Fillable Department of Public Works 375 W. Sahuarita Center (Town of Sahuarita)

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Department of Public Works 375 W. Sahuarita Center (Town of Sahuarita)

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BROWSE TOWN OF SAHUARITA (AZ) FORMS

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APPLICANT INFORMATION
Applicant:
Date:
Contact Name:
Address:
City:
State:
Phone:
Email:
CONTRACTOR INFORMATION
Contractor Name:
Contact Name:
Address:
City:
State:
Zip:
Phone: Email:
State License:
Expires:
Town Business License:
Expires:
PROJECT INFORMATION
Project Address:
Project Description of Work:
Is roadway eligible for open cut per Town Code 10.40.010?
YES NO
Emergency Contact Name:
Phone:
Email:
Estimated Start Date:
FEE SCHEDULE
Base Fee:
$200
Inspection Fee:
2.5% Cost of Construction or Minimum of $75/hour x hours
Haul Route: $150
Traffic Control Plan Check Fee: $10 per sheet
ROW Access Fee: $150
Wireless Communication Facility Plan Review: $200
Total Permit Fee:
PAYING BY APA ACCOUNT: YES NO
ACCOUNT #:
TOTAL FEE PAID:
Permit # Issued:
A copy of this permit shall
be maintained on the job
site at all times.
RIGHT-OF-WAY USE APPLICATION
Department of Public Works
375 W. Sahuarita Center Way
Sahuarita, AZ 85629
SahuaritaAZ.gov
P: (520)344-7100
Page 2 of 3
GENERAL INSTRUCTIONS
1. Along with the ROW Permit; Applicant shall provide a site location map, cost estimate and traffic
control plans (as necessary).
2. Cost of construction includes the cost of work in the public right-of-way (excluding cost of cable, pipe
and other items which may be functional for the utility) including but not limited to all trenching,
imported backfill material, placing and compacting backfill, concrete and pavement replacements.
AGREEMENT
Permission is hereby granted to the above named Applicant for use of the Town Right-of-Way as herein
described on this permit and all attachments, pursuant to the requirements of the Town of Sahuarita,
Ordinance No. 1997-09 and Resolution No. 1997-19, or current revisions thereto. Requirements identified
in the Right-of-Way General Notes shall be adhered to. The holder of this permit must at all times see that
all excavations, construction and/or other operations or improvements performed within the Town shall
confirm to the provisions of Town requirements pertaining to the type of activities herein included and
specifically with the following: adequate barricades with warning lights for dark hours must be provided at
all times around or adjacent to all excavations or hazards; sidewalks must be kept clear of all dirt and
construction debris. Applicant shall give written notice to any affected parties for any construction activities
that require restricting access to commercial or residential driveways.
The Applicant/Contractor shall give notice to the Town Public Works Department a minimum of 48
hours prior to the start of any construction. Public Works Office: 520-344-7100
The Applicant and/or Contractor, upon orders from the Town of Sahuarita, shall perform necessary
maintenance and assume all responsibility for the right-of-way repair described herein. The Applicant shall
save the Town of Sahuarita harmless from any and all claims brought against the Town resulting from or
involving the work herein described during the period between the date of starting this work and final
acceptance by the Town of Sahuarit.a. ROW shall be repaired to original or better condition at completion.
A Certificate of Liability Insurance must be included for the issuance of this permit.
AZ BlueStake (1-800-STAKE-IT) ticket numbers shall be provided, if applicable.
AZ Blue Stake Ticket No:
Approved by the Town of Sahuarita
THIS PERMIT SHALL EXPIRE IF THE WORK IS NOT COMPLETED BY:
Date:
By:
Date:
Applicant Signature:
Date:
RIGHT-OF-WAY USE APPLICATION
Department of Public Works
375 W. Sahuarita Center Way
Sahuarita, AZ 85629
SahuaritaAZ.gov
P: (520)344-7100
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Page 3 of 3
1.
Sign relocation/replacement plans shall be submitted for approval (when applicable). All removed/
replaced signs shall be replaced in accordance with any and all applicable Town standards and
specifications, AZ BlueStake Laws and shall be acceptable to the Town upon inspection.
2.
Striping may need to be replaced, on a case-by-case basis, if apparent damage occurs during any ROW
permitted activity. Striping or re-striping shall conform to any and all applicable Town standards and
specifications and be acceptable to the Town upon inspection.
3.
Roadway surface shall be cleaned of excess dirt and debris at the end of each workday.
4.
Use of Cold Patch must be approved prior to patching any trenches. Hot Mix Asphalt shall be immediately
placed upon completion of trenching.
5.
Testing results shall be forwarded to the ROW Manager, including but not limited to compaction tests.
6.
Applicant shall maintain work zone in conformance to the current edition of the MUTCD and approved
Traffic Control Plan. A copy of the approved traffic control plan(s) must be on-site at all times.
Changes/revisions to approved Traffic Control Plans must be submitted to the Public Works office for
review.
a.
Work Zone traffic control devices, including but not limited to signs, barricades, and cones, shall
periodically be checked, maintained and corrected as needed by Contractor during construction work
hours. All signs shall be set-up at the start of each day and removed or turned away from traffic at times
when operation does not warrant their use.
b.
All hazards shall be marked with Type II Barricades, with flashers. Additional precautions may be
required.
c.
When temporary roadways are required, they shall be expeditiously maintained for potholes or other
deterioration and maintained to prevent dust.
d.
A minimum of Twelve (12) foot wide traffic lanes shall be maintained at all times.
e.
All work personnel in or along roadway shall wear proper PPE for the activity being performed, at a
minimum, high visibility safety vests.
f.
After-Hours Emergency contact numbers and/or an “On-Call” representative(s) shall be provided.
8.
Expiration & Extensions. ROW Permit is valid for 30-Days, unless otherwise determined and approved. An
extension may be granted if described work has not been completed within the allotted time period. In
order for requests for extension to be considered, requests shall be received by the Town prior to permit
expiration date. Failure to request an extension prior to permit expiration date will result in denial of
request and require a new permit application, including applicable fees.
9.
Failure to abide by the above or any other stated requirements within this permit will result in:
a.
Denial of permit, revocation of permit, stop work order or other necessary action.
b.
Miscellaneous Permit Violations Fee = double amount of original permit fee (Town Code Title 3.10),
plus any and all applicable costs incurred by the Town in response to Item (8).
Additional Requirements:
ROW GENERAL NOTES
RIGHT-OF-WAY USE APPLICATION
Department of Public Works
375 W. Sahuarita Center Way
Sahuarita, AZ 85629
SahuaritaAZ.gov
P: (520)344-7100
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Department of Public Works 375 W. Sahuarita Center (Town of Sahuarita)

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Completed 16 July 2020

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