EXCAVATION PERMIT GUIDELINES

Transcription

1 TOWN OF HANOVER, NEW HAMPSHIRE PUBLIC WORKS DEPARTMENT PO Box 483, 194 Lebanon St TEL FAX EXCAVATION PERMIT GUIDELINES 1. Application & Permit (Page 1 & 2): a. Application must be filled out by party responsible for excavation. b. The application fee of eighty dollars ($80.00) is non-refundable. Check should be made payable to the Town of Hanover. c. Diagram of location and any other related materials is required for review. d. Bond amount will be determined by the Director of Public Works or his designee. e. Dig Safe Authorization Number and Effective Date is the responsibility of the contractor. f. Certificate of Insurance (minimum coverage requirements attached-town of Hanover must be named as additional insured). g. Please sign both the Application page and the Permit page. h. Applicant is responsible for presenting this application/permit package in its entirety and explaining scope of work to the Chief of Police and Fire Chief (or their designee), whom may require certain conditions be met (i.e.; emergency access to road, state certified flag person, etc.). i. Upon approval of the Police and Fire Department, this form can be dropped off at the Public Works Department for final processing and approval. j. Bonds are held for twenty-four months (2 years). Bonds will be released by the Town of Hanover only and should not automatically expire. The contractor may request reduction or release of bond/monies at the end of 18 months. ** Excavation/Obstruction Permit Conditions (Page 3): To be filled out by Police Department 2. Trench Excavation Specifications (Pages 4-6): a. It is the contractor s responsibility to contact Public Works if there are any questions or if unclear about what is required. 3. Performance Bond (Pages 7 & 8): a. This is an example Performance Bond. Insurance companies may use their own form. Please inform your insurance company that this is a 2-year bond and that it should not automatically expire at the end of its term. The Town of Hanover authorizes the release of this bond. b. Irrevocable Letter of Credit is also acceptable in place of a bond. 4. Return these Completed Forms to Public Works: a. Permit Application b. Permit with Police/Fire Dept Signatures (as well as Applicant s signature) c. Original Performance Bond d. Original Certificate of Insurance NOTE: No permit will be considered approved and work can not start until all paperwork is completed and turned in. This includes an Authorized Dig Safe Number, Original Performance Bond and Certificate of Insurance.

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3 TOWN OF HANOVER, NEW HAMPSHIRE PUBLIC WORKS DEPARTMENT EXCAVATION PERMIT - APPLICATION Fee $80.00 (made payable to the Town of Hanover) Application #: Diagram Attached: Yes No Date of Application: The undersigned applies for permission to break or dig up the ground on: Street near for the purpose of on said Street, in accordance with the applicable conditions and provisions of Chapter II of Hanover Code of Ordinances, and subject to the further condition that the undersigned will indemnify and save harmless the Town of Hanover against and from all suits and actions of every name and description brought against it and all costs and damages to which said Town may be put on accord of, or by reason of, any injury to the person or property of another resulting from the negligence or carelessness of the undersigned, or from the use of said street by the undersigned for the purpose as noted above, and subject to the further condition, that all refilling shall be carefully done in accordance with the attached specifications. It is further understood, that, if during the next years any depressions shall occur, or the road shall be unduly washed on account of applicant breaking or digging up the ground on said street, the undersigned will compensate the Town for refilling or grading and indemnify and save the Town of Hanover harmless from all loss by suits or otherwise resulting from these causes including reasonable attorneys fees. The undersigned hereby furnishes a bond or escrow in the amount of $ to the Town for a period of twenty-four (24) months as security for the obligations of the undersigned hereunder to restore the highway in accordance with attached specifications. In the event that the Town demands that the undersigned compensate the Town for refilling or grading and payment is not made, then the Town shall have the right to obtain payment from the bond or escrow. -- It is further agreed that the work will commence on and to be completed on or before, 20. Any changes in these dates require notification to and approval from both the Public Works ( ) and the Police Department ( ). Prior to issue of the permit, the applicant is required to discuss excavation plans and its effects on vehicle and pedestrian traffic. In cases of emergency excavations, the applicant may be allowed to waive this process by contacting the Public Works Director at (603) and Police Dispatch at It is important that you speak with both offices before you break ground. Describe effects on vehicle and pedestrian traffic, if applicable: Federal and State law requires excavators to notify utility companies before excavating. Dig Safe Authorization Number and Effective Date: Applicant s Signature Applicant s Name and Title (PLEASE PRINT) Daytime and/or Emergency Telephone Mailing Address Company Name (PLEASE PRINT) City State Zip

