City f Elk Grve Encrachment Permit 8401 Laguna Palms Way Elk Grve, CA 95758 PHONE (916) 478-2256 E-mail: epermitsline@elkgrvecity.rg PERMITTEE INFORMATION USA Phne N. (800) 227-2600 r 811 (TO BE COMPLETED BY PERMITTEE, PLEASE PRINT) Permit Type: MAJOR MINOR (Residential Owner) ANNUAL Permit Number January 2018 ADDRESS LOCATION OF WORK OR PROJECT PERMITTEE / BILLING INFORMATION CITY / STATE / ZIP ASSESSOR'S PARCEL NUMBER PERMITTEE NAME PHONE NUMBER/ EMAIL PERMITTEE SIGNATURE DATE PROPOSED START/END DATE: PERMITTEE WORK ORDER NO. CONTRACTOR INFORMATION CONTRACTOR PERFORMING WORK CONTACT NAME ADDRESS CITY / STATE / ZIP PHONE NUMBER CONTRACTOR'S LICENSE NO. CLASS BUSINESS LICENSE NO. 1 2 3 4 5 6 7 8 CONTRACTOR SIGNATURE DATE I have read, understand, and agree t cmply with the permit cnditins which are a part f this permit. I further agree t cmply with the current City f Elk Grve Standard Specificatins and Details, City f Elk Grve Municipal Cde, and cnditinal requirements. Insurance Requirements: Applicant must prvide a certificate f insurance evidencing $ (amunt shall be determined by the City upn submittal) cmbined single limit fr Bdily Injury Liability and Prperty Damage Liability. An endrsement must be attached naming the City f Elk Grve, its fficers, fficials, emplyees, agents and vlunteers as Additinal Insured. In cnsideratin f the granting f this Applicatin, it is agreed by the Applicant that the Applicant shall indemnify, prtect, defend, and hld harmless the City, its fficers, fficials, emplyees, agents and vlunteers frm and against any and all claims, damages, demands, liability, csts, lsses and expenses, including withut limitatin, curt csts and reasnable attrneys and expert witness fees, arising ut f any failure t cmply with applicable law, any injury t r death f any persn(s), damage prperty, lss f use f prperty, ecnmic lss r therwise arising ut f any activity undertaken under the terms f this applicatin and the permit r permits which may be granted in respnse theret, and that all f said liabilities are hereby assumed by the Applicant. It is further agreed that if any part f the activity interferes with the further use f the highway/radway it must be remved r relcated immediately, as designated by the Directr f Public Wrks, at the expense f the Applicant. Applicant must check with all Utility Cmpanies serving the area cvered by this permit, fr lcatin f existing undergrund pipes, cnduits, r cables. This includes calling USA prir t digging. Befre starting wrk, the Permittee shall ntify City f Elk Grve Cnstructin Inspectin at (916) 216-2187, 24 hurs in advance f the date wrk is t begin. Attentin is directed t the General Prvisins attached heret and t any specific cnditins made a part f heref. Csts incurred by the City f Elk Grve Public Wrks Department, fr prcessing and inspectin shall be billed t the Permittee, Chapter 12.08.030 Permit fees, Title 12 f the City f Elk Grve Municipal Cde relating t Cnstructin in Streets and Califrnia Streets and Highways Cde, Sectin 1462. The Permittee shall take necessary measures t prevent any nn-strm water discharge (pllutants) frm entering the strm drain cnveyance system. This shall include use f Best Management Practices (BMPs) as necessary. Cnstructin Prjects disturbing ne acre r mre will be required t submit a Ntice f Intent (NOI) and Strm Water Pllutin Preventin Plan (SWPPP). DESCRIPTION OF CONSTRUCTION: Wrk under this permit may/shall g int a warranty perid within 1 year after cmpletin as stated under the Guarantee sectin f the General Prvisins n the 2nd page f this permit and per the City f Elk Grve's Cnstructin Specificatins and Standards Sec. 7-23. Csts incurred during this warranty perid shall be the respnsibility f the Permittee. PERMIT ISSUED BY: COMMENTS: NOTE: Permittee shall call the Encrachment Permit Inspectr at (916)216-2187 fr FINAL! Warranty Date: Clse Date: APPROVAL Initial: Initial: INSPECTION FEES PERMIT FEE $ PERMIT DEPOSIT $ TRENCH FEE $ TOTAL AMOUNT PAID $ DEPOSIT TYPE DATE: INSPECTOR'S SIGNATURE ISSUANCE DATE A cpy f this permit is prvided t the Applicant, Encrachment Inspectr and Public Wrks Department. PAGE 1 OF 2
