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P - 48607Engineering WATER AND SEWER Permit No.: �° 1Z�• ! 763-572-3552 PERMIT APPLICATION Receive By'• `'� CITY OF FRIDLEY ��: ��~� �� - 763-571-1287 fax EFFECTivE oiiizi2oiz Date APPLICATION DATE: _ � �U ' /,� YOUR E-MAIL/FAX: THIS APPLICANT IS: ❑ OWNER I�CONTRACTOR JOB ADDRESS: �/ �� /✓l/�Q/.1p� ST" N� � NEW CONSTRUCTION PERMIT# (IF APPLICABLE): PROPERTY NpME: �7�j �/�- h//;rL G%NG jT`�/�,.7 OWNER/ ,r�DRESS: ,icYf� %9 �i�%JO �' S% /��CITY �%(%��' STATEp Y ZIP rry.z � TENANT - PHONE: CONTRACTOR N�tE: �''O�U /%��1� t� SUBMIT A COPY OF �DRESS: ��/.I�� O � 7 /�,d� /� C[TY �'�%�") �r/�i� STATE ZIP ff� % YO(IR STATE � — �� LICENSE WITH PHONE CELL PHONE: /��r,-�t 7G� •07� � �,z S�/ APPLICATIDN STATE LIC # STATE BOND: EXP DATE: 1. Will work take place in City ROW? Yes No�If yes, ROW registration is required — see Engineering. 2. Provide written description of proposed wo . % l G ��Li'�",�� S'f �f =� i-- i; 2� �-,��,</ G- 3. Attach plan/sketch showing proposed work with existing curb, utilities, trees, buildings, etc. with dimensions 4. Circle type of erosion control measures to be installed to prevent disturbed soils from eroding: Silt Fence Bio-rolls Erosion Blanket Sodding Other: ��-�-y-��/�-- �.. 5. Provide minimum of 2 hr notice for inspection ( 8 am — 4:30 pm) and call in the following order: (763) 572- 3552, (763) 572-3556, (763) 238-8058, (763) 572-3562 or (763) 572-3551, or (763) 427-1212. 6. Refer to "Construction Requirements for Water and Sewer Work" on back of pa�, 7. Stipulations: `� .�..��.. ��-;,t .,;t,�-i..�' f ? ��-- 4� PERMIT TYPE ❑ SEWER CONNECTION PERMIT ❑ SEWER DISCONNECT PERMIT $50 0 WATER CONNECTION PERMIT ❑ WATER DISCONNECT PERMIT $50 � SEWER LINE REPAIR ❑ WATER LINE REPAIR $40 G ❑ ADD STATE SURCHARGE $5.00 for each permit ( G SAC CHARGE @ $2365 = TOTAL $ �— OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING NEW WATER METER COST - SEE UTILITY BILLING SPECIAL ASSESSMENTS - SEE FINANCE WATER TAP - SEE ENGINEERING NOTE: WATER METER REPAIR, INSP OR SHUT-OFF /(EVENINGS, wEEKENDS & HoLIDAYS ) $125/HOUR-BILLED THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a water or sewer permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley. I understand this is not a permit but only an application for a permit and work is not to start without city ap roval of this permi application, unless emergency repair is required. f� SIGNATURE OF APPLICANT ��L, � PRINT NAME: SiC-/'�/"E� � Gl�i%E DATE: ��.� Cf �� -,--�f�` .r' APPROVED BY: +� CG ' / DATE: , � COPY GIV��'�1 T: � TILITY BILLING (only if new meter) � PUBLIC WORKS ❑ ENGIN ERIN City of Fridley Engineering Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3552 FAX: 763-571-1287 Construction Requirements for Water and Sewer Work Rev. 1/12/12 General The Contractor shall notify the City for inspection of pipe installation prior to backfill. Pipe inspections include but are not limited to connections to existing service pipe, connections to City owned pipe or manholes, tees, valves, curb stops, corporations, wet taps, bends, mechanical restraints, and hydrants. Protect City infrastructure facilities (curb, manhole, pavement, striping, etc) from damage and loss of foundational support. Loss of foundational support is identified as excavation within the 1: I slope from the bottom of the structure. Surface damage or loss of foundational support shall result in replacement of facility or degradation fee as determined by the City (Fridley Code 407.11). Backfill material shall be compacted in 1 foot lifts (gross) using a mechanical compactor. Upper 4' of utility trench sides shall be excavated and compacted at 1:1 slope unless engineered shoring is installed prior to excavation and approved by the City. Trench sides