HomeMy WebLinkAboutRight-of-Way Permit ApplicationProperty
Project location: ❑ Street Excavation ❑ Street Use 7it No.
Agent / Primary Contact
Name:
Email:
Contact Phone:
Alternative Phone:
Mailing Address: City: State: Zip:
Project Information
❑ Curb and Sidewalk Cutting ❑Water Installation ❑Power Installation ❑Telephone Installation
Check all that apply: ❑ Driveway ❑Sanitary Sewer Installation ❑ Natural Gas Installation []Cable TV Installation
❑ Tree Trimming/Removal ❑ Drainage Installation []Other:
Location in ROW
Traffic Control
Excavation Method
Excavation Dimensions
[:]Open Cut ❑Boring
Length Width Height
[]Off pavement ❑Both
❑Signs ❑Barricades
[]On or under pavement
[:]Cones ❑ Flaggers
❑ Other:
Brief description of the scope of work:
Describe the type of cutting and digging equipment:
Describe backfill, method of compaction and type of material:
Restoration of pavement method:
Street Closures
Construction will require ❑ Full ❑ Partial ® No street closure.
Will excavation be left open overnight? ®Yes ❑ No
Identify the affect street(s): Date(s) of closures:
Conditions of Approval
1.1 have read and will comply with the City of Medina Right -of -Way Construction requirements.
2.1 will notify the Utilities Locator Dispatch at least 48 hours prior to construction (1-800-424-5555).
3.1 will inform the City of Medina Development Services Department (425-233-6414) at least 48 hours prior to construction and after the site has
been restored, cleaned and is ready for final inspection.
4.1 will restore and maintain the following to the satisfaction of the City Engineer for a period of two years: pavement, grade of pavement, and the
shoulder at this ROW site.
5.1 will hold the City of Medina harmless for all claims, damages, and litigation costs which might arise as a result of this construction, or
maintenance of the facilities installed at this site.
By signing below, I agree to follow all conditions of approval, ordinances and policies of the city applicable to my project, and that all applicable
information furnished in support of this application is true, correct and complete.
Signature: Date:
City Use Only
Date No pavement cut/bonng
Approved:
Received: Permit approved subject to ROW requirements and
Fee: conditions attached Issued:
Bond is on file. Bond #
Associated Bond is not needed (Franchise Bond) Final
Permits: Inspection:
Copy to Police Department required
1 of 1 Rev. 05/22/2024
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RIGHT-OF-WAY CONSTRUCTION REQUIREMENTS
All digging, trenching, cutting, jackhammering, picking, marring, defacing, or alteration of any
City right-of-way shall require that a Right -of -Way Use Permit be approved and issued before
construction begins.
GENERAL REQUIREMENTS
1. All rights -of -way shall be restored to pre-existing condition or better. Existing drainage
ditches, culverts, and catch basins shall be kept clear and free of debris at all times during
construction. Any drainage culvert, tile, catch basin, manhole or ditch, etc. disturbed by
construction shall be restored or repaired to the City's satisfaction.
2. Temporary erosion and sedimentation control measures shall be employed to protect storm
drainage facilities and adjacent properties. Public streets shall always be kept clear of dirt and
debris. Clean up operations shall take place within 1000 feet of excavations.
3. Construction materials shall not be stored or wasted in the right-of-way without the City's
permission.
4. Maximum amount of open trench on street shall be 400 lineal feet. At the end of each day all
trenches must be backfilled or covered with steel plates and physically barricaded, with flashing
warning lights as necessary. If weather conditions make traveled roadways unsafe for the public
or are detrimental to the restoration of roads, excavation shall cease immediately and clean up
shall be promptly accomplished.
5. All work shall be performed in accordance with the State of Washington Department of
Transportation's Standard Specifications for Road and Bridge Construction, latest revision.
6. A bond in the amount of $10,000.00 shall be on file with the City prior to any open cut of city
right-of-way. The bond shall be on file prior to construction and may be held for up to one year
after completion of the project.
