Excavation Permit Utility Installation Permit No. 2022-EP299, UID # 5616
App. Status: Work Completed
City of Maple Grove
Engineering Department
12800 Arbor Lakes Parkway
Maple Grove, MN 55369

Kelly Matzke (612-968-3615)
 

APPLICANT

Applicant:
Name:
Cindy Albright
Company:
Telcom Construction
Company Phone:Local Phone:
(320286 - 8369
(320286 - 8369
Email Address:
cindy.albright@telcomconstruction.com
Mailing Address:
PO Box 189
Clearwater MN 55320

CONTRACTOR

Contractor:
Name:
Cindy Albright
Company:
Telcom Construction
Company Phone:Local Phone:
(320286 - 8369
(320286 - 8369
Email Address:
cindy.albright@telcomconstruction.com
Mailing Address:
PO Box 189
Clearwater MN 55320

PROJECT

Nature of Work:
Main Installation
Surface to be disturbed:
Boulevard
Work to start on or after: 08/10/2022
To be completed on or before: 02/10/2023
Applicant Project No.: P.037534

INSTALLATION / CONSTRUCTION

Provide a detailed work description:
Access for splicing at existing MH 8512-8512 near the intersection of Jefferson Hwy and 81st Ave N. Work truck with 360 degree light will be parked more than 2 feet from the curb on the boulevard that has been coned off to pedistrian traffic.
Start excavation in existing HH 8175J bore 230? north along Jefferson Hwy turn west and continue onto customer property.  Work truck with 360 degree light will be parked more than 2 feet from the curb on the boulevard that has been coned off to pedistrian traffic.
Attach detailed plan sheet:
Size and kind of pipe:
1.25" HDPE
Depth from surface: 36"- 48"
Length of utility construction: 107
Method of installation:
Directional Bore
Other
If other is selected, please provide additional information:
access for splicing and bore
Development: Existing

LOCATION

Location/Address: 8175 Jefferson Hwy N, Maple Grove
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TRAFFIC CONTROL

Will traffic control be necessary? Yes

TRAFFIC CONTROL PLAN

Attach Traffic Control Plan:

Terms

DEFINITIONS
  • Public right-of-way. "Public right-of-way" means the area on, below, or above a public roadway, highway, street, cartway, bicycle lane, and public sidewalk in which the local government unit has an interest, including other dedicated rights-of-way for travel purposes and utility easements of local government units. A public right-of-way does not include the airwaves above a public right-of-way with regard to cellular or other nonwire telecommunications or broadcast service.

ACTIVATION REQUIRED
  • Contact Kelly Matzke at (612) 968-3615 at least 24 hours prior to construction to activate permit. Failure to contact Mr. Matzke to activate permit prior to work being started shall be considered a violation of the permit and grounds for dismissing contractor from the job site.

GENERAL
  • (1) Article IV. Public Right-of-Way Management Ordinance will be enforced for work being done in the right-of-way. (2) All excavations taking place in right-of-way must conform to Minnesota Statute Chapter 216D. Excavation Notice System. (3) All rules and regulations for locates must conform to the most current Gopher State One Handbook. (4) Excavations taking place in the Maple Grove city limits in the Hennepin County right-of-way requires permits from the City of Maple Grove and Hennepin County. (5) All properties affected by excavation and construction must be notified in writing prior to beginning work. (6) The permit issued does not in any way imply an easement on private property or grant a right to encroach on private property. (7) A City of Maple Grove Excavation Permit shall be on site at all times and available upon request by any city official. (8) Safety vests must be worn by all people occupying the right-of-way.

CONSTRUCTION
  • (1) All underground utilities must be placed a minimum of 36" and 48" maximum below finished top of curb elevation. (2) Any placement of utilities, including but not limited to cabinets, boxes, and pedestals must conform to city code. (3) Absolutely no removal of bituminous or concrete is allowed without prior approval from the City of Maple Grove. (4) Core drilling is not allowed in street, sidewalk, or trail without prior approval from City of Maple Grove. The City of Maple Grove does not allow core drilling to take place in ped ramps. (5) Vehicles, equipment, and materials are not allowed on sidewalks, trails, or ped ramps at any time unless the contractor performing work has exhausted all other alternatives, including, but not limited to lane closures, boulevard parking, etc. If it has been determined that all alternatives have been exhausted, permission must be obtained from City representative before proceeding to use sidewalks, trails, or ped ramps. (6) Any changes or revisions to the Excavation Permit after approval must be resubmitted and approved before proceeding with work in the right-of-way. (7) Street crossings must be installed perpendicular to the road to avoid future potholing in street. (8) Plowing and pneuma gophering are not acceptable forms of excavation allowed in the City of Maple Grove. (9) All open trenches and holes must be backfilled before leaving work site at the end of the day. (10) All flags from locates must be removed and picked up immediately once excavation has been completed. (11) Inclement weather shall be reason for delay of the project start or suspension of the project as determined by the City of Maple Grove.

