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Access Permit Application 1 (Commonwealth of Massachusetts)

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BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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MassDOT rev 04.11 Page 1 of 6
Application for Permit to Access State Highway
This Access Permit Application, including the attached Access Permit Submittal Checklist, must be completed in full by the Applicant.
Instructions for this page are located on page 2. Descriptions of the two types of access permits and related categories are located
on page 6. MassDOT will make the final determination regarding Access Permit Application type and category.
1. Town/City:
2. State Highway route number and/or name:
3. Locus/Property Address:
4. Description of property and/or facility for which access is sought (attach additional sheets if necessary):
5. Description of work to be performed within State Highway Layout (attach additional sheets if necessary):
Telecommunications (
wireless or wireline
) or Renewable Energy (
Solar, Wind, etc
) – Agreement Process and OREAD*
coordination required.
(
*
see pg 2 Instruction)
6. Dig Safe number:
7. Applicant Information ¹ (See footnote below.)
8. Property Owner
Name
Name
Mailing Address
Mailing address
Telephone
Telephone
Fax
Fax
E-Mail
E-Mail
Signature
Signature
Print Name
Print Name
Date
Date
Return completed application, including Submittal Checklist, to the District Highway Director for your town/city. Refer to reverse side for appropriate address
.
For office use only. Do not write below this line.
1. Application number:
6. Section 61 Finding date:
2. Date received:
7. Mass. Historic Action (yes or no):
3. Fee amount (non-refundable) :
8. Plans returned to DHD:
4. Completeness Pre-Review date: 9. Permit Type/Category:
5. MEPA required (yes or no):
10. Application complete date:
ENF-EOEEA Cert. #
11. Permit written date:
EIR-EOEEA Cert. #
1
2. Permit issued date:
Other-EOEEA Cert. #
13. Permit denied:
14. Permit Recording date at Registry of Deeds
¹
If an agent is representing an Applicant, the application must include a notarized letter from the Applicant outlining the specified duties and responsibilities
of the agent. Where work is proposed on a utility, the utility department must sign the application as the Applicant(s).
MassDOT rev 04.11 Page 2 of 6
Instructions for Completing
Application for Permit to Access State Highway
General Instructions
MassDOT’s Highway Division is granted authority to issue State
Highway Access
Permits by M.G.L. Chapter 81, Sec. 21. MassDOT
adopted 720 CMR 13.00 under the authority of M.G.L. c. 81,
§ 21 and M.G.L. c.85 §2. 720 CMR 13.00 supersedes the
Standard Operating Procedures for Review of State Highway
Access Permits dated November 30, 1971, and board vote of
September 17, 1991.
FEES:
A Check payable to MassDOT for the appropriate
permit application fee must accompany the permit
application. Fees are non-refundable.
Fee schedule for access and Utility Payments:
Residential Access Permits
ACCESS is generally defined, but not limited to:
Any physical work performed within the State Highway Layout.
5 Units or less
……………………………………
$25.00
From 6 to 49 Units
……………………………
$100.00
Greater than 49 Units
……………………….
$2000.00
This Application governs issuance of the two types of access
permit Applications, Non-Vehicular and Vehicular, which are
issued under three categories:
Non-Residential Access Permits
Less than 25,000 square feet
…………………
$500.00
From 25,000 to 300,000 square feet
…………
$1000.00
From 300,000 to 750,000 square feet
………
$2000.00
Category I
Minor Vehicle Access Permits
Greater than 750,000 square feet
……………
$3000.00
Category II
Major Vehicular Access Permits
Category III
Complex Vehicular Access Permits
Non-Municipal Utility Permits
not in conjunction
With Access Permits:
Please refer to the MassDOT Highway Access Permit Submittal
Checklist
for details regarding permit types
and submittals required.
Annual blanket utility permit
……………..…..
$500.00
Capital improvements to a utility
…………….
$500.00
Specific Instructions
(print or type)
Line 1:
Line 7:
List name of municipality in which access is sought.
Individual or business making application must complete
the required information, including application date and signature.
Line 2:
List name or number of State Highway Route(s) to which
access is sought.
Line 8:
Line 3:
Complete this section only if the individual or business
making application is other than the property owner of
the land for which the permit applies.
List Locus/Property address.
Line 4:
Describe property and/or facility. If access is sought under
Category II above, briefly describe facility for which access
is sought,
Return completed application, submittal checklist and
fee to appropriate District Office listed below. Please
contact the Permit Engineer at this address if
additional information is required.
