Fillable DRIVEWAY / CURBCUT / SIDEWALK PERMIT APPLICATION (CITY OF ROCKFORD)

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DRIVEWAY / CURBCUT / SIDEWALK PERMIT APPLICATION (CITY OF ROCKFORD)

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  • 6 check-boxes
  • 26 other fields

Country of origin: US
File type: PDF

U.S.A. forms for CITY OF ROCKFORD

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City of Rockford, Illinois
Public Works Department
Construction and Development Services
425 East State Street, Rockford, IL 61104
Phone: 779-348-7174 Fax: (815) 967-7058
Web: www.rockfordil.gov
DRIVEWAY / CURBCUT / SIDEWALK PERMIT APPLICATION
Project Details
PERMIT FEE : $45.00
Check all that apply: ☐ DRIVEWAY ☐ CURBCUT ☐ SIDEWALK ☐ APPROACH
Project Address:
Scope of Work:
Driveway is: ☐ NEW ☐EXISTING
Sidewalk Installed? ☐ YES ☐ NO
Length of New Sidewalk:
Impervious Surface Percent:
Existing Width at Street:
Proposed Width at Street:
Existing Width at ROW:
Proposed Width at ROW:
Property Owner Information
Name:
Phone:
Address:
City:
State:
Zip:
Contractor Information
Name:
Phone:
Email/
Fax:
Address:
City:
State:
Zip:
CONTRACTOR MUST HAVE PROOF OF INSURANCE AND BOND ON FILE WITH THE CITY OF ROCKFORD TO PERFORM
WORK WITHIN THE RIGHT-OF-WAY. PERMIT WILL NOT BE ISSUED UNTIL REQUIREMENTS ARE MET.
The above applicant requests permission to excavate and/or occupy the public right-of-way in the City of Rockford and agrees to indemnify,
hold harmless, and defend the City of Rockford, its officers, agents, and employees, from any and all claims resulting from injuries, including
death, damages or losses, including, but not limited to the general public, which may arise or which may be alleged to have arisen out of, or in
connection with such excavation and occupancy. I hereby agree to perform the work in accordance with the provisions, specifications and
requirements of all of the following:
Chapter 26, as revised, of the City of Rockford, Code of Ordinance and the current version of the City of Rockford Zoning Ordinance.
Traffic control shall always be provided by the applicant or contractor and will be in accordance with the Illinois Manual on Uniform Traffic
Control Devices for Streets and Highways, as revised. A traffic control plan and standard details may be required based on the Engineer’s or
designee’s discretion. 48 hour notice required for
closure.
Accessibility requirements shall be in accordance with the Illinois Accessibility Code and a current IDOT Standard shall be submitted with the
application when applicable.
Erosion & sediment control shall be in accordance with all requirements set forth in the current revision of the General NPDES Permit No.
ILR10. Stabilization measures must be initiated within seven (7) days after construction activities have temporarily or permanently ceased.
All other federal, state, and local requirements as they may apply.
(AUTHORIZED REPRESENTATIVE SIGNATURE) (AUTHORIZED REPRESENTATIVE PRINTED NAME)
FOR INTERNAL USE
ONLY
APPROVED BY: START DATE:
/ /
EXPIRES:
/ /
APPROVAL DATE:
/ /
PERMIT FEE: PERMIT #:
(PAY CODE -
10101000-61407)
Special Conditions:
Rev.
(12/14/2018)
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DRIVEWAY CURBCUT SIDEWALK PERMIT APPLICATION (CITY OF ROCKFORD)

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Completed 25 February 2021

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