TRAFFIC CONTROL
  • (1) All permit applications requiring traffic control shall conform to the most recent version of the Minnesota Manual on Uniform Traffic Control Devices, including the Temporary Traffic Control Zone Layouts Field Manual, and be approved by the Transportation Operations Engineer. (2) The City of Maple Grove only allows traffic control to occur during off peak hours, which is between 9:00am-3:00 pm Monday thru Friday. (3) All traffic control devices must be removed from the job site promptly upon completion of work. (4) Traffic control on weekends requires prior approval from Transportation Operations Engineer John Hagen. John can be reached via email at jhagen@maplegrovemn.gov or 763-494-6364.

RESTORATION
  • (1) Restoration must conform to Section 28-105. Restoration of Right-of-Way. (2) Restoration Requirements on Soft Surfaces. (a) Turf: Hydroseeding is required unless otherwise directed by Right-of-Way Technician. (b) Soil: Six inches of topsoil is required on all boulevards that are damaged. (c) Sprinklers: Restore to prior condition with like materials and equipment. (d) Pet Fences: Check for continuity after repair. (e) Landscaping: Restore to original with like materials. 3) Removal/Restoration Requirements on Hard Surfaces. (a) Bituminous: Shall be removed and restored in a timely matter to its original or better condition. (b) Concrete: Shall be removed and restored in a timely matter to its original or better condition. (c) Driveways: Notify Right-of-Way Technician of any damage and address with homeowner. (4) Restoration Requirements in areas where core drills were approved. (a) Bituminous: Core drills in bituminous paths are replaced at width of path (example: 8 foot wide path is replaced 8'x8' per core). (b) Concrete: Core drills in sidewalks require a minimum of two panels to be replaced per core to assure base has been properly reestablished. (5) All disturbed areas during excavation must be restored to their original condition within 30 days. (6) Damage on boulevards due to vehicles and equipment must be restored and treated the same way that excavation damage is restored. (7) Work completed in winter months must notify City with plans for restoration to take place in the spring.

ADDITIONAL INFORMATION
  • (1) All contractors, including subcontractors, must be registered with the City of Maple Grove to do work in the right-of-way. Contractors doing work in the right-of-way that are not registered with the city will be considered in violation, and will be dismissed from the work site until registration is completed. (2) Absolutely no removal of bituminous or concrete is allowed during winter months.

MISCELLANEOUS
  • By submitting this application, I (applicant/company) hereby acknowledge that I must adhere to all provisions of City of Maple Grove Code and all applicable ordinances, including statute 237.162 and 237.163 in addition to the terms and conditions which are attached to this document. The applicant shall also comply with the regulations of all other governmental agencies for the protection of the public.

Invoice #5099 (08/03/2022)

Charge Cost Quantity Total
Non-Taxable
added 08/03/2022 10:47 AM

Excavation permit fee per occurance

$160.00 x 1 $160.00
added 08/03/2022 10:47 AM

In addition to excavation permit fee (per lineal foot)

$0.40 x 7 $2.80
Grand Total
Total $162.80
Payment 08/03/2022$162.80
Due$0.00

SPECIAL PROVISIONS

It is assumed that the proposed work will not impact travel lanes and/or shoulders . If the proposed work will impact either of these two items, a traffic control plan will need to be submitted and approved.

Approvals

ApprovalSignature
ApplicantCindy L. Albright - 10/03/2022 12:17 PM
b8efc1b0e6d4c0128728bbc14f741a8c
a6f7860b98549cf0c65aa596109efc3c
#1 Right of Way Technician ApprovalKelly Matzke - 10/04/2022 10:34 AM
5b51da890f3055b2f7a29580e60e55fb
62588265abd7053f73799a29f0ccacbf
#2 Traffic Operations Engineer ApprovalJohn Hagen - 10/04/2022 10:34 AM
e9b52f8e70007bbff8c4f0563ef2681c
e6cd0ad9c53a69db0f64eed30947d3be
Application has been approved. All signatures have been obtained.

Public Notes

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    Internal Notes

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