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Town of Snowmass Village Right of Way Work Permit

2. Permit No:__________________
   (Office Use only)

   (Office Use only)

4. Town of Snowmass Village Right of Way Work Permit
   Public Works Road Division P.O. Box 5010, 3745 Owl Creek Road Snowmass Village, CO 81615 Phone: 970-923-5110 Fax: 970-923-3794

   Public Works Road Division P.O. Box 5010, 3745 Owl Creek Road Snowmass Village, CO 81615 Phone: 970-923-5110 Fax: 970-923-3794

8. Instructions for Completion:
   This form is intended to be used as an electronic way to complete the information required for this permit only. Once the information has been entered into this form, additional documentation such as a diagram of work, will need to be submitted either by email or delivered to the Public Works office at 3745 Owl Creek Road. In addition to a diagram of work, a signed copy of this permit along with any fees (if applicable) may also be required once all information is submitted. Please follow up with the Public Works Department at 923-5110 after submittal of this form to ensure that application is complete. CALL BEFORE YOU DIG 1-800-922-1987

   This form is intended to be used as an electronic way to complete the information required for this permit only. Once the information has been entered into this form, additional documentation such as a diagram of work, will need to be submitted either by email or delivered to the Public Works office at 3745 Owl Creek Road. In addition to a diagram of work, a signed copy of this permit along with any fees (if applicable) may also be required once all information is submitted. Please follow up with the Public Works Department at 923-5110 after submittal of this form to ensure that application is complete. CALL BEFORE YOU DIG 1-800-922-1987

10. Section I: GENERAL INFORMATION:
    (Allow 7 business days for permit approval)

    (Allow 7 business days for permit approval)

12. Property Owner's Name

13. Contractor

15. Property Owner's Mailing Address

16. Contractor's Mailing Address

18. Owner's Phone No.

19. Contractor's Phone No.

21. Owner's Email Address

22. Contractor's Email Address

24. Contractor's License #

25. Emergency Phone No.

29. Section II: PROJECT INFORMATION:

31. Subdivision & Lot No.

33. Work Location/Physical Address

    Street address

35. Type of Work?

    1. Trencher
    2. Boring
    3. Open Cut

36. New or Repair Work?

    1. New
    2. Repair

38. Depth

39. Width

41. Purpose of Work?

    1. Water
    2. Sewer
    3. Gas
    4. Electric
    5. Phone
    6. CATV
    7. Other

43. If you selected Other, please describe

45. Project Start Date

46. Project End Date

47. Length of Project

49. SURFACE IMPROVEMENTS:
    Please provide the length x width in square feet for the appropriate improvement.

    Please provide the length x width in square feet for the appropriate improvement.

51. Asphalt Roadway

    ____ Long x _____wide (SF)

52. Gravel Roadway

    ____Long x ____wide (SF)

53. Concrete

    ____Long x ______wide (SF)

54. Driveway

    length of culvert

56. ATTACH COPIES OF THE FOLLOWING TO THIS DOCUMENT:

58. Traffic control plan

    1. Yes
    2. No

59. Landscaping plan

    1. Yes
    2. No

60. Insurance provided

    1. Yes
    2. No

61. Diagram/Site Plan of Work

    1. Yes
    2. No

63. Building Permit No.

64. Engineer's Name

66. Traffic Control Company

67. Phone No.

69. Traffic Control Supervisor

70. Phone No.

72. Development Plan Approval Date

74. Concrete or backfill and compaction methods for linear runs shall be tested by:

76. Engineer

77. Engineer Phone No.

78. Fax or Email

80. Test results shall be faxed or emailed to this agency within 24 hours, following construction work.

84. OFFICE USE ONLY:

86. Special Conditions Requirements:
    (Office Use Only. Permittee will be issued any special instructions below if necessary.)

    (Office Use Only. Permittee will be issued any special instructions below if necessary.)

94. Fee Structure
    (For office use only. Public Works to determine fees.)

    (For office use only. Public Works to determine fees.)

96. Right of Way Permit Fee:

97. $300.00

99. Access Permit Fee:

100. $100.00

102. Obstruction Permit Fee:

103. $100.00

105. Total Permit Fee:

106. $_________________

107. Paid Check #:_____________

109. Right of Way Security Deposit: $2,000 minimum deposit for 2 years.

111. Right of Way Security Deposit for shallow utility cuts of 30" or less in depth: $20.00 per sq. ft. of asphalt cut equal or greater than $2,000.00 minimum.

113. Right of Way Security Deposit for deep utility cuts of 30" or more in depth: $30.00 per sq. ft. of asphalt cut equal or greater than $2,000.00 minimum.

115. Total *Security Deposit: $______________

117. *Bonding equal to the cost of the work being completed can be used in place of security deposit.

119. *Return of Security Deposits is forfeited if not claimed after one year past the two-year warranty period.

123. Section III: Contractor Signature

125. In accepting this permit the undersigned, representing the Permittee, verifies that they have read and understands all of the foregoing provisions; that they have authority to sign for and bind the Permittee; and by virtue of their signature the Permittee is bound by and agrees to comply with all Town ordinances, standards and specifications regulating construction.

     In accepting this permit the undersigned, representing the Permittee, verifies that they have read and understands all of the foregoing provisions; that they have authority to sign for and bind the Permittee; and by virtue of their signature the Permittee is bound by and agrees to comply with all Town ordinances, standards and specifications regulating construction.

127. _________________________________________
     Contractor

     Contractor

128. ___________
     Date

     Date

130. __________________________________________
     Permit Approval By

     Permit Approval By

131. ___________
     Date

     Date

135. Inspected By:_____________________
     (For office use only)

     (For office use only)

136. Final Inspection By:_____________________
     (For office use only)

     (For office use only)

138. Security Deposit Released Date:___________
     (For office use only)

     (For office use only)

Leave This Blank:


140. 1. Receive an email copy of this form.
141. Email address

     This field is not part of the form submission.

142. Submit Submit and Print

* indicates a required field