Fillable STATE HIGHWAY ACCESS PERMIT APPLICATION (Colorado Department of Transportation)

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STATE HIGHWAY ACCESS PERMIT APPLICATION (Colorado Department of Transportation)

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COLORADO DEPARTMENT OF TRANSPORTATION
STATE HIGHWAY ACCESS PERMIT APPLICATION
Issuing authority application
acceptance date:
Page 1 of 2 CDOT Form #137 12/18
Previous editions are obsolete and may not be used
Instructions: - Contact the Colorado Department of Transportation (CDOT) or your local government to determine your issuing authority.
- Contact the issuing authority to determine what plans and other documents are required to be submitted with your application.
- Complete this form (some questions may not apply to you) and attach all necessary documents and Submit it to the issuing authority.
- Submit an application for each access affected.
- If you have any questions contact the issuing authority.
- For additional information see CDOT’s Access Management website at https://www.codot.gov/business/permits/accesspermits
2) Applicant or Agent for permittee (if different from property owner)
Street address
Phone #
Mailing address
City, state & zip Phone # (required)
county subdivision block lot section township range
6) What side of the highway?
q N q S q E q W
5) What State Highway are you requesting access from?
4) Legal description of property: If within jurisdictional limits of Municipality, city and/or County, which one?
3) Address of property to be served by permit (required)
City, state & zip
1) Property owner (Permittee)
8) What is the approximate date you intend to begin construction?
9) Check here if you are requesting a:
q new access q temporary access (duration anticipated: ) q improvement to existing access
q change in access use q removal of access q relocation of an existing access (provide detail)
7) How many feet is the proposed access from the nearest mile post?
_____________ feet (q N q S q E q W) from:_____________
13) Are there other existing or dedicated public streets, roads, highways or access easements bordering or within the property?
q no q yes, if yes - list them on your plans and indicate the proposed and existing access points.
12) Does the property owner own or have any interests in any adjacent property?
q no q yes, if yes - please describe:
11) Do you have knowledge of any State Highway access permits serving this property, or adjacent properties in which you have a property interest?
q no q yes, if yes - what are the permit number(s) and provide copies: and/or, permit date:
15) If you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of each.
business/land use square footage business square footage
16) If you are requesting residential developement access, what is the type (single family, apartment, townhouse) and number of units?
type number of units type number of units
17) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning is two counts.
# of passenger cars and light trucks at peak hour volumes
# of multi unit trucks at peak hour volumes
# of single unit vehicles in excess of 30 ft. # of farm vehicles (field equipment)
Total count of all vehicles
How many feet is the proposed access from the nearest cross street?
_____________ feet (q N q S q E q W) from:_______________________________
10) Provide existing property use
14) If you are requesting agricultural field access - how many acres will the access serve?
E-mail address E-mail address if available
Indicate if your counts are
q peak hour volumes or q average daily volumes.
Please print
or type
0
If an access permit is issued to you, it will state the terms and conditions for its use. Any changes in the use of the
permitted access not consistent with the terms and conditions listed on the permit may be considered a violation of the
permit.
The applicant declares under penalty of perjury in the second degree, and any other applicable state or federal
laws, that all information provided on this form and submitted attachments are to the best of their knowledge
true and complete.
I understand receipt of an access permit does not constitute permission to start access construction work.
Applicant or Agent for Permittee signature Date
Property owner signature
Date
If the applicant is not the owner of the property, we require this application also to be signed by the property owner or
their legally authorized representative (or other acceptable written evidence). This signature shall constitute agreement
with this application by all owners-of-interest unless stated in writing. If a permit is issued, the property owner, in most
cases, will be listed as the permittee.
Page 2 of 2 CDOT Form #137 12/18
Print name
Print name
Previous editions are obsolete and may not be used
18) Check with the issuing authority to determine which of the following documents are required to complete the review of your application.
a) Property map indicating other access, bordering roads and streets.
b) Highway and driveway plan profile.
c) Drainage plan showing impact to the highway right-of-way.
d) Map and letters detailing utility locations before and after
development in and along the right-of-way.
e) Subdivision, zoning, or development plan.
f) Proposed access design.
g) Parcel and ownership maps including easements.
h) Traffic studies.
i) Proof of ownership.
