Updated 04/04/2023 BEFORE YOU DIG – CALL USA @ 1-811/800-227-2600 Submittal Date: ____________________ Staff: ___________________ Assigned Permit Number (CRW): _______________________________
Applicant:
Property Owner Contractor Utility Company Other Contact Name:
Address:
Phone: Cell:
Email:
Job/Reference Number:
Contractor/Sub-Contractor:
Contractor License No.:
Contact Name:
Address:
Phone: Cell:
Email:
Richmond Business License No:
Scope of Work:
__________________________________________________________
STAFF USE ONLY
Encroachment Permit: $527
Sewer Lateral (Sewer District: Richmond West County Stege) Right of Entry (monitoring wells, pavement coring)
Facility Placement (debris box, temporary fence) $200 Concrete: (sidewalk, driveway approach, curb/gutter) $205 Plumbing: (Cleanout/2-Way Back Flow Preventer) $178
Traffic Control Plan Review:
# of Hours: x $266/hr. $
Design Plan Review:
# of Hours: x $266/hr. $
Major Encroachment: (additional days in ROW, in excess of 3) # of Days: x Inspector Hourly Rate: $176/hr. $ Warranty Bond: (required for street cut and for concrete work by a Licensed Concrete Contractor) $500
2% Credit Card Processing Fee $
TOTAL: $
Property Address: ________________________________________ Property Type for 4” Sewer Lateral:
Single Family Multi-Family (4 units or less)
Property Type for 6” Sewer Lateral:
Multi-Family (over 4 units) Commercial Industrial ( Refer to WRR)
Est. Start Date: # of Days Working in R-O-W : ________ Street Cut Prohibition: Yes / No (See General Conditions)
1. Is the project within the Marina Bay Area: Yes / No : If yes,
2. Is the project within the Deed Restricted Areas: Yes / No : If yes,
3. Additional requirements may apply. (See General Conditions) Please draw below or attach a site plan for the proposed work:
SITE PLAN FOR
PROPOSED WORK
CITY OF RICHMOND
Public Works Department
Encroachment Services Division
Office: (510) 307-8091
Apply Online using eTRAKiT
etrakit.ci.richmond.ca.us
ENCROACHMENT APPLICATION FORM
450 Civic Center Plaza, 2nd Floor
P.O. Box 4046
Richmond, CA 94804
www.ci.richmond.ca.us
[email protected]
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Updated 04/04/2023
GENERAL CONDITIONS
1. Street Cut Prohibition: Additional requirements may apply for Prohibition Streets. If proposed work involves street excavati on, the Applicant must check and indicate if the excavation is within any Prohibition Street. A list of current Prohibition Streets is available on our web site at www.ci.richmond.ca.us/index.aspx?NID=2534.
2. Marina Bay Deed Restricted Areas: Additional requirements may apply for work conducted within the nine (9) Marina Bay Deed Res tricted Areas. If proposed work is conducted within the boundaries of the deed restricted properties, Applicant is to check Deed Restriction and Operation and Maintenance Plan for specific deed restricted area condition of compliance (e.g. Notification of DTSC). A map showing the locat ions and boundaries of these 9 areas is available on our website at www.ci.richmond.ca.us/index.aspx?NID=2752&ART=7571&ADMIN=1.
3. Work shall be done in accordance with the City of Richmond Standard Plans and specifications.
4. This Permit, or a complete copy, shall be kept at the work site at all times while work is being performed.
5. The Permittee shall repair or replace at the discretion of the City Engineer, any and all public facilities damaged as a resu lt of Permittee’s actions in connection with this permit, and shall guarantee repairs or replacements to all work done under this permit, as deemed necessary by the City Engineer, for a period of one year after completion of said work. For concrete and utility trench Works, see Standard Specifications for Concrete Work and Standard Specification for Utility Trench.
6. Permittee shall comply with all Federal, State and Local laws, regulations and statutes applicable to the work being performe d under this permit. This also includes compliance with the requirements and permit conditions of the State of California, Division of Industrial Safety.
7. “No Parking” signs must be installed 24 hours in advance.
8. Traffic and pedestrian access control must be in place prior to start of work. No traffic cones are to be left overnight. Ba rricades with flashers are to be used. Traffic Control plan shall be in accordance with latest California Manual of Uniform Traffic Control Devices (CA MUTCD) and Pedestrian access plan shall be in accordance with the latest ADA requirements.
