Revised 12-15-2020
RIGHT OF WAY PERMIT
PLEASE CHECK APPLICABLE PERMIT TYPE:
Excavation
Utility
Driveway
Sidewalk
Other
Full Street Cut
Half Street Cut
City assistance
will or
will not be required for
Temporary and/or
Permanent asphalt repairs
LOCATION MAP INCLUDED:
Yes
No
SITE INFORMATION
S
ITE
A
DDRESS
:
DISTANCE TO NEAREST INTERSECTING STREET:
Name of Nearest Street: FT.
UTILITY OWNER INFORMATION: EMAIL:
U
TILITY
C
OMPANY
: P
HONE
:
U
TILITY
C
ONTACT
N
AME
: P
HONE
:
A
DDRESS
(S
TREET
, C
ITY
, S
TATE
, Z
IP
):
CONTRACTOR INFORMATION: EMAIL:
C
ONTRACTOR
B
USINESS
N
AME
O
N
-S
ITE
C
ONTACT
N
AME
:
A
DDRESS
(S
TREET
, C
ITY
, S
TATE
, Z
IP
): O
N
-S
ITE
P
HONE
#:
DETAILED PROJECT DESCRIPTION (S
UBMITTAL OF
P
LANS AS REQUIRED
):
*C
OMPLETION
D
ATE
(*R
EQUIRED PRIOR TO APPROVAL OF APPLICATION
)
P
LEASE REVIEW
C
ITY OF
R
EPUBLIC
C
ONSTRUCTION
S
PECIFICATIONS FOR UTILITY AND INFRASTRUCTURE INSTALLATION PRIOR TO
PERFORMING WORK
. A
PPLICABLE AND APPROPRIATE TRAFFIC CONTROL MEASURES
,
AS PRESCRIBED BY
MUTCD
ARE THE
RESPONSIBILITY OF THE
A
PPLICANT
,
OR THE
C
ONTRACTOR
,
HOLDING THE
P
ERMIT
. P
RIOR TO ISSUANCE OF A PERMIT
,
A DEPOSIT
MAY BE REQUIRED
N
ONE
B
OND
C
HECK
. $
IS REQUIRED
.
P
ERMIT
F
EE
: $ M
AKE CHECK PAYABLE TO
C
ITY OF
R
EPUBLIC
. P
ERMIT
N
UMBER
D
ATE
:
S
IGNATURE OF
A
PPLICANT
D
ATE
:
S
IGNATURE OF
Right-of-Way Manager
P
ERMIT IS VOID SIX
(6)
MONTHS AFTER ISSUE
.
Please refer to General Provisions on backside of this sheet before signing application.
BUILDS Department
Public Works & Community Development
204 N. Main Avenue
Republic MO 65738
T: 417.732.3421 Email: rpresley@republicmo.com
click to sign
signature
click to edit
click to sign
signature
click to edit
Revised 12-15-2020
GENERAL PROVISIONS
Section 1. The signing of this application binds the applicant/contractor to the terms of this application, the permit when
issued, and the approved plans. If signed by Applicants contractor, or that contractors authorized representative, the
contractor will be held jointly responsible for all the requirements of this permit until released by the Public Works Director
or designated representative.
Section 2. Applicant shall protect plant materials on right of way, including trees and shrubs. Such materials and turf which
are disturbed will be restored to original condition. Trees and shrubs will not be trimmed, cut, moved, or sprayed without
specific permission from the Public Works Director or designated representative.
Section 3. Construction material and equipment may be stored on the right of way only during the period of actual
construction providing it is not on roadway shoulder, in the ditch, or blocking sight distance, entrances, sidewalk, hydrants,
meters, manholes or shut off valves.
Section 4. It is understood that in granting this permit, the City of Republic waives none of its power or rights to direct the
removal, relocation, and/or proper maintenance in the future of anything within the City right of way, at no cost to the City
of Republic.
Section 5. Applicant/Contractor will provide traffic control in accordance with the current Manual on Uniform Traffic Control
Devices (MUTCD) on all projects requiring the blocking or closure of shoulder or driving lane of roadway.
(a) In the event permitted project includes street closure Applicant/Contractor shall provide a map or drawing detailing
the placement of signage and detour routes. Said map or drawing shall be submitted at the time of application for
review.
(b) Applicant/Contractor will submit a Request for Street Closure application in advance of any and all road closures
within Republic city limits. Please be aware the approval process may take up to 10 days. The Applicant/Contractor
is responsible for informing the Police Department of any street closure at least 48 hours prior to the closure. This
information must include the street closure date, place, and anticipated duration.
(c) When permitted work is being performed in the right of way, but off of roadway or shoulder, Applicant/Contractor
shall have in place signs, cones, or strobe lights warning the public that workers are present. Workers should wear
safety vests, or safety colored shirts, for public safety.
Section 6. Applicant/Contractor will be expected to have knowledge as to the location of right of way, and/or easement lines
in which permitted activity is being performed. If deemed necessary, the Public Works Director or designated representative
may require the staking of said lines at the expense of Applicant/Contractor.
Section 7. Applicant/Contractor will construct the utility facility in such a manner that it may be accurately located both
horizontally and vertically after installation.
Section 8. Applicant/Contractor will contact the Missouri One Call System prior to all excavation. Applicant/Contractor will
be responsible for obtaining information as to the location of any other items which may be of significance to the project that
is not covered by the Missouri One Call System.
Section 9. Applicant/Contractor will contact the Right of Way Technician during the following applicable stages or
conditions:
(a) First day work is to begin.
(b) Before covering road bores.
(c) Before filling open road cuts.
(d) To report damage to City of Republic property or facilities.
(e) To discuss any modification to approved plans or terms of permit.
(f) When project is completed.
Section 10. The infrastructure construction, maintenance, and/or repair in public right of way shall be in accordance with
applicable health, safety, and construction codes.
Section 11. Prior to facilities work or infrastructure work in the public right of way, an Applicant may be required to establish
in the City's favor a Performance Bond in an amount determined by non-discriminatory regulations promulgated by the
Public Works Director or designated representative, as necessary, to ensure the Applicant's faithful performance of the
facilities and/or infrastructure work.
NOTE: The information contained above is an overview of basic permit requirements/procedures and is not to be used in
lieu of applicable codes. For online access to forms, applications, and codes log on to www.buildsrepublicmo.com and
open the E-Government section.