4 TOWN OF HANOVER, NEW HAMPSHIRE PUBLIC WORKS DEPARTMENT EXCAVATION APPROVED PERMIT Permit #: This permit certifies that has permission to break or dig up the ground on Street near. Work will commence on and completed on or before, 20. Any changes in these dates require notification to and approval from both the Public Works ( ) and the Police Department ( ). Further the Town hereby receipts for a bond or escrow from: in the amount of $ as security for and obligations hereunder to restore the highway. Conditions on approval (if any): This permit is hereby accepted and its conditions agreed to: Dated: Dated: Dated: Dated: Signed: Applicant Signed: Chief of Police (or designee) Signed: Fire Chief (or designee) Signed: Director of Public Works (or designee) NOTE: This permit expires December 31 st of the year of issuance. Re-application necessary if work not completed on commencement dates (as listed above). For Department of Public Works Use Only: Application Fee Received: Bond Scheduled for Release: Copy Distribution: Applicant Town Manager Police Department Fire Department Public Works (Original)

5 Applicant Name: HANOVER POLICE DEPARTMENT EXCAVATION/OBSTRUCTION PERMIT CONDITIONS C Work Location: Applicant: Do not write in this box. For use by Town staff only. The applicant shall abide by those conditions checked and/or noted below: Road Closures: (See MUTCD Part 6 generally) The applicant shall comply with the current version of the Manual on Uniform Traffic Control Devices (MUTCD) for signage and specific requirements for road closures. The applicant shall notify the Dispatch Center ( ) when a road is closed and again when it is reopened. Alternate routes for emergency vehicles must be available. Detours: (See MUTCD Part 6 generally) The applicant shall comply with the MUTCD for all signage required through the entirety of all detour routes. Traffic Control: (See MUTCD Part 6 generally) The applicant shall provide certified traffic control personnel when any work impedes a traffic lane. Cones may be used to shift traffic, but minimum lane widths of nine (9) feet shall be maintained. Traffic control personnel must wear a minimum of ANSI Class II safety garments for daytime projects. Sidewalks: (See MUTCD Ch 6D) Where an existing sidewalk is obstructed, pedestrians shall be provided with a reasonably safe, convenient, and accessible path that replicates as nearly as practical the most desirable characteristics of the existing sidewalk(s) or footpath(s). Pedestrian detour routes shall be delineated by temporary traffic control devices. Pedestrians may not share space with traffic unless traffic control personnel are present to coordinate the shared use. Equipment: (See MUTCD generally) All signs and barricades must be MUTCD compliant. Personnel in the vicinity of moving traffic must wear the appropriate ANSI class safety apparel. Warning/Regulatory signs shall not be placed so as to obstruct any bicycle lane or sidewalk. Open trenches: Excavation sites within or adjacent to the Town right-of-way shall be backfilled or properly secured to prevent pedestrian access. Parking: Payment for parking spaces affected by obstructions or excavation must be coordinated with the Parking Division ( ). Date: Signed: Chief of Police (or designee)

6 TOWN OF HANOVER, NEW HAMPSHIRE PUBLIC WORKS DEPARTMENT TRENCH EXCAVATION SPECIFICATIONS Prior to breaking ground an Excavation Permit must be obtained. Part of that process includes discussion with the Police and Fire Department Chiefs regarding how excavation will affect vehicular and pedestrian traffic as well as length of time excavated area will be closed. You must also contact Dig Safe and submit your authorization number as proof of that contact. The following conditions apply to all trench work within the Town of Hanover right-of-way(s): 1. Prior to any excavation, the following equipment and material shall be on site: a. Vibratory compactor. b. Trench box. c. Sufficient 1" steel plates to cover all open trenches, if the trench will remain open over night. Prior approval is required from the Director of Public Works for all trenches not backfilled at the end of each day. 2. Pavement shall be removed a minimum of 1' beyond the edge of any trench. Paving shall be saw cut in a diamond shape (see patch detail). 3. Excavated material shall be stock piled in a manner to allow for replacement in its original state. Unsuitable material shall be replaced with material approved by the Director of Public Works or designee. All pipes shall be properly bedded as required by the Town of Hanover and pipe manufacturer. 4. All backfill material shall be placed in 6" lifts. Each lift shall be compacted to a minimum of 95% compaction in the travel way or under structure and 90% in cross country areas. 5. Pavement patch shall be replaced in two compacted lifts with a minimum of 3" total depth. Base course shall be 2" minimum. All permanent pavement patches shall be completed within 15 days of completion of excavation. 6. Adequate warning devices shall be installed and maintained until a permanent pavement patch is installed. 7. Trench in pavement greater than 8' in length paralleling the street center line shall be repaired with a trench patch and a full width overlay of street of a minimum thickness of 1". (Continued on other side...)

