Distribution:
PU Inspections Traffic Applicant DSC Civil Inspections Landscape Services PW Engineering Convention & Visitor Development
Revised: October 25, 2007
Page 2 of ___ Permit/DSC File #: ________________
CITY OF VIRGINIA BEACH
PERMIT FOR WORK WITHIN A PUBLIC RIGHT-OF-WAY
(Continued)
□ WILL BE PERFORMED BY ONLY THE PERMITTEE.
□ WILL BE PERFORMED BY A SUBCONTRACTOR AND/OR THE PERMITEE.
Subcontractor’s/Company Name: ______________________________________________
Business Address: __________________________________________________________
__________________________________________________________
Business Telephone #: _______________________________________________________
Supervisor/Contact’s Name: ____________________________Phone #: _______________
NOTICE
PROVISIONS APPLICABLE TO CONTRACTORS AND SUBCONTRACTORS
In accordance with City Code §33-63, the permittee shall provide written notice to any and all
adjacent private property owners prior to performing work in public rights-of-way that are
adjacent to private properties. Such notice shall include the following: 1) the full name of the
permittee; 2) the permit number; 3) when the work will be performed; 4) the name and telephone
number of the employee, agent, or representative of the permittee who is responsible for
supervising the work; and 5) the telephone number for the city’s permitting office. The written
notice shall be provided to the private property owner by a door hanger on the property owner’s
front door, which shall be placed on the door at least twenty-four (24) hours prior to permittee
commencing work, but no more than seven (7) days before such work is commenced. In the case of
an emergency in which the permittee is required to immediately commence repair work, the
permittee shall provide the written notice described herein, but the notice may be provided
contemporaneously with the commencement of the repair work.
As permittee, I acknowledge that I have read and understand the above notice requirements and
that I have completed all parts of this application truthfully and to the best of my knowledge.
Should any of the circumstances change regarding who will perform the work described on this
permit or the work to be performed, I will notify the Development Services Center (DSC) and/or
Permits and Inspections (P&I) immediately by written notice, which shall include an updated
SUBCONTRACTOR’S ATTACHMENT and/or other information as required by the DSC, P&I
and/or the City Code.
Permittee Signature Date
DSC Phone Number: (757) 385-8277 DSC FAX Number: (757) 385-5789
P&I Phone Number: (757) 385-4211 P&I FAX Number: (757) 385-5777
Web address for this form: http://www.vbgov.com/dsc (Select DSC Processes, then Subcontractor’s Attachment
under Right-Of-Way Permits)
