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HomeMy WebLinkAboutDPW_Form_33(1)_-_Permit_to_Work_Within_the_County_Right_of_WayPERMIT TO WORK WITHIN THE COUNTY RIGHT-OF-WAY COUNTY OF HAWAI‘IDEPARTMENT OF PUBLIC WORKS – ENGINEERING DIVISIONDPW Form 33(1) Rev 04-10-2015 CHECK ALL APPLICABLE BOXES: Construct new driveway approach Resurface/repair existing driveway approach Construct or repair sidewalk Other (describe work): Type of Driveway:Asphalt Concrete Driveway Use:Commercial Residential WIDTH OF A PPROACH/DIMENSION OF WORK:FT. x FT.ESTIMATED COST: $ Name of County Road / Street TAX MAP KEY: START DATE: (Minimum two working days after approval) COMPLETION DATE:WORKING HRS: (Monday thru Friday) PERMITTEE: MAILING ADDRESS:PHONE NO.: CONTRACTOR: MAILING ADDRESS:PHONE NO.: LICENSE NO.: IN CONSIDERATION OF GRANTING THIS PERMIT, THE PERMITTEE UNDERSTANDS AND AGREES TO:(Permittee to initial each line below) Agree to hold harmless, indemnify and defend the County of Hawaii, its officers, employees and agents thereof, from all claims, demands, suits, actions, or proceedings of every name, character and description which may be brought against the County of Hawaii foror on account of any injuries or damages to any person or property received or sustained by any person by or in consequences of any act or acts of the holder of this permit for actins done under this permit [Hawaii County Code Section 22-4.2(7)]; Submit with this permit a certificate of insurance and proof of a public liability insurance policy naming as an additional insured,the its officers, representatives, employees, and agents covering any claim or liability for damages, injuries or death resulting from any of the uses permitted hereunder. The minimum amount of coverage under such policy shall be $1,000,000 per occ urrence. The policy and coverage shall be kept in force until all work under this permit is com pleted to the s atis faction of the director of the department of public works. [Hawai‘i County Code S ection 22 -4.2(8)]; and County, Comply with all conditions as printed on the back of this permit. [Hawai‘i County Code Section 22.4.4]. By initialing above and signing below, the Permittee certifies that the Permittee has legal authority to sign in the capacity stated, and the Permittee certifies that the Permittee has legal authority to sign in the capacity stated, and the Permittee understands and agrees that the terms and conditions of this permit are a legally binding contract. By: Permitee’s Signature Date Its: APPROVED: Director, Department of Public Works Date AGENCY USE ONLY Final Acceptance Date: By: Inspector’s Signature Comments: PERMIT NO: FEE: County of Hawai‘i is an Equal Opportunity Provider and Employer 7/30/14 DPW Form 33(2) Rev CONSTRUCTION PERMIT CONDITIONS OF APPROVAL (Hawai‘i County Code Section 22-4.4) In addition to any other conditions imposed by Chapter 22 of the Hawai‘i County Code, all permits issued pursuant to this article shall be subject to the following conditions: 1. The applicant shall notify the director at least 48 hours before the commencement of any work within the county street. 2. The applicant shall maintain public safety while working in a county street by using barricades, construction signs, markings, warning lights, traffic control personnel and other devices according to the "Manual on Uniform Traffic Control Devices for Streets and Highways" on file in the Department of Public Works. 3. Unless otherwise permitted by law, the applicant shall keep at least one traffic lane open for two-way vehicular traffic during the working hours of the day and at least two traffic lanes open during non-working hours. When the work interferes with a sidewalk, the applicant shall also provide for the safe passage of pedestrians including the disabled around or through the work area. 4. For any excavation work, the application shall verify the location of all existing private and public utilities and shall be responsible for notifying all utilities affected by the construction 48 hours prior to commencing any work. Should an existing utility be damaged, the applicant shall immediately notify the affected utility. 