7 TRENCH EXCAVATION SPECIFICATIONS - Continued All transitions to existing pavement (for patches and overlays) shall be at a saw cut to obtain a clean butt joint. All butt joints shall be tack coated with an asphalt emulsion. 9. All pavements shall be patched with approved asphalt material at the end of each day. 10. No excavation or interference with traffic shall be allowed on the following streets between the hours of 7:00 A.M. to 9:00 A.M. and between the hours of 3:00 P.M. and 6:00 P.M.: 1. Park Street 2. Wheelock Street 3. North and South Main Street 4. North College Street 5. Lebanon Street 6. Lyme Road 11. All dust, soil and other debris shall be cleaned up at the end of each day. 12. Tracking of debris into and on the right-of-way shall be prohibited. 13. No materials, equipment, barricades or other items shall be allowed to remain in the right-of-way without written approval from the Director of Public Works. 14. A bond or irrevocable letter of credit shall be posted to a two-year warrantee period in an amount determined by the Director of Public Works.

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9 PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: that (Name of Contractor) (Address of Contractor) a, hereinafter called Principal (Corporation, Partnership or Individual) and (Name of Surety) (Address of Surety) hereinafter called Surety, are held and firmly bound unto: Town of Hanover 41 South Main Street, Hanover, NH hereinafter called TOWN, in the penal sum of Dollars, $( ) in lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION is such that whereas, an EXCAVATION PERMIT issued to the PRINCIPAL by the TOWN, dated the day of, 20, a copy of which is hereto attached and made a part hereof for the construction of: NOW, THEREFORE, if the Principal shall well, truly and faithfully perform its duties, all the undertakings, covenants, terms and conditions of said EXCAVATION PERMIT, with or without notice to the Surety and during the two (2) year guaranty period, and if he shall satisfy all claims and demands incurred under such EXCAVATION PERMIT, and shall fully indemnify and save harmless the TOWN from all costs and damages which it may suffer by reason of failure to do so, and shall reimburse and repay the TOWN all outlay and expense which the TOWN may incur in making good any default, then this obligation shall be void; otherwise to remain in full force and effect.

10 PROVIDED, FURTHER, that the said Surety for value received hereby stipulates and agrees that the WORK to be performed thereunder and outlined in the EXCAVATION PERMIT accompanying the same shall in any wise affect its obligation on this BOND, and it does hereby waive notice of any such change, alteration or addition to the terms of the EXCAVATION PERMIT. PROVIDED, FURTHER, that no final settlement between the TOWN and the CONTRACTOR shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. IN WITNESS WHEREOF, this instrument is executed in counterparts (number) each one of which shall be deemed an original, this the day of 20. ATTEST: (Principal Secretary) By: (Principal) (Address) (Witness as to Principal) (Address) (Surety) By: (Attorney-in-fact) ATTEST (Witness as to Surety) (Address) (Address) NOTE: Date of BOND must not be prior to date of PERMIT. If CONTRACTOR is Partnership, all partners should execute BOND. IMPORTANT: Surety companies executing BONDS must appear on the Treasury Department s most current list (Circular 570 as amended) and be authorized to transact business in the State where the PROJECT is located.

11 CERTIFICATE OF INSURANCE This is to certify that the following policy(ies), subject to applicable terms, conditions, and exclusions has (have) been issued by the insurance company(ies) named below and is (are) in effect at date of this certificate. This certificate of insurance neither affirmatively nor negatively amends, extends nor alters the coverage afforded by the policies indicated, except as shown below. Name of Insured: Address: Certificate issued to: Town of Hanover, Hanover, New Hampshire Kind of Policy Insurance Company Policy Number Expiration Date Coverage (Mark X ) A. Broad Form Comprehensive General Liability B. Comprehensive Automobile Liability C. Umbrella or Excess Liability D. Worker s Compensation And Employers Liability continued on next page... Coverages & Limits of Liability Not less than Not less than Bodily Injury Property Damage Each Each Each Person Occurrence Occurrence Aggregate $500,000 $500,000 Aggregate: $2,000,000 $2,000,000 $2,000,000 $500,000 Single Limit per occurrence $2,000,000 aggregate $500,000 $500,000 $500,000 xxxxxxx $500,000 Single Limit each occurrence $1,000,000 Single Limit each occurrence $1,000,000 Aggregate (where applicable excess of primary insurance recorded above) Compensation - Statutory -- State(s) of N.H. Employers Liability - $100,000

12 The undersigned certifies that the policies listed under A, B, and C above has been endorsed as follows: 1. The Town of Hanover is recognized as an additional named insured but only as respects the agreement, contract, or permit between the above insured and 2. This policy(ies) shall be considered as primary insurance and exclusive of any insurance carried by and the insurance evidenced by this certificate shall be exhausted first, notwithstanding, the fact that may have other valid and collectable insurance covering the same risk. 3. This policy shall not be canceled nor reduced in coverage until after 30 days written notice of such cancellation or reduction in coverage shall have been mailed to this certificate holder. 4. No act on the part of the insured shall affect the coverage afforded to under this insurance. Certified this day of, 20 Insurance Agency Address Telephone