City of Maple Grove
Excavation Permit Utility Installation Permit No. 2023-EP168, UID # 6206
App. Status: ApprovedCity of Maple Grove
Engineering Department
12800 Arbor Lakes Parkway
Maple Grove, MN 55369
Kelly Matzke (612-968-3615)
App. Status: ApprovedCity of Maple Grove
Engineering Department
12800 Arbor Lakes Parkway
Maple Grove, MN 55369
Kelly Matzke (612-968-3615)
APPLICANT
| Applicant: |
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| Additional email address to notify: | patrick.edmonds-tlr@consulttlr.us | ||||||||||||||||||||||||||||||||||||||||
CONTRACTOR
| Contractor: |
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PROJECT
| Nature of Work: | Other |
| Surface to be disturbed: | Boulevard |
| Work to start on or after: | 07/12/2023 |
| To be completed on or before: | 08/10/2023 |
| Applicant Project No.: | 21112023E - JB1337550 |
INSTALLATION / CONSTRUCTION
| Provide a detailed work description: | Contractor to set new node pedestal and handhole next to existing power supply. Once completed, contractor to change out existing equipment at locations shown in red on attached map. |
| Attach detailed plan sheet: | |
| Size and kind of pipe: | 2" hdpe |
| Depth from surface: | Other, I will describe below |
| If other is selected, please provide additional information: | 18" |
| Length of utility construction: | 5 |
| Method of installation: | Hand Dig Open Trench |
| Development: | Existing |
JB0001337550_Coax_PAM_DESIGN.pdfLOCATION
| Location/Address: | 15525 73rd Pl. N. |
| Mark the location of the installation How to use: 1. Use only one option (dot, line, or polygon) 2. Made a mistake? Click on feature and press delete key. |
TRAFFIC CONTROL
| Will traffic control be necessary? | Yes |
TRAFFIC CONTROL PLAN
| Attach Traffic Control Plan: |
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Invoice #5706 (05/23/2023)
| Charge | Cost | Quantity | Total |
|---|---|---|---|
| added 05/23/2023 11:18 AM Excavation permit fee per occurance |
$160.00 | x 1 | $160.00 |
| added 05/23/2023 11:18 AM Add obstruction fee if applicable to project. |
$50.00 | x 1 | $50.00 |
| Grand Total | |||
| Total | $210.00 | ||
| Payment 05/23/2023 | $210.00 | ||
| Due | $0.00 | ||
SPECIAL PROVISIONS
It is assumed that the proposed work will not impact travel lanes and/or shoulders and that staging will not impact pedestrian traffic along the existing sidewalks/trails on 73rd Place. If the proposed work will impact either of these two items, a revised traffic control plan will need to be submitted and approved.
Approvals
| Approval | Signature |
|---|---|
| Applicant | Ben Elsenpeter - 05/23/2023 11:19 AM 8cabf06f60d39d9f7be097bea656281d 67849569788615598b340422f71a3d44 |
| #1 Right of Way Technician Approval | Kelly Matzke - 05/26/2023 11:26 AM 02b13bc4e2db780ef646252cf05e273c e001477a38181a888475ec7b758e8320 |
| #2 Traffic Operations Engineer Approval | John Hagen - 05/26/2023 11:26 AM afeb39957713a18cd3ee5de145e336fc 512c8b078688d78750eb96192f96b054 |
Application has been approved. All signatures have been obtained.
Public Notes
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Internal Notes
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