UTILITY SERVICE PERMIT - ci.brooklyn-center.mn.us

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Location:

Applicant Name:

Address:

Zip Code:

Telephone Number:

Contractor:

Address:

City, State, Zip:

Phone Number:

Restoration Bond or Monetary Deposit:

Applicant Signature:

Date:

Bond or Deposit Return Date:

UTILITY SERVICE PERMIT Brooklyn Center Public Works Department 6301 Shingle Creek Parkway Brooklyn Center, Minnesota 55430-2199 763-569-3340 763-569-3440 fax [email protected]

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Brooklyn B lvd

63rd Ave N

June

A veN

58th Ave N

Halifa

xAve

Fran

c eAv

eN 53rd Ave N

Eckberg Dr

50th Ave N

Azeli

aAve

51st Ave

56th Ave

55th Ave

Xerxe

sAve

N

FranceAve

53rd Ave N

Loga

nAve

N

Hum b

oldt A

veN

Dupo

ntAv

eN

57th Ave N

59th Ave N

Lyndale AveN

Bass Lake Rd

John MartinDr

SummitDr

Shingle Cre e

k Pkw

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Freeway Blvd

Shingle Creek Pkwy

69th Ave N69th Ave N

Franc

eAve

N

Noble

Ave 73rd Ave N

Humb

oldtA

veN

Dupo

ntAv

eN70

th Ave N

67th Ave N

65th Ave N 66th Ave N

INTERSTATE 94

HIGHWAY 100

69TH AVE N

DUPO

NT AV

E N

63RD AVE N

73RD AVE N

HIGHWAY 252

INTERSTATE 694

55TH AVE N

XERXES AVE N

JUNE AVE N

RIVE

RRD

W

BEARD AVE N

59TH AVE N

FREEWAY BLVD

SHIN

GLE

CREE

KPK

WY

65TH AVE N

HUMBOLDT AVE N

BROOKLYN BLVD

KNOX

AVE

N

61ST AVE N

IRVI

NG AV

E N

64TH AVE N

UNITY AVE N

60TH AVE N

ALLE

YGI

RARD

AVE

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HOWE LA

LOGA

N AVE

N

LILAC DR N

OLIV ERAVE

N

BRYA

NT AV

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WILL

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GRIM

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FRANCE AVE N

LYND

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NEW

TON

AVE

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53RD AVE N

TWIN

LAKE BLV

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ERICON DR

CAMD

EN AV

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PERRY AVE N

49TH AVE N

KYLE AVE N

BROOK

LYN D

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MUMFORD RD

52ND AVE N

NASH RD

JANET LN

58TH AVE N

JOYCE LN

SUMM

ITDR

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COLFAX AVE N72ND AVE N

NORTHWAY DR

66TH AVE N

AMY LN

PALM

ERLA

KEDR

W

ALDR

ICH

AVE

N

LEE AVE N

4TH ST N

NOBLE AVE N

H AL I F

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FREM

ONT A

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67TH AVE N

53RD PL N

62ND AVE N

48TH AVE N

WOODBINE LN

YORK

AVE

N

H ALI F

AXAV

E N

WINCHESTER LN

EWIN

G AV

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BROOKVIEW DR

QUARLE S RD

OHENRY RD

VIOLET AVE N

THURBER RD

JUDY LN

EA

RLE BROWN DR

WOODBINE LN N

ADM I

RAL LN

ZENI

TH AV

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SCOTT AVE N

RIV

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LER D

JAME

S AVE

N

47TH AVE N

OAK ST N

DREW

AVE

N

PEAR

SON

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ELEANOR LN

ABBO

TT AV

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50TH AVE N

MORG

AN AV

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63RD LN N

5 1ST AVE N

POE RD

68 TH AVE N

HALIFA X DR

SAILOR LN

QUEE

N AV

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QUAIL AVE N

IRVING LN N

O RCH ARDAV E

N

TOLEDO AVE N

BELLVUE LN N

5TH ST N

FRANCE PL

PAUL DR

RUSS

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WING ARD PL

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NT AV

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56TH AVE N

MARLI N DR

REGENT AVE N

INDI

ANA A

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57TH AVE N

BASS LAKE RD

BOULDER LN

EM ER SONA VE

N

54TH AVE N

TWIN LAKE AVE

ECKBERG DR

A

D MIRAL LN N

PE N NAV E N

BURQUEST LN

72ND CIR N

LAKE

VIEW

AVE

N

URBA N A VE N

CHOWEN AVE N

NORTHP ORT DR

70TH AVE N

LAWR E N CE RD

OHENRY RD N

71ST A V E N

COMMODORE DR

PA RK W AY CIR

FR EM ONTPL N

MAJOR AVE N

67 TH LA N

WOODBINE LA N

71ST CIR N

JAM E S CIR N

PONDS DR N

KATH

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70TH CIR N

QUAI L CIR W

UPTO

N AV

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68TH LA N

58 1/2 AVE N

IRVING PL

HOWE LN

58TH PL N

EMERSON LN N

VERA CRUZ AVE N

BASS LAKR RD

HIGH

WAY

252

S COT TAVE N

GIRA

RD AV

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69TH AVE N ZENITH AVE N61ST AVE N

