MCEO formRWP 04132020 Page 1 of 2
APPLICATION FOR PERMIT TO WORK WITHIN
COUNTY/TOWNSHIP ROAD RIGHT-OF-WAY LIMITS
OFFICE OF THE MIAMI COUNTY ENGINEER
2100 N. County Road 25-A, Troy, Ohio 45373
Telephone: (937) 440-5656 Fax: (937) 440-5659
Paul P. Huelskamp, PE, PS E-mail: MCEO@MiamiCountyOhio.gov
Miami County Engineer
APPLICANT NAME: DATE:
ADDRESS:
TELEPHONE:
PROJECT LOCATION: Road Name Township
Address or description of location:
TYPE OF INSTALLATION: Underground Overhead
INSTALLATION METHOD:
Open cut road crossing Work adjacent to roadway - within R/W limits
Boring or tunneling roadway Other describe under “SPECIAL CONDITIONS”
DESCRIPTION OF WORK:
Trench width Type utility or service
Depth of installation Type material installing
Type structures involved Amount/Quantity of work (ft./units)
PROJECT DURATION: Starting date: Completion date:
PERMIT VALID FOR DAYS. After indicated time period permit must be submitted for renewal or extension.
SPECIAL CONDITIONS, comments, or additional information:
I/We hereby agree to all terms, conditions, and restrictions as stated and apply to the work to be done under this permit. All future
responsibilities must be assumed by the applicant, his grantee, successors, and assignees.
SIGNED: Title:
Firm: Date:
PERMIT TO PERFORM WORK AS STATED ON THIS APPLICATION IS HEREBY GRANTED.
Date:
Paul P. Huelskamp, PE, PS County Engineer
* Please submit one (1) set of plans for proposed project with this Application.
TOWNSHIP TRUSTEES NOTIFICATION: Date: Approval Disapproval
Comments:
*This application, when signed by the Miami County Engineer, shall serve as a permit as authorized by the Board of Miami County Commissioner’s
Resolution No. 19-12-1717.
*This permit is also subject to the terms and conditions as listed on page two of this permit.
MCEO formRWP 04132020 Page 2 of 2
GENERAL PROVISIONS APPLICABLE TO PERMITS
You, as applicant and if this permit is approved, as permit holder, must notify the Miami County Engineer’s Office not less than 2 working days prior to
commencement of the work covered under this permit.
All work to be completed shall be under the supervision and to the satisfaction of the County Engineer or his designated representative (hereinafter referred to as
“the Engineer”). Any work found to be unacceptable to the Engineer shall be removed, or corrected, by you, the permit holder, at your sole expense. If such
unacceptable conditions are not corrected by you, as permit holder, the Engineer may correct, or cause to be corrected, such unacceptable conditions and you, as
permit holder, shall reimburse the Engineer for any and all expenses incurred.
Current Ohio Department of Transportation Construction and Material Specifications as well as Miami County’s requirements shall apply to all work performed
under this permit. In all matters pertaining to interpretation of specifications and disputes, the decision of the Engineer shall be final.
If, in the future, improvements or relocation of a County or Township road is deemed necessary, by the Engineer, it shall be the total, financial and otherwise,
responsibility of you, the permit holder, to repair, move, or relocate any and all items or conditions caused by or relating to your work within the County right-of-
way.
It shall be the responsibility of you, the permit holder, prior to the commencement of any work, to contact the owner(s) of any and all utilities and/or facilities within
the project area, and to coordinate your work with and around such utilities and facilities.
Maintenance of all facilities installed within the road right-of-way, under the provisions of this permit, shall be the perpetual responsibility of the applicant. The
applicant his grantees, successors, and assignees shall assume all future maintenance responsibilities of facilities or utilities installed as well as conditions created
or rising out of work performed.
Any changes in plans or installation procedures shall be submitted to the Engineer for review and approval prior to construction or continuing construction of the
work under this permit.
You, the permit holder, shall notify all affected property owners at least 48 hours prior to the commencement of work.
TRAFFIC AND SAFETY
Traffic shall be maintained, unless permission is granted by the Engineer to close the road. Requests for road closings must be submitted to the Engineer for
consideration not less than 48 hours prior to the desired closing time.
At all times during the progress of work, adequate protections shall be provided by you, the permit holder, for the protection of the traveling public. Such
protections shall include signs, barricades, lights and flagmen. All traffic controls shall be maintained in accordance with the Ohio Manual of Uniform Traffic
Control Devices.
