Application Form To Perform Subsurface Work In The Public Right-Of-Way Page 2
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2SECTION D – GENERAL PROVISIONS
1.
Call the City of Newberg two (2) business days prior to the start of work.
2.
All work shall comply with all applicable provisions of Federal, State and local laws,
regulations, ordinances, and administrative rules.
3.
Oregon State Law requires that excavators notify all underground utilities
two
(1-800-332-2344)
(2) business days prior to the commencement of any underground excavation.
4.
Provide adequate erosion and sediment control measure at the job site.
5.
Traffic Control shall conform to the requirements of the latest edition of “Manual on Uniform
Traffic Control Devices”. Notify Police Dispatch
and School District – First Student
(503-538-8321)
Bus Services
if you propose and receive approval to close the streets.
(503-538-8365)
6.
Pavement cutting will not be allowed without prior written approval, which is given on a
case by case basis only. Open cut on roads newer than five years will not be allowed.
7.
Maintain work zone in a safe manner at all times. Open cuts of pavement within travel
lanes shall be patched with temporary cold mix or covered with steel plates and pinned, to
accommodate traffic overnight or until the required final hot patch is constructed.
8.
A copy of an approved permit and construction plans must be on the job at all times when
work is being performed.
9.
All trenching and pavement cuts shall be guaranteed against settlement for two years after
completion of work and the site fully restored to the original condition or better. Certified
compaction tests by the third party are required.
SECTION E – ACCEPTANCE OF THE TERMS, CONDITIONS AND PROVISIONS
The Applicant shall indemnify and hold harmless the City of Newberg, its Council, its officers and
employees from all suits and actions; or claims of any character brought because of any injuries
or damages received or sustained by any person, or property on account of the operations of
the said Applicant, his/her subcontractors or employees of either, or on account of, or in
consequence of any neglect in safeguarding the work; or because of any act or omission,
neglect or misconduct of the said Applicant. By signing below, the Applicant accepts and
approves all the terms, conditions, and provisions contained and attached hereto, including the
“SPECIAL PROVISIONS” under SECTION C, and the City’s adopted Design Standards. Permit for
construction will expire one (1) month from the Date of Issue unless the Applicant submits a
reasonable justification for a longer timeframe at the first application. A maximum of one year
may be granted upon request.
Applicant’s Signature:
Date:
Title (owner(s) / authorized agent):
SECTION F – CITY’S USE
Insurance Certification on File:
Submitted Herewith:
Attached Standard Drawings:
_____________________________________________________________
Permit Issued By:
Title:
Date of Issue:
********************************
***
WHEN APPROVED
***
*** AFFIX AGENCY STAMP ***
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0:\engineering\shared\templates\Developement Applications\Subsurface Utility ROW Permit_Application Form
Page 3
“Working Together For A Better Community – Serious About Service”
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