Fillable PERSONAL NON- CONTRACTORS CAVATION PERMIT RIGHT-OF-WAY/EX When performing (City of La Grande, Oregon)

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PERSONAL NON- CONTRACTORS CAVATION PERMIT RIGHT-OF-WAY/EX When performing (City of La Grande, Oregon)

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PERSONAL
NON- CONTRACTORS
RIGHT-OF-WAY/EX
CAVATION PERMIT
NON-CONTRACTORS
RIGHT-OF-WAY EXCAVATION PERMIT
Date Issued:
Applicant’s Name:
Mailing Address: Phone Number:
Location of Work:
Beginning Date: Ending Date:
When performing work within any public right-of-way within the City of La Grande, and when any of the following apply, an
Excavation/Right-of-Way permit is required.
Excavation in any street, alley or planting strip.
Closure of street, alley or sidewalk, all or part of.
De tour of traffic
Block more than 9-feet of street adjacent to the curb.
Block sidewalk for more than one hour.
Other ________________________________________________________________________________________
DESCRIBE WORK TO BE PERFORMED: ______________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
SURFACE TYPE: Unimproved Gravel Paved Planting Strip
AGREEMENT OF APPLICANT’S IN THE EVENT OF ISSUANCE OF THIS PERMIT
Excavation
: No excavation in the public right-of-way within the city of La Grande shall be made prior to 48-hours from
the time of securing the permit. Repairs are to be made within a reasonable time. Permitee will restore or replace any
repairs in which defects appear during a period of one (1) year subsequent to the date of completion of such repairs.
Repairs to streets, sidewalks, planting strips, or alleys covered under this permit shall be done in accordance with the City
standards and to the satisfaction of the Engineering Division. The permittee shall place temporary surfacing on all cuts
within the driving lane until permanent repairs are in place and in cuts made after September 15
th
in any street until it is
permanently repaired.
Notification Information
: The following agencies must be notified for locate of utilities by permittee before excavation:
ONE CALL UTILITY NOTIFICATION 1-800-332-2344
It is the permittees responsibility to notify any of the utilities not notified by the One Call System.
Additionally
: the following should be notified when applicable (if you are closing all or a portion of any street): Police
(963-1017), Fire/Ambulance (963-3123) & Grande Ronde Transportation (963-6119).
ALL EMERGENCY SERVICE SHALL BE NOTIFIED PRIOR TO CLOSING AND
IMMEDIATELY AFTER OPENING OF ANY STREET OF ALLEY.
In the event, in the opinion of the City, by reason of weather conditions or the season of the year, or for any other reason,
the proposed activity will unusually damage the City right-of-way or seriously inconvenience the public in the use of the
right-of-way, the City shall have the right to delay issuance of the permit until the probability of such damage or
inconvenience has passed.
STREET CLOSURES/DETOURS/TRAFFIC CONTROL
: In the even that work within the public right-of-way requires the
closure of any part of said right-of-way, or detouring of pedestrians or motorists, the City will require the permittee to
provide approved signs and barricades, or any other traffic control as required, to provide protection for workers,
Page
1 of 2
PERSONAL
NON- CONTRACTORS
RIGHT-OF-WAY/EXCAVATION PERMIT
NON-CONTRACTORS
RIGHT-OF-WAY EXCAVATION PERMIT
Page 2 of 2
pedestrians, and motorists. Permittee will maintain required safety devices during all hours of closures or detours of
motorists and pedestrians. Additionally, the following should be notified when applicable: Post Office, U.P.S. and City
Garbage Service.
TO BE COMPLED BY THE ENGINEERING DIVISION
Proof of insurance is required. Contractors will provide proof of a valid residential contractors license or Builder’s Board
Number from the State of Oregon and fill out the appropriate “Contractor’s Right-of-Way/Excavation Permit.
A copy of a Home Owner’s Insurance Liability with a minimum of $500,000 shall be required. The Engineering Division,
depending on the type of work being done in the right-of-way may waive this minimum.
The Permittee agrees to protect and save harmless the City of La Grande and each of the officers and employees of said
City against any injury of damage that may result from the acts of said grantee on or in said right-of-way and against any
damage or liability of any character whatsoever arising or growing out of any act of said grantee due to the issuance of
this permit.
The applicant further agrees to perform the above work in accordance with all of the provisions of Ordinances, policies,
and resolutions of the City of La Grande pertaining to such work. Upon completion, please notify the Engineering
Division for a Final Inspection. All forms must be inspected for compliance to City standards before pouring any
concrete. Please allow 24-Hours for form inspections.
Applicant’s Signature: _______________________________________________________________________________
Certificate of Insurance $____________________________
APPROVED DENIED Issue Date: ____________________ Time: _________________
Comments: _______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Permit Issued by: ____________________________________________________
Permit Valid for __________ days after issuance.
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PERSONAL NON- CONTRACTORS CAVATION PERMIT RIGHT-OF-WAYEX When performing (City of La Grande, Oregon)

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Completed 2 June 2021

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