5. The applicant shall be responsible for notifying all property owners affected by the construction 48 hours prior to commencing. 6. No material, except the trench excavated material, shall be stockpiled closer than 6-feet from the existing edge of pavement. 7. No construction equipment shall be parked or any materials stored in the county street in such a manner that the equipment or materials will obstruct or prohibit pedestrian and vehicular movements, including driveway movements, except during actual working hours. 8. No excavation shall be left open for more than 5 working days. 9. The applicant shall repair, restore, or replace all portions of a county street, including but not limited to utilities, drainage ways and structures, traffic markings and signs, driveways and private property that had been altered, broken up, dug up, disturbed, undermined, dug under or otherwise damaged during construction to a state equal to or better than its original condition. Regardless of existing conditions, work shall also include the construction of new curb-cuts for the disabled, accessible driveways or other improvements such that all repairs, restoration, or replacement work complies with the current requirements of the Americans with Disabilities Act (ADA). 10. Before issuing a permit, for all work with an estimated cost equal to or exceeding $20,000, the director may require a cash bond, surety company bond, or personal surety bond in favor of the county. The value of the bond shall be double the estimated cost of restoring or replacing the county street to a state equal to or better than its original condition. 11. Work must be completed within one year of the starting date shown on the permit unless otherwise specified. Failure to begin or complete the work will result in the termination of the permit. 12. Repair, restoration or replacement of county streets, highways and sidewalks shall comply with applicable specifications and plans on file in the department of public works. Copies of these specifications and plans shall be furnished to each applicant upon making a request. 13. Driveway approaches shall be constructed or repaired according to the provisions of this chapter and applicable specifications and plans on file in the Department of Public Works. Copies of these specifications and plans shall be furnished to each applicant upon making a request. 14. Upon completion of the work, the applicant shall immediately remove all equipment and materials and shall leave the work area in a clean, safe and sanitary condition satisfactory to the director. 15. All restoration and repair work of the pavement, shoulders and any other county facilities shall be guaranteed by the applicant against any defects for a period of one year from the date of final inspection. 16. No work within the County right-of-way shall be done on Saturdays, Sundays and holidays anytime without prior approval from the Department of Public Works. Work on normal working days shall be limited between the hours of 7:00 a.m. to 3:30 p.m. County of Hawai‘i is an Equal Opportunity Provider and Employer Rev. 4/09/15 County of Hawaii DEPARTMENT OF PUBLIC WORKS – ENGINEERING DIVISION Permit to Work within the County Right-of-Way INSTRUCTIONS TO THE APPLICANT 1. The Applicant shall provide three (3) sets of plans to the Department of Public Works. The plans shall include the dimensions of work relative to the road and property lines, type of asphalt or concrete pavement, swales (or other drainage devices) and any other relevant information. 