DAT
E:___________________
PERMIT N
O.______________
1
RIGHT OF WAY MINOR CONSTRUCTION PERMIT APPLICATION
TITLE 35 T.R.O. Chapter 3,4 & 5; Title 11 T.R.O. Chapter 12
SIDEWALK/DRIVEWAY TEMPORARY USE OF STREET STREET/ALLEY CUT IRRIGATION
BORE OTHER EXCAVATION ACTIVITIES
GENERAL INFORMATION
PROJECT NAME_____________________________________________________________________________________________________________
PROJECT LOCATION _________________________________________________________________________________________________________
CONSTRUCTION CONTRACTORS INFORMATION
Name of Company ________________________________________________________________________________
CONTACT NAME AND TITLE __________________________________________________________________________________________________
ESCROW ACCOUNT NUMBER _________________________________________________________________________________________________
ADDRESS ___________________________________________CITY ____________________ STATE ____________ZIP _____________________
PHONE _______________________ FAX NUMBER ___________________ E-MAIL _______________________________________
IF PROJECT WILL HAVE SUBCONTRACTORS WORKING ON PROJECT LIST THE SUBCONTRACORS CONTACT INFORMATION:
NAMES:______________________________________________ Annual Contract No: (For each sub.) __________________________________________
LIST THE NAMES AND PHONE NUMBERS OF TWO PERSONS WHO CAN BE CONTACTED 24-HOURS A DAYS IN THE EVENT OF AN EMERGENCY.
__________________________________________________________________________________________________
PROJECT INFORMATION
Is this project being done in conjunction with any other City permit? (Yes or No, if yes what permit number) ________________________
• Will this project
involve cutting into a Street
or Alley? Yes No If yes, dimensions of proposed cut___________________________
ARTERIAL STREET NON ARTERIAL/ RESIDENTIAL ALLEY
• Will this project involve blocking tr
affic?
Yes No If yes, what street, how many lanes / days _______________________________
ARTERIAL STREET NON ARTERIAL/ RESIDENTIAL
• Will this project involve blocking parking meters?
Yes No If yes, list the number on the meters and state how long they will be
bloc
ked _______________________________________________________________________________________________________
PROJECT START DATE _________________________________________ PROJECT END DATE _______________________________________
• OWNER OF FACILITIES _______________________________________________________________________________________________________
• OWNERS ADDRESS _________________________________________________________________________________________________________
• Owners CONTACT NAME AND TITLE __________________________________________________________________________________________
ADDRESS _______________________________________________ CITY _________________ STATE______________ ZIP __________________
PHONE _________________________ FAX NUMBER_________________________ E-MAIL _____________________________________________
2
APPLICANT AGREES TO COMPLY WITH ALL PROVISIONS OF THE RIGHTS OF WAY OCCUPANCY
MANAGEMENT ORDINANCE,TITLE 11, CHAPTER 12, TITLE 35, TITLE 49, AND ALL OTHER APPLICABLE
CITY ORDINANCE.
CONTRACTOR'S AGREEMENT AS TO INSURANCE: In return for this permit, contractor agrees, in part, to provide
proof of general liability insurance in the amount required by law which names the City of Tulsa as an Additional
Insured and provides 30 days prior written notice of cancellation to the City.
APPLICANT IS REQUIRED TO CALL (918)596-2519 24 HOURS IN ADVANCE OF THE START OF
CONSTRUCTION TO INSURE THAT ALL PERMIT REQUIREMENTS HAVE BEEN MET AND TO REQUEST AN
INSPECTOR BE ASSIGNED TO THE PROJECT. ALL PAVING PROJECTS INCLUDING SIDEWALKS,
DRIVEWAYS, AND CURB CUTS MUST CALL FOR INSPECTION 24 HOURS IN ADVANCE OF CONCRETE
PLACEMENT.
S
IGNED BY: __________________________________________ DATE: _______________________________
TITLE: ______________________________________________________________________________________
_______ Contractor will “Pot Hole” all utilities after using OKIE Locate 1-800-522- 6543 in
Initial accordance with the Underground Facilities Damage Prevention Act 63OS-1991.
Additional information required to process this permit request include the following:
1.
The City shall be provided two (2) sets of drawings showing what construction is to be done and/or
where the proposed construction be located in the Right of Way. All streets should be labeled. All
boring projects will show location of proposed construction and other utilities that are
in the area
should be shown both vertically and horizontally. All facilities both existing and proposed shall be tied
to either a distance off of the centerline of the nearest road or the closest property line.
2.
Two (2) sets of traffic control plans, showing all barrels, cones, signs, etc. will be required for lane
closures. All streets should be labeled, the lanes clearly marked with the direction of traffic noted.
Distances between drums should be noted as well as distances between drums and advanced warning
signs.
3
.
Copies of Certificates of Insurance and bond information, that comply with Tulsa Revised
Ordinances Title 11, Chapter 12, Section 1211 Insurance and Title 35, must be submitted with
this application.
If the project is not an IDP, Gift Line, SSID, or if an approved Paving Cut Contractor is not used then
City of Tulsa’s Restoration Contractor shall restore all pavement.
The applicant shall establish an escrow account with the City to pay the Restoration Contractor upon
completion of the work and for all permit fees.
There may be additional information required and fees assessed after review of the Application
Email Address: ROWPERMITS@CityofTulsa.org