STREET OPENING PERMIT APPLICATION

California Borough

225 Third Street

California, PA 15419

Phone: (724) 938-8878 Fax: (724) 938-8881

Date: ______PA One Call SN: ______

Location

Street/Road Name: ______

Detailed Location: ______

Applicant

Name: ______Phone: ______

Company: ______

Address: ______

City: ______Zip Code: ______

Owner

Name: ______Phone: ______

Company: ______

Address:______

City: ______Zip Code: ______Contractor

Name: ______Phone: ______

Company: ______

Address: ______

City: ______Zip Code: ______

Surface to be Opened Bituminous PavementConcrete PavementConcrete Sidewalk

Driveway (Remove/Repair/Alter)New TeleCom Facility Telecom Repair

Sanitary Sewer ConnectionNew Water Service/Main Water Service/Main Repair

Storm Sewer ConnectionNew Gas Service/Main Gas Service/Main Repair

Other:______

Start Date: ______Expected Completion Date:______

Name of Insurer: ______Policy Expiration: ______

Name of Surety: ______Bond Amount: ______

Signature: ______Date: ______Bond for Performance of Restoration: The Applicant or Permittee upon receipt of a Street Opening Permit, may be required to provide the Borough, prior to commencing the opening(s) permitted, with an acceptable corporate surety bond to guarantee faithful performance of the work authorized by the permit. The amount of the bond shall be as specified on the approved permit. If the Permittee anticipates requesting more than one (1) permit per year, he/they may furnish one (1) continuing corporate surety bond to guarantee faithful performance in such an amount as may be determined by the Borough Street Department Supervisor. In the case of a Public Utility Company, its corporate bond in a form satisfactory to the Borough may be accepted in lieu of the corporate surety bond required by this section.

Insurance Requirements: The Applicant or Permittee, upon receipt of a permit, shall provide the Borough, prior to commencing the opening(s) authorized by the permit, with an acceptable Certificate of Insurance indicating coverage against claims for damages for personal injury as well as against claims for property damage which may arise from or out of the performance of the work. Public Utilities may file an annual Certificate of Insurance in lieu of individual certificates for each permit.

General Conditions:

Public Safety:

  • All excavations within the public right of way require a PA One Call Serial Number.
  • No Excavation shall be left open overnight.
  • Sidewalks and streets shall be kept passable at all times.
  • Maintenance and Protection of Traffic shall be provided at all times and comply with Pennsylvania Department of Transportation Publication 213.
  • Contractor shall comply with all regulations of the Pennsylvania Department of Labor and Industry as well as with Federal Occupational Safety and Health standards and regulations relative to the work being performed.

Trench Restoration:

  • Temporary paving shall be installed and maintained from October 31 through April1 annually.
  • All roadway markings, street signs, parking meters, etc. damaged or displaced during construction shall be replaced.
  • Roadway in the vicinity of the construction shall be swept daily.
  • All trenches shall be cut in neat straight lines.
  • Trench backfill shall be 100% stone compacted by mechanical means in 8” lifts.
  • All sidewalks shall be replaced to the closest control joint with no patches allowed.
  • Stone curbs shall be left in place and tunneled under during construction.
  • All trenches shall be restored in accordance with the sections depicted below.
  • The Borough Street Department Supervisor shall have the authority to suspend all construction activities after reasonable investigation has determined that the Permittee is not complying with the terms of the Borough Ordinance.

------For Official Use Only------

Special Conditions: ______

______

Photos(s) on FileWaive InsuranceWaive Bond

IncompleteDeniedApproved

Permit expires 30 days after issuance unless noted below. Permit Expires: ______

Comments: ______