Work associated with this permit shall comply with Village of Golf Manor Public Works Construction Standards and Applicable Ordinances (Chapter 902).
Applicant Information
Name of Licensed Contractor/Excavator: Licensed Contractor # (If Applicable):
(For Village use only)
Street Address: City/Town: State: ZIP:
Phone No.: Cell Phone No.: 24-Hr Emergency Phone No.:
Work Location:
Street Address:
Owner: Owner’s Address: Phone No.: Email:
Information for Proposed Trench
Specific Location of Trench (Please check all that apply):
Street Side of Road Sidewalk Tree Lawn Driveway Private Other
Trench Purpose/Description:
Trench Type (Include dimensions ONLY for trenches in
Public Right of Way) Type: Water Type: Sewer Type: Drain Type: Gas Type: Electric Type: Other
Trench Dimensions Depth (ft)
Length (ft)
Width (ft)
Total Surface Area (Length x Width)
Grand Total Area of Surface Cut (sf)
Purpose of Permit (Please check all that apply) Draw or Attach Sketch of Proposed Excavation
Obstruct Street or Sidewalk _____
(Days to remain)
Resurface Driveway/Apron
Other _______________________________
Cable Electric Water
Sewer Gas Reconstruct Driveway
Telephone Other ____________
Lane Closure
Sidewalk Closure
Road Closure
Excavation Work On
Public Private Or Both
Excavation Start Date: Excavation End Date:
Project Address: Assessors Map #: Lot/Parcel #:
For Village Use Only:
Special Requirements by Village
5 Year Moratorium Grant of Location Controlled Density Fill Infrared
Special Work Zone Signage No Plates Traffic Detail(s) Notify Abutters
No Work Before ________ AM No Work After _________ PM
Ron Hirth, Village Administrator
JMA Consultants, Engineer
513-531-7418 Fax: 513-531-4404
(For Village use only)
Street Opening Permit
(Signatures) Please read application and above acknowledgments before signing. The following attest by signature below that they have
been read, understood and parties assume full responsibility for all conditions of this permit application.
Applicant’s Signature: Date:
Check if Applicant is
Check if Applicant is
Excavator’s Signature: Date:
Owner’s Signature (If different) [For work on private property]: Date:
Permit Approved By (For Village use only - Do not write in this section): Date: Permit Expiration Date:
Remit Fee Amount:: ______________
513-531-7491 •
No person, firm, or corporation other than the Village Administrator or the authorized employees or agents of the Village Administrator, may make any
opening in any street, alley, sidewalk, or public way of the municipality, unless a permit to make such opening shall have been obtained prior to
ommencement of the work, as herein provided
Each permit for making such opening shall be confined to a single project and shall be issued by the Village Administrator. Application shall be made on a
form prescribed by the Village Administrator giving the purpose of the proposed opening, the exact location of the proposed opening, the type of paving to
be excavated, the area and depth to be excavated and such other facts as may be requested by the Village Administrator in the application. A fee as
adopted by the Village Administrator and approved by the Village Engineer to recover the cost to administer this program, shall be collected by the Village
Administrator before issuing such permit. Such application fee shall be paid into the General Fund of the Municipality By applying for, accepting and
signing the permit, the applicant shall attest that they have read and understand (1) the regulations set forth herein, including the requirements to restore
the street or sidewalk excavation, (2) all required by public safety practices with regard to construction related excavations and trench safety, (3) the
Federal safety standards promulgated by the Occupational Safety and Health Administration for excavation, and (4) any other requirements established by
the Village Engineer for such specific excavation.
The permit shall be issued only after bond, or other surety, sufficient to cover the cost of restoration has been posted with the Village Administrator,
conditioned upon prompt and satisfactory refilling of excavations and restoration of all surfaces disturbed.