EMER

SON A

VE N

XERX

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E N

CAMDE NA VE

N

MAJO

R AVE

N

62ND AVE N

DREW AVE N

BRY ANT AVEN

FRAN

CE AV

E N

65TH AVE N

59TH AVE N

70TH AVE N

HIGHWAY 100

GIRARD AVE N

CAMD

EN AV

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66TH AVE N

73RD AVE N

65TH AVE N

WIL L

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58TH AVE NKNOX

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TOLE

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62ND AVE N

61ST AVE N

CAMD

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ALLE

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70TH AVE N

71ST AVE N

70TH AVE N

EMERSON AVE N

PENN

AVE

N

OLIVE

R AV

E N

71ST AVE N

IRVI

NG AV

E N

LILAC DR N

HUMB

OLDT

AVE

N

69TH AV E N

NEW

TON

AVE

N

REGENT AVE N

MORG

AN AV

E N

ORCHARD AVE N53RD AVE N

LEE AVE N

LOGA

N AVE

N

MORG

AN AV

E N

LEE A

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JUN E

A VE

N

DUP O

NTAV

EN

NOBLE AVE N

61ST AVE N

SCOT

T AVE

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INTERSTATE 94

TOLEDO AVE N

ALLE

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HALIF

AX AV

E N

FREMONT AVE N

WINCHESTER LN

ALLE

YWOODBINE LN

EWING AVE N

67TH AVE N

55TH AVE N

68TH AVE N

64TH AVE N

IRVI

NG AV

E N

57TH AVE N

72ND AVE N

70TH AVE N

ALLE

Y

ALLE

Y

64TH AVE N

OR

CHARD AVE N

62ND AVE N

67TH AVE N

MAJO

RAV

EN

PERRY AVE N

UNI TY AVE N

67TH AVE N

KNOX

AVE

N

LEE A

VE N

56TH AVE N

XERX

ES AV

E N

QU AIL AVE N

63RD AVE N

BROOK LY NBLV D

66TH AVE N

BEARD AVE N

68TH AVE N

PERR

Y AV

E N

EWIN

G A V E NBE

ARD A

VE N

OHENRY RDINTERSTATE 694

ALDRICH AVE N

ALLE

Y

54TH AVE N

XERXES AVE N

QUAI

L AVE

N

6 5TH AVE N

LILAC

DR N

EWIN

G AV

E N

67TH AVE N

SHIN

GLE C

REEK

PKW

Y

FREM

ONT A

VE N

72ND AVE N

ADMIRAL LN N

BRYANT AVE N

DREW AVE N

COLF

AX AV

E N

57TH AVE N

NOBLE AVE N

66TH AVE N

ALLE

Y

DREW

AVE

N

JAME

S AVE

N

EMER

SON A

VE N

LILAC DR N

EWING AVE N

LILAC

DR N

REGE

NT AV

E N

EMER

SON A

VE N

ALLE

YFRA NC E

AVEN

65TH AVE N

CAMDEN AVE N

56TH AVE N

BEARD AVE N

ALLE

Y

WILLO W

LN

60TH AVE NAL

LEY

67TH AVE N

BRYA

NT AV

E N

KYL E

AVE

N

RESTORATION BOND AMOUNTSBrooklyn Center Public Works Department6301 Shingle Creek PkwyBrooklyn Center, MN 55430-2199763-569-3340 763-569-3440 fax

June 2013

LegendSchedule ASchdedule BCounty Road (County Permit Required)

Restoration Bonds or Monetary Deposit Schedule A Schedule BDriveway Permit $2,500.00 $1,500.00Water & Sewer Permit

Street Cut $4,000.00 $2,500.00Sidewalk Impacts Only $250.00 $250.00

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Utility Service Permit General Conditions

The following general conditions apply to work within the cities right of way.

1. The property owner or contractor must submit a Utility Service Permit prior to commencement of work.

2. The applicant is responsible for providing and maintaining traffic control as specified in

the latest version of the Minnesota Manual of Uniform Traffic Control Devises (MMUTCD). If the applicant does not posses a copy of MMUTCD, one can be obtained from the Engineering Department.

3. The applicant is responsible for complying with all employee, trench and roadway safety

standards.

4. Underground utility installations placed within roadway right-of-way must be inspected by the Public Works Department (763-569-3340) prior to backfill of trench.

5. Underground utility installations placed within private property must be inspected by a

member of the Inspections Department (763-569-3330) prior to backfill of the trench.

6. Type, quality and thickness of base and pavement structure placed within the roadway patch area shall be a minimum of 4” Class 5 Aggregate, 2” of type LVNW35030B bituminous mix and 1 ½” of type LVWE45030B bituminous wear course as established by the Engineering Department. The new pavement section shall match the existing conditions unless it is less than the minimums in which case the minimums shall apply.

7. Pavement of a roadway patch must be done under the inspection of a member of the

Public Works Department.

8. Failure to comply with items 1 through 6 may result in reconstruction of all or part of the project to the satisfaction of the City Engineer; or assignment of the project completion to a competent party with subsequent costs charged against the posted monetary deposit or bond.

9. City shall release balance of monetary deposit against which it has no claim upon project

completion and acceptance. Date: __________________ Signature: ______________________________________