2. All work shall be in accordance with Chapter 22 – County Streets, of the Hawaii County Code, and as shown on the approved plans. 3. As required, all work shall be performed by a licensed contractor. The contractor may sign the permit application on behalf of the permittee/owner. 4. If required, the Applicant shall provide a copy of DCAB’s “Document Review” confirmation letter with the application. A copy of DCAB’s form and associated fee schedule can be found at http://health.hawaii.gov/dcab/files/2013/01/HRS-103-50-Transmittal-Form-Dec-2012.pdf. 5. If not already on file with the Department of Public Works, the contractor shall provide a certificate of insurance specifically naming as an additionally insured, the County, its officers, representatives, employees, and agents as required by Hawaii County Code. 6. The issued permit will become null and void if the authorized work is not completed within one (1) year of the issuance date. 7. If you are closing a road, at least two (2) weeks before the scheduled closure, complete an application form and drop it off at the Police Department’s Traffic Services. (Application Forms are available from Traffic Services 961-2227 or 961-2226). Attach a map of the area to the application. The Police Department will route the application through all applicable County agencies for approval. County of Hawai‘i is an Equal Opportunity Provider and Employer R/W COUN'IY RIGHT-or-WAYI SHOULDER RO>DNAY SURFACE SHOULDER :~·L_ PRIVATE UTIUIY SHAU. BE LOCATED AS CLOSE TO RIGHT-Qf'-WA\' BOUNOAAY AS POSSIBLE. PRIVATE UTIUIY SHAU. BE BURIED ur Mitt WHERE IT CROSSES PRIVATE DRIVEWAYS AND COUNIY RCW>WA'YS. S£E ROAD PAVEMENT ANO SHOULDER RESTORATION DETAILS. lYPICAL ROADWAY SECTION NOT TO SCALE SAW CUT BOTH SIDES & APPLY TACK C04T 1S' MIN. Q' MIN. MIN. I= TRENCH WIDTH MIN. ..::!::It,-.-BACKFIU MATERIAL SHAU. BE IN CONFORMANCE WITH STD. SPECS. f'OR PUBLIC WORKS CONSTRUCTION,Oi\TEO SEPT. 1986. ROAD/DRIVEWAY ·RESTORATION DETAIL NOT TO SCALE NOTES: 1. WHERE EXISTING RESIDENTIAL DRIVEWAY IS CON~ 4• THICK Cl.ASS •If CONCRETE REINFORCED WITH 6x6-10/IO WWI.I ON 4 BASE COURSE SHAl.l BE USED IN LIEU Of' THE ABOYE SECTIOf.I. 2. WHERE N4 DCISTINC DRIVEWAY IS UNPAVED, THE DRIVEWAY SHALL BE RESTORED 10 A CONDITION EQUAL TO OR BETTER THAN THE EXISTING DRIVEWAY. J. CONTRACTOR SHALL NOTIFY THE OWNER Of' JHE DRIVEWAY 48 HOURS BEFORE THE COMMENCEMENT Of' N4Y WORK. 4. AREAS WITH PAVEMENT I GEOTEXTll.£ f'ABRIC SHALL BE RESTORED AS DIRECTED BY THE DEPAl'lTl.IENT Of' PUBLIC WORKS. _.J I 111" MIN. r' MIN. SHOULDER RESTORATION DETAIL NOT TO SCALE •NOTE: f'OR PAVED OR OTHER IMPROYED SHOUL.D£R_...!URf'ACE SHALL BE RESTORED TD A CONDITION EQUAL TD OR Bt.11 t.R THAN THE EXISTINC SHQULOERS, AS DIRECTED BY THE DEPARTMENT Of' PUBLIC WORKS. ,2 Min.** -.t- Q) 0 z E_ ::I 0 E+:i ·­c:x Q) 0 "O :::E ·­en -~ ~-- "O • E §en ::I E -o~ · ­Q) ..0c ..0 ,_ ·­,_ ::I:::E ::I 0 - o I 0 '-c I") 0 0 LL. c en -Q) ~ a:: ... . ,. .. .·: . •• •• 11 , . . ..-. ·. ·. .. .... .. . . .. .:-> Ol Property Line NOTES: 1. 2. 3. 4. 5. NO OBJECT WITH A HEIGHT BETWEEN THREE FEET (3-FEET) AND EIGHT FEET (8-FEET) ABOVE THE NEAREST SURFACE OF THE COUNTY STREET SHALL BE ALLOWED IN THE SHADED AREA. ~ a.. I--.-----'i----~,- PRIVATE DRIVEWAY 1 I I 1s· . / / / / ,. // / //' ... / / / / / ; . / ..· /// . ; '._ / / / / Min. / / / SEE/N011:." 1/ / /---+--J / / . / / / .. / / ----11­/ / / ,/ .·'' / / / / / ,./ // / ; / / / / // / , .'/ _/ /' .