PERMIT #_________________
City of Council Bluffs, Iowa
Public Works Department
Engineering Division
Right Of Way Office
Office 712-328-4635
Location of Work Address: ____________________________________________________________________________________
Street, City, State, Zip
Property Owner Name: _______________________________________________________________________________________
Address: __________________________________________________________________________________________________
Property Owner’s Address if different than location of work address
Applicant Name: _____________________________________ Company Name: _______________________________________
Copy of Insurance on File with City Yes No (If No a copy must be placed on file prior to receiving a permit)
Applicant Address: ___________________________________________________________________________________________
Street, City, State, Zip
Phone #: (______) ______ - ________ Cell Phone #: (______) ______ - ________ Fax Phone #: (______) ______ - ________
Applicant E-mail address: ______________________________________
Applicant: (Select one) Property Owner Contractor Sub-Contractor Business
Application Date: ___/___/______ Proposed Work Start Date: ___/___/______ Completion Date: ___/___/______
Description of Work: _________________________________________________________________________________________
Indicate on attached drawing location of improvements
Check All That Apply:
Residential Driveway (New) Sidewalk (New) Sewer Connection (New) Commercial Driveway (New)
Residential Driveway (Repair) Sidewalk (Repair) Sewer Connection (Repair) Commercial Driveway (Repair)
Excavation in Street Excavation between Curb and Property Line Water Service Other
*Contractor is responsible for scheduling all required inspections and being present during the inspection process.
Applicant Signature:__________________________________________________
By signing this application, I hereby agree to abide by the terms of the Standard Permit Conditions and if applicable, any
Supplemental Permit Conditions, if a permit is issued.
Applicant Signature:_________________________________________________ Date ________________
Signature to Authorize Charge to Credit Card on file with the City Treasurer for this permit only
APPROVED by:_____________________________________________ Date ___/___/________
DISAPPROVED by:_____________________________________________ Date ___/___/________
Signature from the Right-of-Way Division or Engineering
(712) 890-5296
Standard Permit Conditions for
Construction Work in Public Right-of-Way
The applicant agrees that if granted a permit to perform work within the public right-of-way (ROW) as described in the
permit application form, the following stipulations or conditions shall govern.
1. The applicant must file the proper permit application form with the Public Works Building Division at 209 Pearl
Street, Council Bluffs, Iowa, 51503
2. All FEES must be paid upon obtaining a permit (see the attached schedule of fees) prior to commencing work.
3. All permits must be obtained prior to commencing construction work within the Public Right-of-Way (ROW).
In the case of emergency repairs please consult with the Public Works ROW department concerning the issuance
of the proper permits.
4. Individual issued permits will remain on file for 60 days from the approval date of the permit. If the work is not
begun during that time, the permit will become null and void with the exception of sites where the work is
phased. A new permit will have to be obtained at the time the work is to be done for permits that expire.
5. The applicant shall notify Iowa One Call at 1-800-292-8989 prior to any excavation for utility locates.
6. All insurance forms shall be current and on file with the City of Council Bluffs prior to a permit being issued and
commencement of work.
7. All construction work shall conform to the current edition and any revisions or amendments of the SUDAS
Specifications and the City of Council Bluffs Supplemental Specifications.
8. All surfacing shall be replaced to its original condition satisfactory to the Public Works Department. Grass
surfaces may be seeded and mulched or sodded.
9. The applicant shall assume all responsibilities for sediment and erosion control during the construction process.
10. Parks Department shall be notified immediately of any damage to tree trunk, limbs, or roots within the drip line
of any City tree.
11. The applicant agrees to provide all traffic control measures required. Said applicant shall furnish, erect and
maintain the necessary traffic control such as barricades, signs and flaggers as required. All traffic control shall
be in accordance with the “Manual on Uniform Traffic Control Devices for Streets and Highways” as adopted by
the Iowa Department of Transportation.
12. The applicant shall be responsible for notifying all appropriate departments such as Public Works Traffic
Division of any lane closures or street closures. This notification shall be a minimum of 48 hours in advance of
the closure.
13. The City ROW shall have a uniform cross slope with a maximum 2% slope from the property line to the back of
14. All sidewalks and sidewalk curb ramps shall meet the Americans with Disabilities Act (ADA) as identified in
Chapter 12 of the SUDAS manual.
15. The longitudinal slope of the sidewalk shall match the top of curb line or in the instance where there is no curb
the longitudinal slope shall match the apparent centerline of the roadway. Any pavement irregularities such as
dips, valley gutters, or potholes shall be ignored. The sidewalk cross slope shall be a maximum 2% with the
target cross slope being 1.50%. The sidewalk through the driveway shall meet these cross slope requirements
16. The applicant agrees to abide by Supplemental Conditions attached to the permit.
17. Applicant / Contractor shall be responsible for scheduling any required inspections. All inspections require 24
hours advanced notice. The applicant / contractor shall be present during the inspection to answer questions or
provide information as requested by the City inspector.
18. An inspection is required prior to the placement of concrete. Placing concrete without a prior inspection is at the
risk of the applicant / contractor and burden of proof to standards shall be theirs.
19. Sidewalk and driveway approaches require a final inspection that shall be scheduled with the applicant /
contractor present to respond to questions or provide information to the City inspector in order to close out the