HomeMy WebLinkAboutRight-of-way Permit Applicationvia email at: RiahtofWavPermitastlucieco.ore
NAME OF APPLICANT Panelli Fort Pierce, LLC PHONE NO. 786-250-5268
MAILING ADDRESS 6498 Powerline Road, Suite 101; Ft. Lauderdale, FL 33309 EMAIL 9abdel9wolflube.com
TYPE OF PROJECT (CHECK ONE) oRESIDENTIAL ]!COMMERCIAL oUTILITY oDEVELOPMENT ORDER
Name of OWNER responsible for utility after installation Mr. Gabdel Takayama
PHONE NO 786-250-5268 EMAIL gabdel@wolflube.com
Ultimate OWNER does not take possession until acceptance of work.
PERMITTEE REPRESENTATIVE RESPONSIBLE FOR NOTIFYING ST. LUCIE COUNTY 24 HOURS PRIOR TO WORKING IN COUNTY RIGHT-OF-WAY
NAME Peter Herring- RF Concrete Construction, Inc. PHONENO 772-567-3356
WE SHALL COMMENCE CONSTRUCTION OF THE PERMITTED INSTALLATION ON M21 AND COMPLETE WITHIN 7�021 DAYS THEREOF.
CONTRACTOR'S NAME RF Concrete Construction, Inc.
MAILING ADDRESS 664 Old Dixie Hwy.; Vem Beach, FL 32962
PHONE/EMAIL 772-667-3356 / peter@dconslmction.com
As the Applicant, we request permission to construct road drainage, or combination drainage/utility, in Right -of -Way or easements deeded to
or maintained by St. Lucie County, or dedicated to the public areas of St. Lucie County, (hereinafter referred to as "County Right -of -Way").
Type of work that is being performed in County Right -of -Way, and name of County Road:
2 driveways on South Jenkins Road.
The following MUST be submitted with an original signed copy of this application (3 COPIES OF EACH).
1) Detailed maintenance of traffic plan from FDOT's "Design Standards 600 Series". If traffic control requires detours, and/or road
closures, a Florida Registered Professional Engineer will be required to design, sign, and seal said plans.
2) Show on an attached set of plans (I FN 17" preferred) the location and character of the work, and detail the aspect of the work that will
disturb County maintained improvements (hereinafter referred to as "IMPROVEMENTS").
This permit and all its attachments must be kept on the work site and be available upon request or prominently displayed.
Appli Owner Gabdel Takayama Title Operations Manager
X By: ate' Date �� �% Email/Phone: 76s-z50-s2se / gabriel@wolflube.com
By 'ceding wtd installati n of v ork covered by this permit, I agree to comply with the "GENERAL AND SPECIAL
CO DITIONS OF THE GHT-OF-WAY PERMIT".
OFFICE USE ONLY
RIGHT-OF-WAY DESCRIPTION:
REVIEWED BY ACQUISITIONS DIVISION DATE V2027
REVIEWED BY ROAD & BRIDGE DIVISION DATE
The aforestated installation is hereby permitted under the following provisions
BOARD OF COUNTY COMMISIONERS, ST. LUCIE COUNTY, FLORIDA
County Engineer -enforcing official
Revised January 2017
Page 1 of 3
R/W PERMIT NO
The applicant declares that prior to filing this application, he/she has (1) ascertained the location of existing utilities that would be
affected by the proposed installation, and (2) notified such affected utility owners in writing regarding same, and (3) correlated the
proposed installation with owners of such utilities and determined that the proposed installation can be made without detriment to such
existing utilities. If granted a permit for construction of proposed installation on County rights -of -way, the applicant agrees to the
following:
1. Safety. -All construction work shall comply with the safety provisions of all federal, state and local laws.
2. Traffic Control: Measures shall be provided during construction in accordance with the FDOT Design Standards 600 Series.
Traffic shall be maintained to the degree required by the County Engineer.
3. To Save Harmless the Board of County Commissioners and each and every member thereof from the payment of any
compensation or damages resulting from the exercise of rights and privileges herein granted.
4. In the event that modification or repair of the improvements on aforestated County right-of-way becomes necessary, to
promptly move/remove the installation permitted herein, as requested by the Board of County Commissioners of St. Lucie
County, Florida, at no cost to the County.
5. Removal of Installation: In the case of noncompliance with the requirements stated herein, the installation permitted herein
will be promptly brought into compliance or removed from County right-of-way by applicant at no cost to the County.
