PERMIT #__________________ PERMIT FEE: $100.00 HIGHWAY DEPARTMENT PERMIT UNDER SECTION 149 OF THE HIGHWAY LAW Street or Highway Name:____________________________________ No._______________________ Property Owners Name ______________________________________ Phone_____________________ Address:______________________________________________________ Under provisions of the Highway Law, permission is hereby granted to: Company/Person Name: __________________________________________ Address:_____________________________________________________ 24 Hour Phone #:_____________________________ Liability Insurance Policy Holder: ________________________________________ (CERTIFICATE OF INSURANCE MUST ACCOMPANY THIS APPLICATION ISSUED IN THE TOWN'S NAME AT THE TIME OF APPLICATION) To do the following work: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ CONDITIONS AND RESTRICTIONS The work authorized by this permit shall be performed under the supervision and to the satisfaction of the Town Highway Superintendent, or his representative. The said Town Highway superintendent reserves the right to at any time revoke or annul this permit should the applicant fail to comply with the terms and conditions upon which it is granted. If it becomes necessary to remove, relocate or replace said installations due to repair or construction of said Highway or for other reasons the work shall be done as directed by the Superintendent or his representative and such work or the cost so incurred shall be the obligation of the owner. All permanent installations constructed within the highway right of way shall be maintained by the owner. Driveway and shoulder construction within the highway right of way shall slope to drain away from the edge of the pavement at least 1/2 inch Per foot. Traffic shall be maintained and properly protected by the applicant on the section of highway while the work is in Progress and until final completion. Unwarranted interruption of traffic is not permitted. All warning devises and placement shall conform to New York State Department of Transportation regulations. A sufficient number of flag men will be provided by the owner. Only half of the pavement shall be opened at one time, so traffic can be maintained. Any work upon the right of way will be maintained by the applicant for 1 year after the work is completed. Trenches in the shoulder of the pavement are to be back filled with type #4,-2 inch gravel in 6 inch lifts mechanically tamping each lift. Any cut within the pavement must be back filled with type #4, -2 inch gravel in 6 inch lifts mechanically tamping each lift to the bottom of pavement thickness. A minimum base of 4 inches of type 3 binder and two inches of 7F top plant mixed bituminous macadam shall be used to return the pavement to proper elevation to match the existing highway. No town signs, guide i2osts, guide railing for traffic control device shall be disturbed. Prior to issuing this permit the owner shall contact the UFPQ under ground locating documenting the assigned number for this project in the space provided. UFTO # ___________________________________________________ PERMIT WILL BE KEPT ON THE JOB AT ALL TIMES. DETAILED DRAWING OF WORK TO BE ACCOMPLISHED WILL ACCOMPANY THIS PERMIT. THE APPLICANT SHALL RESTORE THE RIGHT OF WAY IN A TIMELY FASHION, SHOULD THE SUPERINTENDENT RECEIVE COMPLAINTS ABOUT CONSTRUCTION, HE/SHE SHALL CONTACT APPLICANT IMMEDIATELY. THE APPLICANT SHALL RESPOND IMMEDIATELY TO ALL EMERGENCY SITUATIONS. SHOULD THIS NOT HAPPEN, THE SUPERINTENDENT WILL RESPOND AND CAUSE REPAIR AT THE APPLICANTS EXPENSE. SHOULD THE APPLICANT FAIL TO MAINTAIN AND OR RESTORE ALL AREAS WITHIN THE ROAD/STREET RIGHT OF WAY, THE TOWN SUPERINTENDENT SHALL CAUSE PROPER REPAIR AND THE APPLICANT WILL BE SUBJECT TO THE COST OF REPAIR AND THE APPLICANT WILL BE SUBJECT TO THE COST OF REPAIR PERFORMED BY A CONTRACTOR HIRED BY THE SUPERINTENDENT-OR REPAIRS BY TOWN FORCES. SPECIAL CONDITIONS __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ IN CONSIDERATION OF GRANTING THIS PERMIT, THE UNDERSIGNED ACCEPTS AND AGREES TO ALL CONDITIONS ABOVE INCLUDING SPECIAL CONDITIONS DESCRIBED, NAME PLEASE PRINT_______________________________________ COMPANY TITLE___________________________________________ SIGNATURE________________________________________________ TOWN SUPERINTENDENT_____________________________________ DATE APPROVED______________________________________