ACCEPTANCE OF PROVISIONS. It is understd and agreed by the Applicant that any wrk perfrmed under this permit shall cnstitute an acceptance f all the general and specific cnditins heref. CLEANUP. All radside drainage ditches shall be restred t a true grade and intake and utlet ends f all culverts shall be left free frm all excess material and debris. FUTURE MOVING OF INSTALLATION. The installatin authrized herein shall, upn demand f the City Engineer, be relcated in a timely manner by, and the sle expense f the Applicant whenever cnstructin, recnstructin, maintenance, r traffic cnditins n the highway may require such relcatin. The Applicant must cmmence such relcatin within the time specified in said demand and thereafter diligently prsecute the same t cmpletin. GENERAL DEPOSIT. Applicant shall pst n less than a $2,000.00 depsit, fr permit prcessing and inspectins. Additinal funds may be required fr any Applicant as deemed necessary by the Directr. The depsit may be released 180 days after acceptance f the wrk as specified in Chapters 12.08.070 f the City f Elk Grve Municipal Cde. GUARANTEE. Shuld any failure f the wrk ccur within a perid f ne year after cmpletin and Public Wrks acceptance (i.e., sign ff f permit and as-built drawings) f the permitted wrk, the refilled excavatin settles, r if the resurfacing r restratin f the radway disintegrates r develps ruts r hles r if fund t have used materials nt in cmpliance with the City f Elk Grve Specificatins, the Applicant shall be required t repair and/r resurface t the satisfactin f the City t eliminate all such recnstructin failures. If the Applicant fails r refuses t d such crrective wrk, the City may elect t cmplete the crrective wrk and cllect the cst f the wrk frm the Applicant, r t pursue such ther remedies as may be available t cmplete the crrective wrk at the Applicant's expense. MAINTENANCE. The Applicant agrees by the acceptance f this permit t safely and prperly as called fr under the highest f its industry standards t maintain any encrachment placed bypermitee in the City right-f -way. If the Applicant fails t meet this requirement t the sle satisfactin f the City as determined by the City Engineer, the Applicant will be liable fr all lss, damage, expense, r claim incurred by the City by reasn f this encrachment. Expenses include but are nt limited t: crrecting, repairing r eliminating the encrachment and any trt liabilities. MONUMENTS. All survey mnuments disturbed/remved shall be replaced. Pursuant t Sectin 8771 f the Califrnia Business and Prfessins Cde. ROAD CLOSURE. N highway r street may be clsed withut first btaining apprval in writing frm the City Traffic Engineering Office, telephne (916) 478-2256. If permissin t clse a street is granted, it shall be the Applicant's respnsibility t ntify the Plice and Fire Department prir t clsing the street. STRIPING AND PAVEMENT MARKINGS. Any remved r disturbed traffic markings and striping shall be replaced in kind. TREES. Unless specifically apprved n the face f this permit, the remval r trimming f a tree(s) requires a separate tree permit pursuant t Elk Grve Municipal Cde Chapter 19.12, please call the Planning Department at (916) 478-2265. TRENCHING. Nt mre than ne-half f the width f a traveled way shall be disturbed at ne time and remaining width shall be kept pen t traffic by bridging r backfilling. Pedestrian and bicycle facilities shall be maintained thrugh the wrk site at all times unless prvisins have been shwn n the apprved permit. TUNNELING. N Tunneling will be permitted except n majr wrk as may be specifically apprved and set frth n the face heref. UNDERGROUND UTILITIES. Disregard f r destructin f undergrund utilities may be cause fr revcatin f this permit r denial f future permits at the discretin f the City Engineer. U.S.A. NOTIFICATION REQUIRED. The Applicant shall ntify Undergrund Service Alert tw wrking days in advance f perfrming excavatin wrk by calling the tll-free number (800) 227-2600 r 811. U.S.A. ntificatin t be renewed at n less than 14 calendar-day intervals. GENERAL PROVISIONS City f Elk Grve 8401 Laguna Palms Way, Elk Grve, CA95758 Phne: (916) 478-2256 E-mail: epermitsline@elkgrvecity.rg PERMIT. The permit is issued in accrdance with Divisin 2, Chapter 5.5 f the Streets and Highways Cde f the State f Califrnia and Chapter 12.08 f the City f Elk Grve Municipal Cde. AS-BUILTS. Upn cmpletin f undergrund r surface wrk f cnsequence, the Applicant shall furnish as-built drawings t Public Wrks shwing lcatin and details f wrk perfrmed. BACKFILL AND RESTORATION OF SURFACES. Cmpacted backfill n all rads shall be made in cmpliance with the City f Elk Grve Cnstructin Specificatins and Standards, Sectin 19. DRIVEWAYS. Prtland cement cncrete is nt allwed fr private driveway appraches within the City right-f-way. MAINTAINING AND PROTECTING TRAFFIC