Example 1:
Private single family residence at 100 State Road.
Approximate size of proposed building 2,500 s.f. Approximate lot
size 0.75 acres.
Example 2:
500,000 s.f. enclosed shopping mall adjacent to
State Route I-290 and Route 20. Approx. lot size 67 acres.
District One
District Four
270 Main Street
Lenox, MA 01240
Tel. (413) 637-5700
Fax. (413) 637-0309
519 Appleton Street
Arlington, MA 02174
Tel. (781) 641-8300
Fax. (781) 646-5115
Line 5:
Briefly describe the proposed work to be performed
within the State Highway Layout.
*Office of Real Estate and Development (OREAD)
District Two
District Five
Example 1:
Remove 50 feet of existing granite curb on south side of
highway in order to construct driveway access and modify the
roadway geometry to accommodate left-hand turn.
811 North King Street
Northampton, MA 01060
Tel. (413) 582-0599
Fax. (413) 582-0596
1000 County Street
Taunton, MA 02780
Tel. (508) 824-6633
Fax. (508) 880-6102
Example 2:
Excavate 10 foot x 10 foot section of roadway at
Station 100+00 in westbound lane in order to install water service
to residence at 100 State Street.
District Three
District Six
403 Belmont Street
Worcester, MA 01604
Tel. (508) 929-3800
Fax. (508) 799-9763
185 Kneeland Street
Boston, MA 02111
Tel. (857) 368-6100
Fax. (857) 368-0106
Line 6:
A Dig Safe number must be provided if the work will commence
within 30 days of the filing of the permit.
NOTE:
A Dig Safe
number must be obtained by calling
1-888-DIG-SAFE
(1-888-344-7233). If construction within the State
Highway Layout does not commence within the period
allowed by Dig Safe, a new number must be obtained
prior to beginning construction. (www.digsafe.com)
Highway Division Website:
www.massdot.state.ma.us/highway
MassDOT rev 04.11 Page 3 of 6
GREY:
DOT
USE
ONLY
Access Permit Submittal Checklist
This checklist provides the Applicant with a list of required submittals to obtain an Access Permit. However, additional sub
mittals may be
required to issue an Access Permit. All Applicants must fill out Part A and one additional part that correlates to the selected application
type. To help identify the application type, please see the descriptions on page 6. Check each box that pertains to your application.
MassDOT will make the final determination regarding Access Permit Application type and category.
PART A: ALL APPLICANTS MUST FILL OUT
1. APPLICATION TYPE – CHECK ONE
NON-VEHICULAR:
Non-Vehicular – Fill out Part B
VEHICULAR
Category I
– Minor Vehicle Access Permits: Fill out Part C-1
Category II
– Major Vehicle Access Permits: Fill out Part C-1 and Part C-II
Category III
– Complex Vehicle Access Permits: Fill out Part C-1 and Part C-III
2. APPLICATION TYPE
(Check all applicable boxes)
Application Complete
Permit corresponds to appropriate MassDOT District
Non-refundable check or money order on correct amount payable to:
MassDOT
Evidence certifying property owner(s) consent
Notarized Applicant Letter outlining agent’s duties and responsibilities (if applicable)
Utility department sign-off as the Applicant(s) (if applicable)
PART B: NON-VEHICULAR PERMITS
IF NO PHYSICAL MODIFICATION
to state highway layout
–
i.e. parade, road race, traffic counts, etc.
Required submittals:
Map of route
Traffic Management Plan (designed in accordance with the Road Flagger & Police Regulations: 701 CMR 7.00)
Detour Plan(s) with municipal approval (if applicable)
IF DRAINAGE:
If requesting connection or discharge to any MassDOT drainage system, contact
District Personnel for additional information regarding required submittals.
IF CONSTRUCTION, RELOCATION OR REPAIR OF UTILITIES:
Required submittals:
EXISTING PROJECT:
reference(s) to the documents and plans already filed with
MassDOT for the affected project
NEW PROJECT/UTILITY WORK:
Required submittals:
Engineered Plan(s) including method of crossing Highway
Traffic Management Plan (if applicable)
(Designed in accordance with the Road Flagger & Police Regulations: 701 CMR 7.00)
Detour Plan(s) with municipal approval (if applicable)
Tree Cutting or Landscaping Plan (if applicable)
Vegetative Plan including plant species and maturity size (if applicable)
Blasting Plan (contact District Personnel for additional information)
MassDOT rev 04.11 Page 4 of 6
GREY:
DOT
USE
ONLY
CATEGORY I – Minor Vehicular Access Permits
Required submittals:
Engineering Plans
ENF - (Environmental Notification Form) Certificate (if applicable)
IF RESIDENTIAL DRIVEWAY:
Detailed plan/sketch showing the drive location in relation to the property lines, MassDOT baselines,
distance from nearest mile marker, and an easily identifiable fixed object (distance from telephone poles,
mail boxes, other drives, etc.).
