A right-of-way user that: (1) has been denied registration; (2) has been denied a permit; (3) has had a permit revoked; (4) believes that the fees imposed are not in conformity with M.S. § 237.163, Subd. 6; or (5) disputes a determination of the Director regarding § 96.22(B) may have the denial, revocation, fee imposition, or decision reviewed, upon written request, by the City Council. The City Council shall act on a timely written request at its next regularly scheduled meeting, provided the right-of-way user has submitted its appeal with sufficient time to include the appeal as a regular agenda item. A decision by the city council affirming the denial, revocation, or fee imposition will be in writing and supported by written findings establishing the reasonableness of the decision.
(Ord. 7517, passed 10-20-2009)
RIGHT-OF -WAY PERMIT FORM
CITY PERMIT NO.: | 20____- | PERMIT FEE: Minimum | $150.00 |
COMPANY PERMIT NO.: | DATE: |
APPLICANT INFORMATION:
DEVELOPMENT/ADDITION/LOCATION DESCRIPTION OR SITE ADDRESS:
OWNER (Applicant):
UTILITY COMPANY:
CONTACT PERSON:
TELEPHONE NO: ADDRESS:
CITY: STATE: ZIP CODE:
CONTRACTOR INFORMATION:
CONTRACTOR PERFORMING WORK:
CONTRACT NAME: CONTRACT NUMBER: PHONE:
CONTRACTOR PERFORMING WORK MUST ATTACH CURRENT CERTIFICATE OF INSURANCE NAMING THE CITY AS AN ADDITIONALLY INSURED AND IN AN AMOUNT NOT LESS THAN $1,000,000. WITHOUT SUCH PROOF OF INSURANCE NO PERMIT WILL BE ISSUED.
TYPE OR WORK:
NEW PRIVATE UTILITY
REPLACE/REPAIR
COMMERCIAL DRIVEWAY APRON (WIDTH?) Feet
RESIDENTIAL DRIVEWAY APRON (WIDTH?) Feet
CONNECTION TO CITY SYSTEM (REQUIRES PREPAYMENT OF ACCESS FEES):
WATERMAIN OTHER
WHAT THE WORK WILL INVOLE (REQUIRES SECURITY TO INFRASTRUCTURE/ COMPLETE RESTORATION. Complex plans many incur additional costs for mitigation plan review and inspections. Must include erosion control, protective measures, and restoration plans- all new utilities must be fully located for future GSOC requirements):
STREET OPEN CUT (requires approved plan with access, traffic control, and inspected full width restoration- security required)
PATHWAY CUT (requires approved plan with full width restoration and security for restoration)
EXCAVATION IN BOULEVARD or CITY OWNED PROPERTY (requires approved plan and security for restoration)
R.O.W. ACCESS (requires approved plan on use, control, mitigation and restoration. Must have full marking of new utilities)
EXPLANATION OF WORK/ ADDITIONAL COMMENTS:
PROPOSED START DATE:
PROPOSED END DATE:
Applicant agrees to abide by and follow all applicable ordinances, laws, rules, and regulations of all regulatory bodies, including but not limited to city, county, state or federal regulatory agencies. Applicant acknowledges that placement of its utilities in any right-of-way is subject to the rights and rules of the City of Lakeland. Damage, loss or destruction of applicant’s facilities and/or its resulting business interruption will not be restored, compensated or reimbursed by the city in the event the city needs to remove, relocate or terminate such facilities while accessing its utility services in the area for any reason. Private utility locates are required by the owner and/or applicant for the utility in the right-of-way and in perpetuity.
The applicant shall provide, at its sole expense, full “as-built” drawings for all infrastructure installed in the city right-of-way. All “as-built” drawings shall be completed by a licensed Minnesota engineer or surveyor. “As-built” shall be provided in paper and digital form acceptable to the City of Lakeland including GPS coordinates in the Washington County coordinate system. The city additionally reserves the right to remove and/or deactivate any and all installed infrastructure placed in its right-of-way should these “as-built” not be provided or should these prove inaccurate.
The applicant accepts in perpetuity the responsibility to perform at its expense all necessary locates (Gopher State One Calls) that may arise or be requested in the future by the city or other parties. The applicant does release and hold harmless the city from any and all responsibility for utility / service locates.
APPLICANT SIGNATURE. By your signature you accept and agree to all conditions as stated above. Must be signed by owner, president or CEO of firm installing utilities.
Name:
Title:
Signature:
Date:
Phone:
TO BE COMPLETED BY CITY: | ||
PERMIT EXPIRATION DATE: SECURITY ESCROW AMOUNT REQUIRED: $ HAS PROOF OF INSURANCE BEEN SUPPLIED? | ||
TYPE OF FINANCIAL SECURITY: CASH/CHECK ANNUAL | ||
APPROVAL SIGNATURE: | TITLE: | DATE: |
RIGHT-OF-WAY FEES AND CHARGES
Base Permit Fee TBD
Includes initial review, plan and restoration review, permit issuance and tracking, one final inspection.
Additional Hourly Fee TBD
Based on regular hour rate, does not include overtime or minimum hours for non-standard work hours.
Engineer/ Legal Services Actual Cost +10%
Developer is required to pay for all city out of pocket expenses, e.g. contract work as required by the City for review, testing, additional mapping, digitizing, survey work, recording, and the like.
Re-inspection (1/2 hr min) TBD
Escrow Deposit Requirements:
Tracer wire installations in grass ROW shall have a $1,000 deposit, minimum, in case engineer needs to be brought in to survey and perform a trace. Separate escrow amounts will be required for street or trail impacts or other excavations based on proposed project, materials and areas to be disrupted. Fees for trenching, excavation, and additional infrastructure impacts will be estimated prior to permit issue and be adjusted for additional work on an hourly basis.