CONTROL FACILITIES. Metal bjects (such as manhle frames and lids, valve bxes, bre casings, r similar), shall nt be installed within 72 inches f a traffic detectr lp. Any signal r detectr peratin disruptin shall be repaired and the system made peratinal within eight hurs f the damage. Shuld the City elect t prvide repair r replacement services, the Applicant shall be required t reimburse the City fr all csts invlved. PROSECUTION OF WORK. Any wrk authrized by this permit shall be perfrmed in a wrkmanlike, diligent and expeditius manner t the satisfactin f the Directr. WORK AND MATERIALS. All wrk and materials shall be in accrdance with the current editin f the City f Elk Grve "Standard Cnstructin Specificatins". All wrk shall be in cmpliance with the Americans with Disabilities Act. PAGE 2 OF 2
Page 1 f 5 CITY OF ELK GROVE TRAFFIC CONTROL PLAN SUBMITTAL PACKET PROJECT: SUBMITTED BY: CONTACT PHONE NUMBER: SIGNATURE OF APPLICANT: ONLY PDF OR OVER THE COUNTER SUBMITTAL SUBMIT TO PUBLIC WORKS PERMITS DEPARTMENT INTERNAL USE ONLY PROJECT NUMBER: PUBLIC WORKS PROJECT INSPECTOR: DATE SUBMITTED: DATE RETURNED TO APPLICANT: SPECIAL CONSIDERATIONS:
TRAFFIC CONTROL PLAN REQUIREMENTS Page 2 f 5 The City f Elk Grve shall be ntified any time wrk is t be perfrmed in the public right-f-way r therwise impacts traffic in the public right-f-way. Any encrachment int a traffic lane, shulder, sidewalk, r bicycle lane requires a Traffic Cntrl Plan (TCP). Encrachment includes, but is nt limited t, actual wrk, equipment/materials, and/r wrk vehicles. TCPs shall cmply with guidelines and mandates prvided in Part 6 f the Califrnia Manual n Traffic Cntrl Devices and lcal prvisins. Traffic Cntrl Plans are t be develped, submitted (by the cntractr) and reviewed (by the City) prir t the cmmencement f any wrk. The Diagram Page (page 5 f the Packet) and any attachments are t be signed and dated by the authr. Traffic cntrl plans may be suspended r revked at any time due t traffic safety r traffic efficiency cnsideratins. ALLOW 10 BUSINESS DAYS FOR PUBLIC WORKS REVIEW OF PROPOSED TRAFFIC CONTROL PLANS. The TCP packet may be btained frm Public Wrks Permits Department. The TCP Packet includes: TCP Cver/Submittal Page (page 1); Plan Requirements (page 2); Plan Checklist (page 3); Infrmatin Page (page 4); and Diagram Page (page 5). Diagrams f the traffic cntrl zne drawn n separate pages (nt drawn n page 5 f the Packet) becme attachments t the TCP Packet. Write see attached n page 5 f the packet and attach the separate diagram drawing page(s) with the authr s signature and date. Specific TCP requirements may be discussed at the prject s pre-cnstructin meeting. TCP Plans reviewed and signed by the City shall be maintained by the cntractr at the site f the encrachment fr the duratin f the prject. Hurs f Wrk: Wrk hurs are determined in the City s TCP review prcess. Generally, day wrk during week days is 8:30am t 3:30pm and night wrk is 9pm t 5am. Specific wrk hurs will be nted n the TCP. Beginning and Ending Times: Beginning times: Signs and devices directing r cntrlling traffic are installed and encrachment ccurs. Ending times: Encrachment is remved, signs and devices directing r cntrlling traffic have been cmpletely remved and traffic is n lnger diverted r therwise cntrlled. Special Events and Schl Functins: Wrk hurs may be limited r eliminated during day wrk mratriums. These mdified hurs f wrk may be implemented at any time. Advance ntice will be prvided when pssible. Afternn Wrk Impacting Traffic n Fridays: Wrk is prhibited n certain majr arterials. Check with prject inspectrs fr details n Friday wrk. Traffic Cntrl Devices: All traffic cntrl applicatins (devices placed in the public right-f-way) are t be mnitred and maintained. Devices bserved t be displaced r remved shall be re-psitined r replaced. Cntractrs shall cntinually mnitr the traffic cntrl zne t assure the safe and efficient flw f traffic. All devices and device placement shall cmply with the Califrnia MUTCD and lcal prvisins. Persns respnsible fr placing traffic cntrl devices shall be knwledgeable in traffic cntrl prcedures and understand the traffic cntrl plan t be applied. Flaggers: All flagging is t be perfrmed by trained flaggers cnsistent with Title 8, Sectin 1599 f the Califrnia Cde f Regulatins. Evidence f flagger training shall be made available upn request. Signs: All existing radway signs temprarily mved r remved shall be prperly reinstalled r therwise accunted fr prir t prject cmpletin.