If severe topographic conditions exist, an engineered plan showing the driveway layout, profile and storm
water management may be necessary to show that the edge of the proposed drive is protected during and after
construction to prevent sediment and debris from entering upon the State Highway Layout (SHLO).
IF COMMERCIAL DRIVEWAY:
(where no MEPA review is required)
Required submittals:
Two (2) 40 scale plans that include:
A. Route Number, Road Name, Property Address
B. Property Corners and Bounds
C. Lot Line Dimensions, Bearings and Distances
D. State Highway Layout Lines (both sides) and Nearest Massachusetts Highway Bounds (if found).
E. State Highway Baseline and both edges of roadway including any sidewalks and type of edging, if any,
and shoulder information (grass, gravel etc.).
F. Any existing drive to be altered or closed shall be indicated. Existing and proposed dimensions should
be included for altered drives.
G. Information on all proposed drives including radii, widths, handicap ramps, etc. must be shown.
H. All existing and proposed buildings, utilities, trees, stonewalls, fences etc., should be labeled and
shown in their correct location.
I. It is required that all stands, buildings, gasoline pumps and structures of any kind be placed at least
12 feet back from the State Highway Layout Line, since conducting of business within a State
Highway Layout is forbidden.
J. Complete detail on drainage; all drives should be constructed on a downgrade from the edge of the
highway surface or shoulder to the State Highway Layout Line.
K. Engineered plans will be required to show that storm flows are not directed into the SHLO, using
contour lines, where applicant/owner property elevations are raised from the edge of the highway.
L. The plans should identify measures to protect the edge of the proposed drive during and after
construction to prevent sediment and debris from entering upon the SHLO.
IF NEW STREET / SUBDIVISION ROAD:
Minor Intersection and Roadway Reconstruction
(where no MEPA review is required)
Required submittals:
All Commercial Driveway requirements (above) apply in addition to the following: Evidence of acceptance, including
its line, grade and proposed drainage, by a local planning board, or other City of Town official with such authority.
A street/road profile from its nearest high point and plan of drainage.
Please be advised:
• It will be required that all such future street approaches be constructed on a downgrade, where possible,
from the edge of highway surface or shoulder to the State Highway Layout Line.
• Common driveway criteria may apply and must be shown on plans as mentioned above.
PART C-I: VEHICULAR PERMITS
MassDOT rev 04.11 Page 5 of 6
GREY:
DOT
USE
ONLY
CATEGORY II – Major Vehicular Access Permits
Required submittals:
Engineering Plans based on the standards in the Manual On Uniform Traffic Control Devices (MUTCD),
MassDOT’s Project Development & Design Guide or its successor, MassDOT’s Standard
Specifications for Highway and Bridges, and any current technical policies or engineering directives
Issued by MassDOT. All PS&E design submissions must be both in hard copy (one set) and electronic
format. Electronic format includes PDF files transmitted to DHD or designee via USB Flash Drive,
CD or posted to a FTP site.
In cases where a proposed access is to be shared by multiple development sites, the Applicant(s)
will provide evidence of the rights of access between the parties involved prior to the issuance of
the Access Permit.
MEPA Certificate
Section 61 Finding
PART C-III: VEHICULAR PERMITS
CATEGORY III – Complex Vehicular Permits
Required submittals:
Engineering Plans based on the standards in the Manual On Uniform Traffic Control Devices (MUTCD),
MassDOT’s Project Development & Design Guide or its successor, MassDOT’s Standard
Specifications for Highway and Bridges, and any current technical policies or engineering directives
Issued by MassDOT. All PS&E design submissions must be both in hard copy (one set) and electronic
format. Electronic format includes PDF files transmitted to DHD or designee via USB Flash Drive,
CD or posted to a FTP site.
In cases where a proposed access is to be shared by multiple development sites, the Applicant(s)
will provide evidence of the rights of access between the parties involved prior to the issuance of
the Access Permit.