1- It is the applicant’s responsibility to contact appropriate agencies and obtain all environmental clearances that apply to
their activities. Such clearances may include Corps of Engineers 404 Permits or Colorado Discharge Permit System
permits, or ecological, archeological, historical or cultural resource clearances. The CDOT Environmental Clearances
Information Summary presents contact information for agencies administering certain clearances, information about
prohibited discharges, and may be obtained from Regional CDOT Utility/Special Use Permit offices or accessed via the
CDOT Planning/Construction-Environmental-Guidance webpage: https://www.codot.gov/programs/environmental/
resources/guidance-standards/environmental-clearances-info-summary-august-2017/view
2- All workers within the State Highway right of way shall comply with their employer’s safety and health policies/
procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not
limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926
- Safety and Health Regulations for Construction.
Personal protective equipment (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection,
respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a
minimum, all workers in the State Highway right of way, except when in their vehicles, shall wear the following personal
protective equipment: High visibility apparel as specified in the Traffic Control provisions of the documentation
accompanying the Notice to Proceed related to this permit (at a minimum, ANSI/ISEA 107-1999, class 2); head protection
that complies with the ANSI Z89.1-1997 standard; and at all construction sites or whenever there is danger of injury to
feet, workers shall comply with OSHA’s PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, and
1926.96. If required, such footwear shall meet the requirements of ANSI Z41-1999.
Where any of the above-referenced ANSI standards have been revised, the most recent version of the standard shall
apply.
3- The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access Board
under the American Disabilities Act (ADA). These guidelines define traversable slope requirements and prescribe the use
of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Plans and can be
found on the Design and Construction Project Support web page at:
https://www.codot.gov/business/civilrights/ada/resources-engineers
INSTRUCTIONS FOR COMPLETING APPLICATION FOR ACCESS PERMIT
(CDOT FORM NO. 137)
December 2018
To construct, relocate, close, or modify access(es) to a State Highway or when there are changes in use of
such access point(s), an application for access permit must be submitted to the Colorado Department of
Transportation (CDOT) or the local jurisdiction serving as the issuing authority for State Highway Access
Permits. Contact the CDOT Regional Access Unit in which the subject property is located to determine
where the application must be submitted. The following link will help you determine which CDOT Region
office to contact:
https://www.codot.gov/business/permits/accesspermits/regional-offices.html
All applications are processed and access permits are issued in accordance to the requirements and
procedures found in the most current version of the State Highway Access Code (Access Code). Code
and the application form are also available from CDOT’s web site at:
https://www.codot.gov/business/permits/accesspermits
Please complete all information requested accurately. Access permits granted based on applications found
to contain false information may be revoked. An incomplete application will not be accepted. If additional
information, plans and documents are required, attach them to the application. Keep a copy of your
submittal for your records. Please note that only the original signed copy of the application will be accepted.
Do not send or enclose any permit fee at this time. A permit fee will be collected if an access permit is
issued. The following is a brief description of the information to be provided on each enumerated space on
the application form (CDOT Form 137, 2010).
1. Property Owner (Permittee): Please provide the full name, mailing address and telephone
number and the E-mail address (if available) of the legal property owner (owner of the surface rights).
Please provide a telephone number where the Permittee can be reached during business hours (8:00
a.m. to 5:00 p.m.). Having a contract on the property is not a sufficient legal right to that property for
purposes of this application. If the access is to be on or across an access easement, then a copy of the
easement MUST accompany this application. If federal land is involved, provide the name of the
relevant federal agency AND attach copy of federal authorization for property use.
2. Agent for permittee: If the applicant (person completing this application) is different than the
property owner (Permittee), provide entity name (if applicable), the full name of the person serving as
the Agent, mailing address, telephone number, and the E-mail address (if available). Please provide a
telephone number where the Agent can be reached during business hours (8:00 a.m. to 5:00 p.m.).
Joint applications such as owner/lessee may be submitted. Corporations must be licensed to do business
in Colorado: All corporations serving as, or providing, an Agent as the applicant must be licensed to do
business in Colorado.
Instructions for completing Application for Access Permit (CDOT Form #137), 12/18
Page 1
3. Address of Property to be Served: Provide if property to be served has an official street
address. If the access is a public road, note the name (or future name) of the road.
4. Legal Description of Property: Fill in this item to the extent it applies. This information is
available at your local County Courthouse, or on your ownership deed(s). A copy of the deed may be
required as part of this application in some situations. To determine applicability, check with the
CDOT’s Regional Access Manager or issuing authority staff.
