200 S Hamilton Rd | Gahanna, OH 43230 | (614) 342-4005 p | (614) 342-4100 f
Updated: 12/18/2015
Address / Location of Work: ____________________________________________________________________
Plans detailing City utilities will be attached and returned with the approved application.
Description of Work to Be Performed: ____________________________________________________________
Request Lane Closure: Yes No Proposed Start Date: ________ Proposed End Date: _________
(mm/dd/yyyy) (mm/dd/yyyy)
All lanes on all City streets are to remain open at all times. If lane closures are necessary, call (614)
342-4005, at least, one business day before lane closure. Lane closures are limited to 9 AM to 3 PM,
Monday through Friday.
Pavement Cut Needed: Yes No Notes: _________________________________________________
Permit Application Submitted By (name): __________________________________________________________
Owner of Utility (name if applicable, otherwise leave blank): __________________________________________________
Contractor Performing Work (company name): ______________________________________________________
24-Hour Field Contact:
Name: _________________________________ Company: _________________________________
Email: ____________________________________________ Phone: ______________________
1. Along with this application, the contractor/applicant must submit one electronic copy illustrating the location of work. Permit applications
shall be submitted to Grant.Crawford@gahanna.gov.
2. All communications, including approved permits, will be sent by email. Work cannot begin until an approved permit has been issued.
3. Based on the scope of work, inspection fees may be assessed. The contractor/applicant will be notified of fees before permitting approval.
Fees must be paid in full before work can begin.
4. By state law, the contractor/applicant must contact the Ohio Utilities Protection Service, OUPS, at least, 48 hours but no more than 10
working days (excluding weekends and legal holidays) before beginning any digging by calling 8-1-1 or (800) 362-2764.
5. All pavement shall be maintained in a safe and passable condition during work. If lane closure is necessary, the contractor/applicant must
contact the Dept of Public Service at (614) 342-4005, at least, one business day before lane closures. It is the responsibility of the
contractor/applicant to provide traffic control devices and other safety measures as required by the Ohio Manual on Uniform Traffic Control
6. The ROW permit expires on the proposed end date unless otherwise noted. If the contractor/applicant needs an extension, they must contact
the Dept of Public Service at (614) 342-4005 before the proposed end date.
7. It is the responsibility of the contractor/applicant to restore all areas involved in this work to a like or better condition and must abide by the
rules and regulations of the City of Gahanna and the State of Ohio.
8. The contractor/applicant shall comply with all provisions of Gahanna Codified Ordinance Chapter 931 and any other applicable code.
9. The contractor/applicant hereby assumes all responsibility for work to be performed and indemnifies the City of Gahanna from any and all
liability that may arise, directly or indirectly, from their operations within the public right-of-way.
__________________________________________ ______________
Applicant Signature (or Authorized Representative) Date
__________________________________________ ______________
Approval Signature Approval Date
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