deeper than 4' exhibiting loss of lateral density (i.e. cave in, sloughing, undermining, cracking, etc) shall be excavated and recompacted as approved by the City. The City may consider a 5 year bond in lieu of the additional excavation and compaction required to achieve uniform density. Contractor shall comply with current OSHA excavation provisions and CEAM Standard Utility Specifications (1999 Ed.). Horizontal directional drilling shall require the televising of other pipe in the vicinity to verify no damage has occurred. Excavations within ROW require density of backfill materials to be 100% in the upper 3' and 95% below the upper 3'. Density shall be verified by one of the following methods as allowed by the City: • City approved soil testing company (2 test minimum) or; • Granular soils may be flooded with 2' of water twice (5' and 2' from grade) or; • Visual observation during backfill by City (hourly cost of $75 to observe during 8am — 5 pm, M-F). Reconstruct pavement patch area: • Sawcut pavement as marked by City — contractor to coordinate marking with City • Residential street - 6" Cl. 5 aggregate and 3" LV4 bituminous asphalt (2 lifts) • Non-residential street — 8" Cl. 5 aggregate and 4" MV3 bituminous asphalt (2 lifts) • Match existing patch sections if greater than the above minimums. Provide traffic Control per MMUTCD. If 2 way vehicle travel (22' minimum width) is not maintained, contractor shall provide a trained flagger to direct traffic or provide detour as approved by the City. If work impedes a pedestrian travelway (i.e. sidewalk, bike path, etc.) Contractor shall provide a pedestrian detour route in accordance with ADA rules and regulations. Sewer �__._..._..._._.. ___.�4:- .. lines ghall be m ntained ]evel and continuous by align ng the inside walls of the two pipes. Contr ct �� 1-use..ecc�xit�ie�coupl low Non- asketed i e connections shall use a flexible cou ler Fernco or e uivalent as allowed b Cit th stam�es,�_steel-ba�ds�� er r _.... _._._. i ermg pipe diameters. -- Cure in-place sewer liner may not extend more Yz" into the City sewer main. Contractor shall coordinate live CCTV viewing of liner prior to City acceptance. Pipe bursting or horizontal directional drilling work requires a plan with greater detail than a typical open trench excavation. Contractor shall provide live CCTV viewing to City for the installed pipe prior to City acceptance. Disconnection of service pipe shall be plugged at property line with mechanical plug and marked with a 4" x 4" post. All pipe shall be removed within the property unless otherwise a�proved bv the Cit� Water Flaring existing copper is not allowed, Contractor shall silver solder or use compression fittings to make connections to existing copper services. Contractor shall notify owner of inoperable curb stop requiring repair (Fridley Code 402.06). Disconnection shall typically be on building side of curb stop. Contractor shall leave a 1' stub and silver solder the end closed. Then, curb stop shall be opened fully for 5 minutes and checked for leaks by the City. Contractor shall correct any leakage of the curb stop or 1' stub and retest. All piqe shall be removed within the propertv unless otherwise approved bv the Citv Erosion Control Disturbed soils shall be stabilized within 7 days after completion of work. Disturbed vegetated areas shall be backfilled with 4" topsoil with equal or greater quality than surrounding topsoil as determined by the City. Erosion control measures shall be installed to stabilize and prevent exposed or disturbed soils from eroding off-site or into a waterway. Contractor shall identify erosion control measures to be used on front of permit. � � � � �. `` � �... N�. �- �... 1 i� � �.. 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