5. State Highway: Provide the State Highway number from which the access is requested.
6. Highway Side: Mark the appropriate box to indicate what side of the highway the requested
access is located.
7. Access Mile Point: Without complete information, we may not be able to locate the proposed
access. To obtain the distance in feet, drive the length between the mile point and the proposed access,
rounding the distance on the odometer to the nearest tenth of a mile; multiply the distance by 5,280 feet
to obtain the number of feet from the mile point. Then enter the direction (i.e. north, south, east, west)
from the mile point to the proposed access. Finally, enter the mile point number. It is helpful in rural or
undeveloped areas if some flagging is tied to the right-of-way fence at the desired location of the access.
Also, if there is a cross street or road close to the proposed access, note the distance in feet (using the
same procedures noted above) from that cross street or road.
8. Access Construction Date: Fill in the date on which construction of the access is planned to
begin.
9. Access Request: Mark items that apply. More than one item may be checked.
10. Existing property use: Describe how the property is currently being used. For example,
common uses are Single Family Residential, Commercial or Agricultural.
11. Existing Access: Does the property have any other legal alternatives to reach a public
road other than the access requested in this application? Note the access permit number(s) for any
existing state highway access point(s) along with their issue date(s). If there are no existing access
point(s), mark the “no” box.
12. Adjacent Property: Please mark the appropriate box. If the “yes” box is marked, provide a
brief description of the property (location of the property in relation to the property for which this
access application is being made).
13. Abutting Streets: If there are any other existing or proposed public roads or easements
abutting the property, they should be shown on a map or plan attached to this application.
14. Agricultural Acres: Provide number of acres to be served.
Inst
ructions for completing Application for Access Permit (CDOT Form #137), 12/18
Page 2
15. Access Use: List the land uses and square footage of the site as it will be when it is fully
developed. The planned land uses as they will be when the site is fully developed are used to project
the amount of traffic that the site will generate, peak hour traffic levels and the type of vehicles that can
be expected as a result of the planned land uses. There may be exceptional circumstances that would
allow phased installation of access requirements. This is at the discretion of the CDOT Regional Access
Unit or issuing authority staff.
16. Estimated Traffic Count: Provide a reasonable estimate of the traffic volume expected to use
the access. Note the type of vehicles that will use the access along with the volume (number of vehicles
in and out at either the peak hour or average daily rates) for each type of vehicle. A vehicle leaving the
property and then returning counts as two trips. If 40 customers are expected to visit the business daily,
there would be 80 trips in addition to the trips made by all employees and other visitors (such as
delivery and trash removal vehicles). If the PDF on-line version of this application is being used, the
fields for each type of vehicle will automatically be added together to populate the last field on the page.
17. Documents and Plans: The CDOT Regional Access Manager or issuing authority staff will
determine which of these items must be provided to make the application complete. Incomplete
applications will not be accepted. If an incomplete application is received via U.S. mail or through
means other than in the hand of the Access Manager or issuing authority staff, it will not be processed.
It is the responsibility of the applicant to verify with the CDOT Regional Access Manager or
issuing authority staff whether the application is complete at the time of submission.
Signature: Generally, if the applicant is not the property owner, then the property owner or a legally
authorized representative must sign the application. With narrow exceptions, proof of the property
owner’s consent is required to be submitted with the application (proof may be a power of attorney or a
similar consent instrument). The CDOT Regional Access Manager or issuing authority staff will
determine if the exception provided in the Access Code (2.3 (3) (b)) is applicable.
If CDOT is the issuing authority for this application, direct your questions to the CDOT Regional Access
Manager or the issuing authority staff serving the subject property.
https://www.codot.gov/business/permits/accesspermits/regional-offices.html
If the application is accepted, it will be reviewed by the CDOT Regional Access Manager or the issuing
authority staff. If an Access Permit is issued, be sure to read all of the attached Terms and Conditions
before signing and returning the Access Permit. The Terms and Conditions may require that additional
information be provided prior to issuance of the Notice to Proceed.
The CDOT Regional Access Manager (or issuing authority staff) MUST be contacted prior to commencing
work on any Access Permit project. A Notice to Proceed that authorizes the Permittee to begin
access related construction MUST be issued prior to working on the access in the State Highway
right-of-way. The Notice to Proceed may also have Terms and Conditions that must be fulfilled before
work may begin on the permitted access.
Instructions for completing Application for Access Permit (CDOT Form #137), 12/18
Page 3
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Completed 13 August 2020

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