Page 3 f 5 TRAFFIC CONTROL PLAN CHECKLIST IS THE TRAFFIC CONTROL PLAN PAGE #4 (INFORMATION PAGE) COMPLETE AND ACCURATE? (Speed limits are critical t plan review) IS THE PLAN LEGIBLE/UNDERSTANDABLE? Use English measurement system (N metric measurements) DOES THE PLAN REPRESENT THE ACTUAL WORK AREA AND LOCATION? Typical applicatins (frm State/Federal MUTCDs) nrmally d nt reflect cnditins at the actual wrk lcatin. All signs, signals and markings must be indicated n the plan. Bicycle lanes, sidewalks and relevant multipurpse pathways must be included n the plan. The actual wrk space must be accurately represented and delineated. Special rad characteristics (curves, hills etc.) shuld be included when relevant t traffic safety. Other factrs (schl znes, business access, bus stps etc.) must be represented and accunted fr. ARE LANE AND SHOULDER WIDTHS ACCURATELY PRESENTED? A minimum f 10-feet is allwed fr vehicle lanes in traffic cntrl znes. ARE THE PLANS CONSISTENT WITH MUTCD GUIDELINES? Device spacing and distances must be n the plan. Sign/cne spacing and buffer/taper distance charts with apprach speeds nted satisfy this requirement. Signage must warn traffic f what t expect and what is required t safely traverse the traffic cntrl zne. Traffic diversin must be safe and understandable t the mtring public, pedestrians, bicycle traffic and individuals with disabilities. DOES THE PLAN CONTAIN VERBIAGE INDICATING THAT THE APPLICATION INCLUDES THE FOLLOWING? Cntinual mnitring and maintenance f the traffic cntrl zne, emergency access, accmmdatin fr pedestrians, bicycle traffic and the individuals with disabilities. Prper training f flaggers, prper devices and device usage and apprpriate ntificatins. HAS THE PLAN S AUTHOR SIGNED AND DATED ALL DIAGRAM PAGES?
Page 4 f 5 Traffic Cntrl Plan Infrmatin Page Check all apprpriate bxes and fill in the blanks where apprpriate. Name f primary street impacted by wrk: Where is the wrk site in relatin t ther streets/highways? Clsest majr crss-street: Other streets impacted by wrk: Apprach Speed: Speed limit appraching wrksite: MPH (Use psted speed r prima facie speed limit e.g. business/residential speed limit = 25 mph) What type f street/highway is impacted? Divided highway Multiple-lane street/highway Business district Residential district Tw-lane rural Other Other criteria: Intersectin wrk Sidewalk Bike lane Schl zne Other (list) What part f the street/highway will be impacted? Entire street/highway (rad clsure) One r mre traffic lanes Median r center-divider wrk Shulder wrk Wrk within 15 feet f the street/highway Hw lng will traffic cntrl be needed? Wrk ccupying a lcatin mre than 3 days (and nights) Overnight wrk (up t 3 days) Daytime wrk that ccupies a lcatin frm 1 t 12 hurs Daytime wrk that ccupies a lcatin up t ne hur Mbile wrk wrk mving intermittently r cntinuusly Existing traffic cntrls at r near wrk site r impacted by wrk: Signs (number, lcatin & type) Signalized intersectin: Yes_ N_ Radway markings/lane dimensins see Plan Checklist (All striping, lanes and lane widths must be accurate and represent the actual wrk lcatin.) Other (explain):
Traffic Cntrl Plan Diagram Page Directins Use Traffic Cntrl Plan Checklist as a guide. Page 5 f 5 Date Signature Cntractr Shall: Mnitr and maintain traffic cntrl zne at all times Maintain access fr EMS equipment and persnnel Assure safe passage f pedestrians, bicyclists and individuals with disabilities Apply and remve signage cnsistent with the Calif. MUTCD Refer t MUTCD chart fr device spacing, buffers and tapers Cmply with MUTCD device specificatin and placement Utilize trained flaggers per Title 8 CCR Speed mph MUTCD Chart - Guideline Taper Lengths based n 11' r 12' Offset Sign Merging Shifting Shulder Buffer Space Taper Taper Taper Cne Spacing Zne Taper Cnflict 25 150' 125' 63' 42' 155' 26' 13' 30 200' 180' 90' 60' 200' 32' 15' 35 250' 245' 123' 82' 250' 37' 18' 40 350' 320' 160' 107' 305' 42' 20' 45 550' 540' 270' 180' 360' 48' 23' 50 600' 600' 300' 200' 425' 53' 25' 55 1000' 660' 330' 220' 495' 58' 28' 65 1000'+ 780' 390' 260' 645' 69' 33'