CITY OF RICHMOND 450 Civic Center Plaza, 2* Floor
Engineering & Capital Improvement Projects Department P.O. Box 4046 Office: (510) 307-8091 Richmond, CA 94804
Biol www.ci.richmond.ca.us
Fax: (510) 307-8116
[email protected]
ENCROACHMENT APPLICATION FORM
Submittal Data: Staff: S:12 Assigned Permit Number (CRW): EI20 - 00583 Trivers BY OLUNER
Applicant Nathan Contractor/Sub-Contractor:
• Property Owner I Contractor Ulity Company It athor *Contractor Licenso No.:
Contact Name: Nathan Trivers Contact Name:
Addross: 2W Rich mond Ave Address:
Rich mona CA 1480(
phono 916)640 6239 cat. Coll: _
Phone:
Emal: [email protected] Email:
Job/Reference Number: _ *Richmond Business License No: _ Scope of Work: Ploase check if sewer is in Front, Rear or Side of Yard) O Patio - Parklet at 2W.RKHMOND
AVE, RICHMOND, CA 94801 IF YES, LOCATION
Est. Start Date: _ #of Days Working in R-O-W: _
• Encroschument Permit: Street Cut Prohibition: Yes D / No • (See General Conditions) • Sower Lateral (Sewer District: Richmond West County Stage) 1. Is the prolect within the Marina Bay Area: Yes / No O: If yes, • Right of Entry (monitoring wells, pavament coring) 2. Is the project within the Deed Restricted Aroas: Yee O / No : If yea,
3. Additional requirements may apply. (See General Conditions) EL Facility Placement flatri bed, POD, torporary funca) Blesse draw below or stinch a site pian for the proposed word:
• Concrete: (eidewalk, drivoway approach, curt/gutter)
• Plumbing: (Cleanout/2-Way Back Flow Prevonter) FEE WAVED 21192020
(FOR STAFF USE ONLY) NOTE ON FINAL PERMIT
• Treffic Control Plane/Construction Plans Review:
i of Hours: _x $253/hr. PERMIT VALID FOR ONE
YEAR DUE TO COVID-19
#of Days:_ PANDEMIC CONPITIONS
• Werenty Bond: (required for etreat cul) $500
TOTAL: 1|1/2020
Any Contractor found in violation of working w/o a valid permit, will be assessed a double foe of the IOTAL cost of the job.
NO EXCEPTIONS WILL BE GRANTED.
Updated 07/18/2019 BEFORE YOU DIG - CALL USA @ 1-811/800-227-2600 No Fees and Permit
extended until 12|31 21
Due iana-14. Approvedy Yader Benudet.
GENERAL CONDITIONS
Street Cul Prohibition: Additional requirements may apply for Probbition Streets. If proposed wurk involved street excavation, the Applicant must check and indicate if the excavation is within any Prohibition Street A list of current Prohibition Streets is available on our website at wwww.cachmond causandex aspx?NID=2534 Manna Bay Deed Restricted Areas Additional requirements may apply for work conducied within the nine (9) Marina Bay Deed Restricted 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 restacted area condition of complance (e.g. Notification of DTSC) 9 areas is available of
www.cirichmond.ca.us/index.aspx?NID-27528ART=75718ADMIN=1 Werk shall be done in accordance with the City of Richmond Standard Plans and specifications.
This Permit, or a complete copy, shall be kept at the work site al all times white work is being performed Tha Permittee shall repair or roplace at the discretion of the City Engineer, any and all public facilities damaged as a result 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 penod of one year after completion of said work. For concrete and utility trench Norks, see Standard Specifications for Concrete Work and Standard Specification for Utility Trench.
Permittee shall comply with all Federal, State and Local laws, regulations and statutes applicable to the work being performed under this permit This also includes compliance with the requirements and permit conditions of the State of Califomia, Division of Industnal Safety.
No larkand HES SE
8. Traffic and pedestran access control must be in place prior to start of wotk. No traffic cones are to be left overnight. Barricades 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 limes. Complete street closures must be approved by the City
10. The Permittee shall not work on Saturdays, Sundays, City of Richmond holidays nor belween the hours of 5,00 p.m. and 8.00 a.m. without the witten permission of the City Department Head/Engineer. 11 Driveways (business, apartments, homes, side streets) must not be closed but are lo have access al all times. 13 in the event of an emergency excavation work, the Applicant shall notfy the City of Richmond and apply for a street cut permit for emergency work' within four (4) hours after the City of Richmond's office opens. 14 All excavation shali be backfilted and paved either temporanly or permanently at the end of each work day of covered with steel Iraffic plates held securely in place and flush mounted with a non-skip surface.
15. Use and install Best Management Practices (BMP) fo comply with the City of Richmond Stormwater Management Discharge ant 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 swap all streets daily. 16 Report all utility tine breaks to the appropriate utilly company immediately and notify the City of Richmond Engineering & Capital Improvement Projects Department at (510) 307-8091.
17 The Applicant shali designate in wating before starting work, an authorized English speaking representative who shall have the 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 wall be considered as fadure on the part of the Applicant to provide adequate supervision and work will be suspended until a representative is present.
15. Construction activity shall be conducted in such a manner that the maximum sound levels at affected properties shall not exceed per Municipal Code Chapters 9.52 - Community Noise Ordinance and 15 04.840 - Performance Standards
19. All utlity markings and construction signs shall be removed upon completion of the project Spectal conditions may apply afier the antal review of the application and will be marked with i Applicant Shall review and acknowledgo each spectal condition by mitial next to each & before Signing below Door hanger nolices shall be distbuted no sooner than 72 hours and no later than 24 hours prior to the start of work.
Additional requirements apply for recently improved street See attached Special Conditions for Street Excavations 3 Oblain permit from Richmond Fire Department. Call (510) 307-8031 Approval from County Health Department must be obtained prior to starting work. Call (925) 646-5225.
Comply with California Public Utilities Commission General Order 95 and General Order 123.
CCCCCOO Contact West Counly Sewer District (WCSD) lor line location and provide copy of their permit at (510) 222-6/00 Contact Stege Sanitary District for line location and provide copy of their permil at (510) 524-4668
8. Provide AC Transit with information for te-route. Call (510) 891-1839 or (510) 891-1734
9. Install two way cleanout/ backflow prevention valvel overflow device per City of Richmond Sewer Lateral Complance Plan RMC 12 17.040
10. Prior to start of work, the Permittee shall inform the property owner/occupant in woting, 72 hours in advance the detais (purpose, schedule, time and duration, contact person, etc) of work in the atea. broke condey that all fomatom proded the peteaten is tone and comple and lage toromply with to General Conditions and any applicable Special Conditions attached to the penand all information provided of this apphcation lom APPLICANT NAME (PRINT): Nathan. Trivers,
APPLICANT SIGNATURE: 2( DATE: 9/30/2020