The following conditions and requirements shall apply to all applications for street and/or sidewalk openings: Persons engaging in any trenching operation shall familiarize
themselves with the Federal safety standards promulgated by the Occupational Safety and Health Administration for excavations. No trench may be excavated unless the
requirements of Federal, State and Local standards and regulations have been met and the permit is invalid unless and until said requirements have been complied with by the
excavator applying for the permit. Trenches may pose a significant health and safety hazard. An excavator shall not leave any open trench unattended. Excavators shall consult
regulations promulgated by the Federal, State and Local codes in order to familiarize themselves with the recognized safety hazards associated with excavations and open
trenches and the procedures required or recommended by said department in order to eliminate said safety hazards which may include covering, barricading or otherwise
protecting open trenches from accidental entry. At a minimum, any excavation or opening must be fully barricaded at all times to prevent injury to persons or animals. Any
required traffic control shall be contracted through the Village Police Department or the Chief of Police’s designee. Excavators engaging in any trenching operation who utilize
hoisting or other mechanical equipment shall only employ individuals licensed to operate said equipment by the Department of Public Safety presented to said licensed operator
before any excavation is commenced. Any person engaged in or employing others in excavating or otherwise in any manner obstructing a portion or all of any street, sidewalk,
alley, or other public way, at all times during the night season shall cause the area to be secured consistent with the requirement of the Ohio Manual of Uniform Traffic Control
Devices. Any permit issued shall be posted in plain view on the site of the trench and/or a copy maintained at all times on site.
The opening and restoration of a pavement, or other surface, shall be performed under the direction and to the satisfaction of the Village Administrator, and in accordance with
rules, regulations, and specifications heretofore or hereafter established by the Council. Upon failure or refusal of the permittee satisfactorily to fill the excavation, restore the
surface, and remove all excess materials within the time specified in the permit or where not specified therein, within a reasonable time after commencement of the work, the
Village may proceed, without notice, to make such fill and restoration and the bond required herein shall be deemed forfeited. Thereupon, such funds shall be paid into the
general fund for the street repairs. Any funds forfeited in excess of such repair costs shall be paid to the permittee. If the amount of such services performed by the municipality
should exceed the amount of such deposit, the Village Fiscal Officer shall proceed to collect the remainder due from such permittee. If the security posted is a surety bond,
notice shall be given to the surety to complete such restoration. The restoration of any opening made in a street right-of-way pursuant to this section outside of the paved surface
shall be made by backfilling the opening with compacted granular backfill or controlled density backfill to a distance of four feet from improved portion of street, or to the
satisfaction of the Village Administrator. The top filling of the backfill shall be of soil. That portion of any opening that is in the improved portion of a street shall be restored by
filling said opening with compacted granular backfill or controlled density backfill properly compacted, but the improved portion shall be rebuilt to the street specifications of the
type of street that has been opened, and at the recommendation of the Village Engineer, the restoration may extend from curb to curb within the impacted street, if such
impacted street has been constructed or reconstructed with asphalt within the previous five (5) years for concrete within the previous ten (10) years. All sections of concrete
roadway that have been cut or damaged shall be replaced to the nearest joint. Additional sections of concrete may need to be removed beyond the visibly damaged sections if
there are any voids under the concrete roadway at the joints. New concrete roadway shall match the thickness of the existing roadway and include the same reinforcing bar as
the removed sections. If the centerline joint had reinforcing bar in the concrete between the two sections of concrete, the contractor shall insert epoxy coated rebar dowels back
into the existing slab at the same spacing and size as the existing rebar. Whenever any tunneling, boring or drilling under a street right-of-way with an opening in excess of six
inches is made, the opening shall be refilled by blowing or compacting either compacted granular backfill or controlled density backfill around any pipe or conduit inserted in such
902.99 PENALTY.
A violation of this chapter shall be an unclassified misdemeanor punishable by a fine of up to $1,000 for a first offense, and $2,000 for a second and
subsequent offenses. Each day when an offense has occurred or when the work has not been properly permitted may be cited as a separate offense. The
imposition of a fine under this chapter shall not prevent the Village from proceeding with civil action against an offender for any damages done to the
sidewalks or the roadways in the Village of Golf Manor.