $265.00 Railroad Grade Crossings Unit $525.00 $200.00 $200.00 Temporary Use $460.00 $165.00 $165.00 Test Holes or Borings 1 to 5 $230.00 $65.00 $65.00 Test Holes or Borings Greater than 5 $460.00 $165.00 $165.00 Vegetation Canopy Management - Plan Unit $2000.00 $1000.00 N/A Vegetation Canopy Management - Site Investigation Unit $395.00 $130.00 $130.00 Wireless Communications Site Survey Annual $790.00 $265.00 $265.00 The Department will not be responsible for any errors or misinformation given in the application and on the accompanying plans.

9.0.0.2.20101008.1.734229