6. Repair of Improvements by Permittee: Applicant agrees to promptly repair any damage/injury to improvements on County
right-of-way caused by reason of the exercise of rights and privileges herein granted, restoring same to a condition equal to
that which existed immediately prior to the infliction of such damage or injury in a manner satisfactory to the County.
7. Permit Life: If this permit is granted, it shall be valid for a period of 180 calendar days from date of approval subject to
termination by the County in the event that improvements on aforestated County right-of-way are to be
constructed/reconstructed, or in the event that such right-of-way shall be closed, abandoned, vacated or discontinued.
8. The attached sketch(s) covering details of the permitted installation shall be made a part of this permit. Deviations from the
approved work or maintenance of traffic plan shall require prior approval of the County Engineer.
9. Notification to County Eneineer: The County Engineer's office shall be notified twenty-four (24) hours in
advance of starting work on County rights -of -way. New construction that is discovered to have begun
without notification will be subject to a stop work order until proper permits have been acquired. Unless
the work activity is accomplished in continuous work days (excluding weekends and holidays), re -
notification shall be required upon any lapses.
10. Permit on Job Site: All projects requiring a County Right -Of -Way or Driveway Permit will be required to have a copy of the
permit on the job site and be able to produce said copy when requested. Failure to do so will be considered as operating without
a valid permit and operations shall cease and desist. As in the past, field work that is classified as maintenance will not be
subject to the above. The exception on maintenance would be in the event excavation adjacent to a roadway is to be left open
overnight. We would want notification for the purpose of inspecting for adequate barricades, lights, etc.
11. Rights of a Prior Permittee: The construction and maintenance of aforestated installation shall not interfere with the property
and rights of a prior permittee.
12. Final Inspection: The County Engineer's office shall be notified by the applicant upon completion of the installation permitted
herein, so that a final inspection may be made.
13. Other Entities: This permit in no way waives the authority and/or jurisdiction of any other governmental entity. Applicant is
solely responsible for ensuring that all other stakeholders affected by the work or that have ownership of the work site, or
portions thereof, have been adequately notified and have given permission to perform work.
Revised January 3 2017
Page 2 of 3
1. Applicant agrees that in case of future damage (test of time) to the right-of-way or pavement due to subject installation, the
applicant shall repair and restore same to condition acceptable to the County Engineer.
2. Applicant agrees that the expense for any modifications to subject utility installation required before, during or after any future
right-of-way, drainage or roadway improvements are implemented shall be borne solely by the applicant, including but not
limited to: removal, relocation, manhole adjustments, etc.
3. All work done within right-of-way shall be done Monday through Friday, 8:00 AM - 5:00 PM, excluding County observed
holidays and County closures, unless otherwise approved by the County Engineer. A;v work performed after hours shall
be supervised by a County Insnector. for which the Contractor shall reimhnrse the Cnunfv at fhe current insnectnr
rate.
4. Any road closures shall be requested in writing, along with an accompanying traffic detour plan for review, to the County
Engineer twenty-one (21) days prior to requested closure. The County Engineer reserves the right to modify the maintenance
of traffic (MOT) as needed based upon performance.
5. Any approved open pavement cut or trench cut in proposed limits of future pavement shall be restored to FDOT and St. Lucie
County standards.
6. No excavation shall take place within a minimum of five (5) feet of the edge of pavement or within the Clear Recovery Zone
(CRZ). This distance may be increased by County Engineer dependent upon posted speed limit of roadway.
7. Minimum cover of 36" under the travelway and 30" elsewhere, including swales/ditches, shall be maintained over the utility.
Conflicting utilities shall maintain 18" separation unless specifically approved by County Engineer.
8. Jack & Bore or Directional Bore installations shall be done per FDOT specifications. Casings under the travelway shall extend
a minimum of eight (8) feet beyond the edge of the travelway. Bentonite or drilling fluid shall be removed from Right-of-
Way/project site same days as drilling operations.
9. Driveways, roadways, trenches and/or sidewalks shall be restored per the detail approved on the plans or specified in this
permit. Proof of compaction shall be copied to the County Engineer.
10. Two (2) sets of certified record drawings shall be submitted to this office immediately upon completion of subject
utility installation.
11. Dependent upon the type of project, additional permit(s) and/or agreement(s) may be required prior to approval of the right-of-
way permit.
