Fillable RIGHT-OF-WAY/EASEMENT PERMIT APPLICATION (Brevard County Board of Commissioners)

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RIGHT-OF-WAY/EASEMENT PERMIT APPLICATION (Brevard County Board of Commissioners)

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BROWSE BREVARD COUNTY BOARD OF COMMISSIONERS (FL) FORMS

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Public Works Engineering
2725 Judge Fran Jamieson Way
Building A, Room 204
Viera, Florida 32940
RIGHT-OF-WAY/EASEMENT PERMIT APPLICATION
Commercial or Utility
Project Information
_________________ ________________________________ ___________________ ___________
Tax Account No. Site Address City Zip Code
Description of work to be done:
Property Owner / Utility Owner Information
_______________________________________________ ___________________________________
Owner or Company Name Contact Name
_____________________________________________________________ _________________
Street Address Apartment/Suite No.
____________________________________ ___________________ _________________
City State Zip Code
_______________________________________ ___________________________________________________
Phone Number Email address
Applicant Information, if other than Owner: Contractor Engineer
__________________________________________ ______________________ _________________
Applicant Name Contact Name License No.
__________________________________________________________________ _________________
Street Address Suite No.
____________________________________ ____________________ _________________
City State Zip Code
_______________________________________ _____________________________________________
Phone Number Email address
Page 2 of 4
Schedule of Fees
Required at the Time of Submittal
Type
Fee
Quantity
Total
Processing Fee
Projects over $200,000 (Certified Cost Estimate Required)
Storm Sewer Construction
Stormwater Discharge
Sidewalk Construction
Commercial Driveway (Temporary, per each connection)
Commercial Driveway (Permanent, per each connection)
Engineering Revision Review (Projects under$200,000.00)
Engineering Revision Review (Projects over $200,000.00)
Paved Road Open Cut, per each cut
Jack & Bore/Directional Bore, per each (all approved tunneling
methods)
Utility Open Pits including short side service connections
Roadway/Intersection improvements (turn lanes and signals, misc.
median work), in addition to commercial driveway
Right-of-Way utilization fee (underground/aerial)+linear footage
Provide linear footage for underground/aerial
Right-of-Way utilization fee OR Bus Shelter
Right-of-Way Environmental Analysis (Natural Resources)
Applicable fees (as required) per Resolution No. 16-189
GRAND TOTAL
For projects over $200,000, inspection fees are required prior to the issuance of the right-of-way easement
permit. The fees are calculated as follows and are cumulative until the estimated cost is reached:
Project Cost Tier
Of the first (up to) $500,000.00
Of the next $500,000.00
Of the amount over $1,000,000.00
$ 25.00
1
$ 25.00
$ 1,000.00
0
$ 0.00
$ 200.00
0
$ 0.00
$ 500.00
0
$ 0.00
$ 250.00
0
$ 0.00
$ 500.00
0
$ 0.00
$ 750.00
0
$ 0.00
$ 200.00
0
$ 0.00
$ 500.00
0
$ 0.00
$ 1,200.00
0
$ 0.00
$ 500.00
0
$ 0.00
$ 150.00
0
$ 0.00
$ 1,000.00
0
$ 0.00
$ 125.00
0
$ 0.00
$ 0.30
0
$ 0.00
$ 200.00
0
$ 0.00
$ 180.00
0
$ 0.00
0
$ 0.00
$ 25.00
Page 3 of 4
Checklist
for Required Information and Exhibits
BUS SHELTHER
To be accompanied by documents as required per BCC-72 & AO-66, to include Right-of-Way Use
Agreement
COMMERCIAL IMPROVEMENTS AND INCORPORATED SUBDIVISIONS
Proposed Maintenance of Traffic attached to or included in each set of plans
One signed and sealed detailed drawing depicting the location of the proposed improvements within
the right-of-way or easement drawn and dimensioned on a survey or plot plan by a Certified Surveyor
or Professional Engineer
One survey (signed and sealed)
Approved Concurrency Form from Brevard County Planning and Zoning Office
Owner’s Authorization to Act as Applicant Form (if application is not signed by the Owner and if
Owner desires for the County to correspond directly with the authorized representative)
If property has been annexed within the past three years, provide copy of Recorded Annexation
documents.
Stormwater Calculations (if discharging to County system\right-of-way)
1 hard copy signed and sealed
1 pdf signed and sealed
Traffic Impact Study or Analysis
1 hard copy signed and sealed
1 pdf signed and sealed
Page 4 of 4
STATEMENT OF ACCU
RACY
I hereby confirm that the above information is true and correct and I assume all responsibility for the truth
and validity of this application and associated exhibits submitted herewith.
The Property Owner shall be responsible for repair and maintenance of driveway materials including, but not
limited to, culvert/pipe and headwalls or mitered ends (if applicable) within the County right-of-way.
______________________________________ ____________
Property Owner/Applicant’s Signature Date
______________________________________
Print/Type Property Owner or Applicant Name
Office Use Only
____________ __________________ _________________ Concurrency: Y N
Date Received Fee Reviewed By
Send to: Engineering Road & Bridge Road & Bridge Construction Stormwater
Survey Traffic Operations Utilities/Water Resources
Land Acq Const. Insp. 1 Const. Insp. 2
Review Days: 15 8 Other: ____ Performance & Maintenance Bond required? Y N
Inspection fees due: Y N _______________________
Application/Permit#
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RIGHT-OF-WAYEASEMENT PERMIT APPLICATION (Brevard County Board of Commissioners)

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Completed 1 April 2021

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