CONTRACTOR SHALL PROVIDE:
Contractor License Number and expiration date:
Contractor’s Insurance Company and Policy Number:
Amount of Insurance carried by Contractor:
Start Date:
CONTRACTOR MUST FOLLOW THE FOLLOWING PROCEDURE:
(1) Notification of Public Works Department of project start date.
(2) Notification of project inspection during construction.
(3) Notification of project completion date.
(4) Notification for Final inspection and approval.
(6) Provide set of as-built plans to the City at the completion of the project, if applicable.
(7) Excavators are required to locate and protect all existing underground utilities. You may be held liable for
damages. Call for utility locates before you dig. 811
TO BE COMPLETED BY STAFF
ADDITIONAL REQUIREMENTS
Additional Insurance Required by City in the amount of:
Bonding required by the City in the amount of:
Attach Construction Plans
Other:
No movement of vehicles or equipment across curb except at approved driveway opening
No storage of materials or equipment in the street
No operation of tracked vehicles or equipment within the street
Contractor responsible for keeping street clean at all times
If insurance is required, prior to starting any work in the right-of-way, you will need to provide the City of Veneta with
an insurance certificate naming the City as additional insured. Failure to provide insurance is cause to cancel this
permit.
APPROVED BY:
_______________________________ ________________
Public Works Superintendent Date
** THIS PERMIT IS NOT TRANSFERABLE **
S:\FORMS\PUBLIC WORKS\RIGHT-OF-WAY PERMIT CONSTRUCTION PERMIT.DOC