HOLD HARMLESS
You, the permit holder, shall hold harmless, defend and indemnify the Board of Miami County Commissioners and the Miami County Engineer, its elected and
appointed officials, all employees and volunteers, all boards, commissions and/or authorities and board members, including employees and volunteers thereof
against all claims, suits, actions, costs, counsel fees, expenses, damages, judgments, or decrees, of every name and description, by reason of any person or
persons or property being damaged or injured by you, the permit holder, or any of your assigns, or any person employed by you, or any subcontractors, or in any
capacity during the progress or arising or growing out of the work; whether by negligence or otherwise.
Storage of any material, equipment, or other items within the road right-of-way is not permitted.
The permit holder further agrees to hold harmless, defend and indemnify Miami County, Ohio, its elected and appointed officials, all employees and volunteers, all
boards, commissions and/or authorities and board members, including employees and volunteers thereof against all claims, suits, actions, costs, counsel fees,
expenses, damages, judgments, or decrees, of every name and description, by reason of any person or persons or property being damaged or injured by Miami
County or any of its subcontractors, or any person employed by Miami County, or under any of its subcontractors, or in any capacity or arising or growing out of
facilities installed under this permit, or any similar permit, whether by negligence or otherwise.
RESTORATION
All areas disturbed or damaged by operations shall be restored to their original condition and the satisfaction of the Engineer.
Any drainage tiles, culverts, or other utilities or facilities encountered during the course of work under this permit shall be replaced or repaired to the satisfaction of
the utility or facility owner and the Engineer. Existing drainage, water, electrical, telecommunications and all other facilities shall be maintained during the course
of the work. Any liability or problems arising out of the cutting, blocking, or interference with any of these items shall be the sole responsibility of you, the permit
holder.
Upon completion of work associated with this permit, all rubbish, trash, and construction debris shall be removed and the roadway and right-of-way shall be
restored to a condition that is acceptable to the County Engineer. This shall include, but is not limited to: Backfilling, grading, raking, seeding and mulching. You,
the permit holder, shall be responsible for restoration of, in most cases, healthy, thick, growing grass in appropriate areas. Your responsibility does not end with
seeding.
ROADSIDE EXCAVATION
Any excavations made within the limits of the highway for conduits, drains, or other underground structures shall be properly backfilled with approved material. All
trenches and openings within 5 feet of the edge of the pavement must be backfilled with compacted, acceptable, granular material.
Buried cables shall be installed to a minimum of 30 inches. It shall be the permit holder’s responsibility to maintain the minimum 30" in perpetuity depth coverage
over the buried cable.
Special provisions apply to the installation of Fiber Optic Cable. Contact the Engineer’s Office for installation specifications
Backfilling and restoration shall follow completion of excavation, as closely as possible. At a minimum, each day’s excavation shall be backfilled to the current
excavation site and restored to an acceptable rough condition.
Roadside drainage shall be maintained at all times.
The pavement and berms must be kept clean of dirt, mud, and debris at all times. Excavated material shall not be piled or broadcast upon the road surface.
Material is to be loaded onto trucks as excavated for removal or reuse.
Operation of construction equipment from or on the roadway shall be prohibited unless approved by the Engineer
You, the permit holder, shall be responsible for any pavement and/or berm damage and/or failure or trench settlement occurring within twelve months of
completion of the project, if determined by the Engineer, to have resulted from your operations within the right-of-way.
OPEN CUT OF ROADWAYS
The pavement over open cut roadways shall be saw cut in a straight line parallel to, and 12 inches beyond, the edge of the trench. Any pavement or berm area
less than four (4) feet in width shall also be removed and replaced in its entirety.
Preferred backfill for areas under the pavement shall be Controlled Density Fill (CDF) material. Alternate materials may include No 57 stone, ODOT Item 411,
ODOT Item 617 or ODOT Item 304 (ODOT Item 703 Structural Backfill Type1, and Type 3) as approved by the Engineer. In the case of granular material, each
course shall be compacted by the use of mechanical compactors or alternate methods as approved by the Engineer.
Pavement and base materials shall be replaced “in kind” to include the type and depth of existing material. At a minimum pavement repairs shall consist of 12
inches of ODOT Item 304, 2 inches of ODOT Item 448 Type II, and 2 inches of ODOT Item 448 Type I.
You, as the permit holder, shall maintain a suitable temporary driving surface of gravel or bituminous material until final pavement restoration is completed.
You, the permit holder, at your sole expense, shall restore damages to roadway areas outside of the trench limits.
You as permit, holder, shall be responsible for any deficiency occurring in the restored pavement for a period of not less than 12 months following final completion
of the work under this permit.