-" ,.. ~ ,./ / ,. / /' , / E :::i­.s~ x c 0 Q) :::E :12 For non-curbed areas, driveway conform with standard detail 0-35 depending on the conditions fronting the property. No driveway approach shall Municipal facilities or other Culverts, swales and other No driveway approach shall proper runoff of surface waters of waters through existing swales, ditches, watercourses, depressions. When in the driveway approach, the proper waters and other waters require of a drainage structure other such drainage structure shall an engineer and subject to the the director. · Distances shall conform to of the Hawaii County Code. Ref. Sec. 22.2 Intersection apron shall 0-33, 0-34 or existing drainage interfere with street structures. drainage improvements. interfere with the into, or passage drainage culverts, defiles, or construction of a runoff of surface the construction than a swale, be designed by approval of Section 22-4.9 Sight Distance Edge of Pavement 30' See Note 41---..:::..:::.----1-.w-­ lS c.,..., ..,~,..c:.:c.\ 36' Maximum 2' Min.** (Residential) NON-CURBED STREET 1­w w !=!= (/) 0 w CD a:: ::> (..) ** No minimum if frontage is less than 20 feet. STANDARD . DRIVEWAY LAYOUT R-38COUNTY OF HAWAII DETAILS REVISED SCALE: NOT TO SCALE FEBRUARY 2003 A<.;Uf(LJ~ ~J::.K I lrll,,1-\. It: Ut" LIJ-\tjlLI I T IN~Ut(J-\Nl,,t: ~ 09/11.10·6 .PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVI! BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TliE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTliER DOCUMENT WITH RESPECT TO WHICH TlilS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUIS.IECT TO AllTHE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CV.IMS. TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY A X X ·COMMERCIAL GENERAL LIABILllY CGLS 4. ·j Cl.AIMS MADE [Kl OCCUR 1---+-~ A ----------- GEN'l AGGREGATE LIMIT APPLIES PER: ilPOLICY n ~~8i .n LOC AUTOMOBILE LIABILITY-X ANYAUTO-ALL OWNED AUTOS -SCHEDULED AUTOS -X HIRED AUTOS X NON-OWNED AUTOS - GARAGE LIABILITY ~ANY AUTO EXCESS/UMBRELL.A LIABILITY =:J OCCUR D Cl.AIMS MADE I DEDUCTIBLE I RETENTION s WORKERS COMPENSATION AND B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes. describe under SPECIAL PROVISIONS below OTHER ~ .. ' CBA S3.6· FWC ·713· 06/01/06 06/01/06 12/01/05 EACH OCCURRENCE S 1, 000 1 000 06/01/07 PREMiSesfi;........~"r::na.1 s100,ooo MEO EXP (~one person) S 5 , 0 0 0 PERSONAL&ADVINJURY S 1,000, 000 GENERAL AGGREGATE s2,000,000 PRODUCTS ·COMP/OP AGG $ 2 1 0 0 0 1 0 0 0 COMBINED S1NGLE LIMIT s06/01/07 (Ea accident) BOOIL Y INJURY s1,000,000(Per person) BOOIL Y INJURY s 1, 000, 000(Per accident) PROPERTY DAMAGE s1,ooo,ooo(Per accident) AUTO ONLY· EA ACCIDENT s OTHER THAN EAACC s AUTO ONLY: AGG s EACH OCCURRENCE s AGGREGATE s s s s· x hoRY"'L1Mlf's I IUER" 12/01/06 E.L EACH ACCIDENT sS00,000 E.L. DISEASE· EA EMPLOYEE ssoo,ooo E.L DISEASE· POLICY LIMIT ssoo,ooo DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The County of Hawaii, its officers, representatives, employees and agents are named as additional insured in accordance with the General Liability policy provisions, cov~ring any claim or liability for damages,. injur.ies or death resulting from any of .the uses permitted hereunder ~:: :=~:: ;::::::~:... -· .......... .. . .-· ...­·-.. • • , ••-.... _ .. _ •• t. : • : ~-~ .-:-~-~ :· :··-:·--t~·: t INSURERS AFFORDING COVERAGE NAIC# INSURED -INSURER A:. 41 INSURERB: INSURERC: INSURERO: 7· --_-.·~:· ••.·~ INSURERE: _,_-, ACORD 25 (2001/08) ©ACORD CORPORATION 1988 CERTIFICATE HOLDER CANCELLATION County of Hawaii Dept. of Public Works Engineering Division 101 Pauahi st Ste 7 Hilo HI 96720 :,"". -;·= • ·-,C,OUD;tL. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION -: • :~ )•: ... : ": •: •: ··: •-:·· DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN 00 0 0 ·.,·~: .: ~·-· • ': " ' NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL ~~~~It~~!~~:~:~~ • :::::::TIONOR ~UTY OF ANY ~ND UPON THE ~SUR~ rrs AGENTS OR ~.: • > :_;>>!·°!~: .;.:1-,..-UTH=---0-0~=----~---~~------T....A-~......,=-.---------------------1 ··-. --....-. ....... ... ... ~ • -. • ec . .a • - • County of Hawaii is an Equal Opportunity Provider and Employer