Revised January 3 2017
Page 3 of 3
Notes for completing a St. Lucie County Right -of -Way Permit
Name of Applicant: this is the name of the entity requesting the permit (i.e. FPL, FPUA, AT&T,
Comcast, etc)
Name of Owner responsible for utility after installation: if a utility is being installed by a
contractor not hired by a utility, the utility company MUST accept the work before it can be
transferred.
"We shall commence construction of the permitted installation on _ and complete the same
within _ days thereof." The Right -of -Way Permit is valid for 180 days from the date it is
approved by the County. Your anticipated start date and anticipated duration of the work is
REQUIRED.
Permittee Representative: the person who is responsible to coordinate with the County
regarding schedules, begin and end work, and inspections. The County will be randomly
following up on coordination and schedules so this contact information is critical.
Contractors Name (and contact information): if you have selected a contractor, that information
should be included. However it is not required.
Please complete the description of the work to be done as accurately and completely as
possible.
Three copies are not required for emailed applications. However the applicable detail from
FDOT's 600 series for Maintenance of Traffic is required. Detours and road closures require
additional coordination with St. Lucie County Engineering and the design must be signed and
sealed by a registered Florida Professional Engineer.
PLEASE HAVE THE FOLLOWING ACKNOWLEDGEMENTS NOTARIZED:
I CERTIFY THAT: (CHECK ONE)
AI AM THE OWNER OF RECORD OF THE ABOVE DESCRIBED
PROPERTY AND WILL BE CONDUCTING THE WORK AS OWNERIBUILDER.
Disclosure Statement. State raw requires construction to be done by licensed contractors You have applied for a permit
under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor
with certain restrictions even though you do not have a license. You must provide direct, onsite supervision of the
construction yourself. You may build or Improve a one family or two-family residence or a farm outbuilding. You may also
build or improve a commercial building, provided your costs do not exceed $75,000. The building or residence must be for
your own use or occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a building you
have built or substantially improved yourself within 1 year after the construction is complete, the law will presume that you
built or substantially improved it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed
person to act as your contractor or to supervise people working on your building. It is your responsibility to make sure that
people employed by you have licenses required by state law and by county or municipal licensing ordinances. You may not
delegate the responsibility for supervising work to a licensed contractor who is not llrensed to perform the work being done.
Any person working on your building who is not licensed must work under your direct supervision and must be employed by
you, which means that you must deduct F.I. C.A. and withholding tax and provide workers' compensation for that employee,
all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes, and zoning
regulations
B. ( ) I AM NOT THE OWNER OF RECORD OF THE ABOVED
DESCRIBED PROPERTY; HOWEVER, I HAVE AUTHORITY TO ACT AS AGENT
FOR THE OWNER OF RECORD. (St. Lucie County Code and Compiled Laws requires
that this type ofwork be done by a licensed contractor. PLEASE PROVIDE
DOCUMENTATION).
I CERTIFY THAT ALL INFORMATION SUBMITTED WITH THIS APPLICATION IS TRUE AND
ACPLET �0 TH BEST OF MY KNOWLEDGE.
� .
NER/ GEN SIGN URE CO CT R SIGNATURE
STATE OF FLORIDA, STATE OF FLORIDA,
COUNTY OF ST. LUCIE COUNTY OF ST. LUCIE
The foregoing instrument was acknowledged The foregoing instrument was acknowledged
before I e this O day of NatV, 20'Ap before me this O day of IVovv , 201p
b who is by , who is
personally know to me r has s produced personally kn w_ to me or has produced
`L Griner �lLGNSL as identification. as identification.
?,ASO-. 98-flSf- Y6-/
Signah a of No 'y Sign re of No
/ bGJ Coicorar/ A&A'e'J (oi
Type or Pri t Name of Notary Type or Print Mame of Notary
Notary Public ✓ Title Notary Public ✓ Title
Gar/+f y 5f 9 Commission Number Orr /,VT y4/ 4 Commission Number
(SEAL): (SEAL): 11V
NANCY CORCORAN
NANCYCORCORAN ,: MY COMMISSION # GG 145449
MY COMMISSIONNGG145449 •�` EXPIRES: November4,2021
EXPIRES: November4,2021 oE "" Banded Tbm Notary Public Undend(ers
Bonded Thor NuteryPublic Undetwdiers
FOR OFFICE USE ONLY
APPROVED_ DENIED_
REVIEWED/ APPROVED BY:
ENVIRONMENTAL RESOURCES DEPARTMENT / DATE
UPDATED 10/21/2014