9. Traffic shall be permitted to pass through the work area at all times. Complete street closures must be approved by the City Department Head/ Engineer.
10. The Permittee shall not work on Saturdays, Sundays, City of Richmond holidays nor between the hours of 5:00 p.m. and 8:00 a. m. without the written permission of the applicable City Department Head/ City Engineer or their designee.
11. Driveways (business, apartments, homes, side streets) must not be closed but are to have access at all times.
12. Except in an emergency, street cut permits shall be obtained in advance for excavation work. An emergency is considered to exis t only when life or property is endangered or when an essential utility service is or may be interrupted during weekends, holidays, or between 5 p.m. and 8 a.m. of normal working days.
13. In the event of an emergency excavation work, the Applicant shall notify the City of Richmond and apply for a street cut per mit for “emergency work” within four (4) hours after the City of Richmond’s office opens.
14. All excavation shall be backfilled and paved either temporarily or permanently at the end of each work day or covered with s teel traffic plates held securely in place and flush mounted with a non-skip surface.
15. Use and install Best Management Practices (BMP) to comply with the City of Richmond Stormwater Management Discharge and Cont rol Ordinance.
Construction activities, including trenching and pavement repair work will be limited when rain is forecast within five days. Supply a recovery system for saw cut waste and sweep all streets daily.
16. Report all utility line breaks to the appropriate utility company immediately and notify the City of Richmond Engineering & Capital Improvement Projects Department at (510) 307-8091.
17. The Applicant shall designate in writing before starting work, an authorized English speaking representative who shall have t he authority to represent and act for the Applicant. Failure of the authorized representative to be present at the jobsite at all times when work is in progress will be considered as failure on the part of the Applicant to provide adequate supervision and work will be suspended until a representative is present.
18. Construction activity shall be conducted in such a manner that the maximum sound levels at affected properties shall not exc eed per Municipal Code Chapters 9.52 – Community Noise Ordinance and 15.04.840 – Performance Standards.
19. All utility markings and construction signs shall be removed upon completion of the project.
20. Traffic Control Plans and/or Design Plans must be submitted at least fifteen (15) business days prior to the construction sta rt date.
21. A minimum of 0.5 hour will be charged for Traffic Control Plans and/or Design Plans separately. Increments of 0.5 hour will be charged based on the Engineer’s time to review.
22. No POD container encroachment permits will be issued on the public right of way.
23. A $500 guarantee deposit fee is required for concrete work performed by a licensed concrete contractor.
SPECIAL CONDITIONS
Special conditions may apply after the initial review of the application and will be marked with 55. Applicant shall review and acknowledge each special condition by initial next to each 5 before signing below. ______ 1. Door hanger notices shall be distributed no sooner than 72 hours and no later than 24 hours prior to the start of work. ______ 2. Additional requirements apply for recently improved street. See attached “Special Conditions for Street Excavations in recently Improved Street”.
______ 3. Obtain permit from Richmond Fire Department. Call (510) 307-8031. ______ 4. Approval from County Health Department must be obtained prior to starting work. Call (925) 646-5225. ______ 5. Comply with California Public Utilities Commission General Order 95 and General Order 128. ______ 6. Contact West County Wastewater District (WCWD) for line location and provide copy of their permit at (510) 222-6700. ______ 7. Contact Stege Sanitary District for line location and provide copy of their permit at (510) 524-4668. ______ 8. Provide AC Transit with information for re-route. Call (510) 891-4839 or (510) 891-4734. ______ 9. Install two way cleanout/ backflow prevention valve/ overflow device per City of Richmond Sewer Lateral Compliance Plan RMC 12.17.040.
______10. Prior to start of work, the Permittee shall inform the property owner/occupant in writing, 72 hours in advance the details (purpose, schedule, time and duration, contact person, etc.) of work in the area. ______11. _____________________________________________________________________________________________________________ I hereby certify that all information provided in this application is true and complete and I agree to comply with the General Conditions and any applicable Special Conditions attached to the permit and all information provided of this application form.
APPLICANT NAME (PRINT): _______________________________________________________ APPLICANT SIGNATURE: _________________________________________________________ DATE: ___________________________ /BUIBO5SJWFST
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