SUPPLEMENTAL REQUIREMENTS
1. I have read and will comply with the City of Medina Right -of -Way Construction
requirements.
2. I will notify the Utilities Locator Dispatch at least 48 hours prior to construction (1-800-424-
5555).
3. I will inform the City of Medina Development Services Department (425-233-6414) at least
48 hours prior to construction and after the site has been restored, cleaned and is ready for final
inspection.
4. I will restore and maintain the following to the satisfaction of the City Engineer for a period
of two years: pavement, grade of pavement, and the shoulder at this ROW site.
5. I understand that by placement of improvements in the right of way that I am obligated to
continuously maintain insurance that will remain in effect during all periods of use of the City's
rights of way. Such insurance shall provide for public liability and property damage of be of a
type and with limits acceptable to the City. Said insurance shall not be cancelable or reduced
without prior written notice to the City, not less than 30 days in advance of the cancellation or
alteration. Said insurance shall name the City as a named or additional insured and shall be
primary as to any other insurance available to the City.
6. I understand that by placing improvements within the City rights of way, I do so at my own
risk. I acknowledge that I have no future assurance of the continued right to use the City's rights
of way and that the City may, at any time and in its sole discretion, request that I move my
improvements from the rights of way. In addition, if the City or its contractor(s) need(s) to do
any work in the City rights of way that will disturb, damage, or otherwise impact the
improvements that I have placed on or in the City rights of way, the City and its contractor(s)
has(ve) no obligation to repair, restore, or otherwise replace the improvements or restore my
property. I understand and agree that any restoration, repair, or replacement shall be at my sole
cost and expense.
7. I will indemnify and hold the City of Medina harmless for all claims, damages, and litigation
costs which might arise as a result of this construction, maintenance, or use of the facilities
installed on City right of way at this site.
TRENCHING
1. Trenches shall be completely free of water prior to backfilling. All backfill material under
asphalt and shoulder areas shall be 1 1/4 inch minus crushed rock; 5/8 inch minus crushed can
be used in the last one foot of the trench backfill. Native material may be used as backfill only in
the right-of-way outside the shoulder area.
2. The City of Medina reserves the right to require foundation material of specification to be
determined by the Public Works Director.
3. A typical street section is required for any pavement cut on city streets. Onsite inspection by
the Public Works Director or designee is required for final restoration and paving.
PATCHING
1. Unless approved otherwise by the City, any longitudinal trench cut in excess of one hundred
(100) feet must be covered by a full width overlay of the road surface.
2. All final asphalt or concrete cutting must be done with a cutting saw. The final cut must be
made at least 12 inches wider than the initial trench (T-Cut). Neat cutting with a jackhammer is
allowed only on the initial cut.
3. Temporary patches shall consist of four inches (4") of Class B Asphaltic Concrete and shall
be placed in the cut bringing the excavated area back to original grade. After temporary patch
settlement is complete and a minimum of three (3) months have elapsed, the temporary patch
shall be replaced with a permanent patch consisting of a minimum of four inches (4") of Class B
asphaltic concrete. Permanent patch shall extend at least one (1) foot beyond either side of trench.
Patch shall be installed with a roller and brought up to existing road grade. Meet lines shall be
tacked and sealed.
4. Cold patch may be used for temporary patch. If cold patch is used, the permanent patch shall
be completely removed and replaced with four inches (4") of Class B Asphaltic Concrete,
approved by the Public Works Director or designee.
5. Any failure of a temporary or permanent patch will require immediate restoration by the
responsible party.
TRAFFIC CONTROL
1. Signing, flagging and traffic control devices shall be in accordance with the Manual of
Uniform Traffic Control Devices, latest edition. Arterial lane closures are limited to one lane of
traffic open at all times unless approved by the Public Works Director or designee.
501 EVERGREEN POINT ROAD, MEDINA, WA 98039 (425) 233-6400