MEPA Certificate
Section 61 Finding
PART C-II: VEHICULAR PERMITS
Recording of Access Permits
Applicants must record any Vehicular Access Permit and plans or any Non-Vehicular Access
Permit and plans involving drainage at the appropriate Registry of Deeds. Any Permit issued by
MassDOT that requires recording will not be effective until recorded at the appropriate Registry
of Deeds and a notice of recording is submitted to the District Highway Director (DHD). Changes
may require the re-recording of permits and related documents. In those cases, permits will not
be effective until re-recorded at the Registry of Deeds and a notice of recording is submitted to
the DHD.
MassDOT rev 04.11 Page 6 of 6
THERE ARE TWO TYPES OF ACCESS PERMIT APPLICATIONS:
VEHICULAR, ISSUED UNDER THREE CATEGORIES & NON-VEHICULAR:
1. VEHICULAR ACCESS PERMITS:
Category I – Minor Vehicular Access Permits:
Access Permits for Projects that require entry to the State Highway Layout (SHLO), require little to no non-signalized
modifications, and do not significantly alter the operating characteristics of traffic. These Projects ordinarily do not exceed the
Massachusetts Environmental Policy Act (MEPA) transportation thresholds beyond the filing of an Environmental Notification
Form (ENF).
Category II - Major Vehicular Access Permits:
Access Permits for Projects that require significant non-signalized modifications that may alter the operating characteristics of
traffic at residential or commercial driveway intersecting with the SHLO; that require significant non-signalized modifications that
may alter the operating characteristics of traffic at or upon any other intersection or roadway under the jurisdiction of MassDOT;
that require the installation of a new traffic signal at a residential or commercial driveway intersecting with the SHLO or at any
other intersection or roadway under the jurisdiction of MassDOT; or that require modification of structures, equipment, or
hardware at an existing traffic signal at a residential or commercial driveway and its intersection with the SHLO or at any other
intersection or roadway under the jurisdiction of MassDOT.
Category III – Complex Vehicular Permits
Access Permits for Complex Projects requiring actions similar to major Projects, but which require a new or altered SHLO; that
require significant non-signalized and/or signalized modification within the SHLO over an extended distance or at a number of
intersections that significantly alters the operating characteristics of traffic along a corridor; or that require the construction of a
new, or modifications to an existing, bridge. These Projects generally require MEPA review and may require Federal review.
2. NON-VEHICULAR ACCESS PERMITS:
Access Permits for Projects that require access to the SHLO that do not involve physical modifications such as a parade or road
race; construction, relocation or repair of utilities within the SHLO; tree cutting or landscaping within the SHLO; the use of
explosives to remove material from within 250 feet of the SHLO; or connection to or discharge to any MassDOT drainage system
(in cases where it can be shown that no practical alternative exists).
CONDITIONS REQUIRING AN ACCESS PERMIT
Vehicular Access Permits are required for:
• New residential or commercial driveways or streets intersecting the SHLO; or,
• Physical modifications to existing residential or commercial driveways or streets at their intersection with the SHLO; or,
• Change in use of an existing residential or commercial driveway onto SHLO that results in a
Substantial Increase in or
Impact on Traffic
(as defined below) over the current use; or
• Construction of new or change in use of existing, residential or commercial driveway from properties that abut the SHLO to
serve a building or facility, or expansion of a building or facility, that generates a Substantial Increase in or Impact on Traffic.
Substantial Increase in, or Impact on, Traffic as referenced above is defined as:
A Project that meets or exceeds any of the following thresholds:
(i) Generation of 2,000 or more new ADT on roadways providing access to a single location; or,
(ii) Generation of 1,000 or more new ADT on roadways providing access to a single location and construction of 150 or
more new parking spaces at a single location; or,
(iii) Construction of 300 or more new parking spaces at a single location; or
(iv) Creation of a change in the type, pattern, or timing of traffic that is determined by MassDOT to generate a significant
impact on traffic flow and safety.
Non-vehicular Access Permits are required for:
• Access to the SHLO for Projects that do not involve physical modifications; or
• Connection to or discharge to any MassDOT drainage system (in cases where it can be shown that no practical alternative
exists); or
• Construction, relocation or repair of utilities within the SHLO; or
• Tree cutting or landscaping within the SHLO; or
• The use of explosives to remove material from within 250 feet of the SHLO.
In cases where a particular Project or activity may seek both vehicular and non-vehicular access,
separate and distinct Permit Applications must be filed.
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Access Permit Application 1 (Commonwealth of Massachusetts)

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Completed 26 July 2020

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