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Home My WebLink AboutRIGHT OF WAY PERMIT APPLICATION FORM_ t SCANNED BY St. Lucie County RIGHT-OF-WAY PERMIT APPIJCATION FORM ST.LUCIE COUNTY ENGINEERING DIVISION Z300 VIRGINA AVENUE. 2'" FLOOR, FT. PIERCE, FL 349B2 (772) 462-1707 Submit via email at: Righ INVjI y_tjtnitfiistlncie_co.� NAME OF APPLICANT _R q Lt c MAILING ADDRESS!tQQ tXffJ JYT 4'-Cf117Y j, V cITY W t G yn R mch STATE _ T'L ZIP �"" EMAILyY aQ (0.1)QJW1/IhQ � PHONENO. ,$b -(Ji1D 1 TYPE OF PROJECT (CHECK ONE) ❑UTILITY ----COMMERCILSI.❑RESIDENTIAL 0 DEVELOPMENT ORDER (other) Name of OWNER responsible tur facility alley installation_ �MiA1'-COfO (orollt•t' Qd! Aj1p+ PhoneN 'L 4- 2- 1-7'2- EMAIL_ PERMITTEE'S REPRESENTATIVE RESPONSIBLE FOR ADMINISTERING WORK WITHIN COUN/T'Yr RIGHT-OF-WAYAND NOT'IFYING��I�OnIE NTY I !C� I� PHONE NO MINIMUM OF 24 HOURS PRIOR1 ��LVI lI ;O�T lX NAME M�ty{yty��ll 11 111 I 1 \ Work shall commence on or about 040h(r 2,1 1018 with a duration of ) Z O days. (?4-hones prtornorrrerrquirerfj CONTRACTOR'S NAME- R �� m Yi oa e " L MAILING ADDRESS. 4n f) J6X-� tit- C ti7 I)r , .QjAi-f A 10 VAIPP, I ?L 3 1 As tite Applicant, we request permission to constmet improvement(s) within a C'onnty maintained Riglrt-of-Way or ensenrents deeded to or maintained by St. Lucie county as public areas of the County. Below is a description of the type of worl(to be performed in County Right -of -Way and name of County Road: '.Rftkt boa Air poi°+ tfttTArl(.t sign on Cu; ►ib 14nq Vvi i d SI. LUC,c 81vd. The following MUSThe submitted with an original signed copy of this application: 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 plan(s) O1 "xIT' 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 "IMPROVEMENT'S"). Rd Bp proccudlag with installation of work covered by this peamit, 1 agree to comply with the "GENERAL AND SPECIAL CONDITIONS OF THE RIGHT-OF-WAY PERMIT". //F —OQFF' CE Il. E ON 1' /� f I RKII.IT--OP-WAY DESCRIP/TIONt �' �uCt i - t�U "-^�voo, UJ a.* , S O r UIUM- h%ou .iwt 4r ..d ✓L�_� T c-y.� Wa„(�a_LGu.oC.�_ Win. U----"—.----------- -- REVIEWED BY ACQUISITIONS The afarestated installation is herebypermitted under the following provisions: DATE 10-I5-aolg BOARD OFF COUNTY COMMISIONERS, ST. LUCIE COUNTY, FLORIDA 13Y�pSfwJrJ LL_ _.__DA•I'E�D I�v_itt RIW PF.i Count, •netneer-lieprescnlauce "' HECEIVEb i&LF. ; .-o. OCT 10 2018 OCT 10 2018 OCT I(p,.PIP ENr-INFrPPrr 01VISp ENGINFERINQ 1 / / ; • 1 tINN 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. Access: By application and acceptance of this permit, any employee of or person performing a duty for the County, is granted access at any time to perform inspection or such duties as determined by and for the County. 2. Safety: All construction work shall comply with the safety provisions of all federal, state and local laws. 3. Traffic Control: Measures shall be provided during construction in accordance with the FDOT Design Standards 600 Series. Traffic shall be maintained to the minimum applicable standard required for the type of site presence or by the County Engineer. 4. 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. 5. 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. 6. 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. 7. 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 satisfactoryto the County. 8. 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. 9. 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. 10. Notification to County Engineer: 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. 11. Permit on Job Site: All projects requiring a County Right -Of -Way 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. 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. The County shall be notified for the purpose of inspecting for adequate barricades, lights, etc. 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. Issuance of this permit in no way waives the authority and/or jurisdiction of any other governmental entity or existing facility installed in accordance with applicable law. 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. Rev. 8-3-18