USE OF RIGHT-OF-WAY (ROW)
PERMIT APPLICATION
No ulity, corporaon, rm, or individual shall perform any excavaon work in the public rights-of ways
without a permit from the Town of Richmond, in accordance with Title 19 VSA, Chapter 11, Secon 1111
and any relevant Town of Richmond ordinances. All work must comply with the Public Improvement
Standards & Specicaons for the Town of Richmond (see municipal website), State of VT AOT Standard
Specicaons for Construcon, and the Manual of Uniform Trac Control Devices (MUTCD).
Permit #
Please provide all the informaon requested in this applicaon. If you have quesons please contact the Highway Department at
434-2631. Addional local permits and approvals may also be required, contact the Zoning Administrave Ocer at 802-434-2430.
Applicaon Date: ______________ Physical Address of site work: ___________________________________________________
Applicant Name: ______________________________________
Applicant Mailing Address: ______________________________
____________________________________________________
____________________________________________________
Phone: ______________________________________________
Email: _______________________________________________
Subcontractor Name: _________________________________
Subcontractor Mailing Address: _________________________
____________________________________________________
____________________________________________________
Phone: ______________________________________________
Email: _______________________________________________
Applicant (check one): □ Company □ Contractor □ Advisor License # (if applicable) _____________________________________
Project Supervisor: ___________________________ Phone:____________________________ Email:_______________________
Emergency / Evening or Weekend Contact: __________________________________________ Phone: ______________________
Descripon of Project: ________________________________________________________________________________________
____________________________________________________________________________Is project in oodplain? ____________
Applicaon is for (check all that apply): □ installaon □ maintenance □ overhead ulies □ underground ulies
Purpose of work (check all that apply): □ water □ sewer □ natural gas □ electric □ cable □ phone □ internet
Type of work (check all that apply): □ cut □ bore □ jack □ other:____________________________________
Dimensions of total work area: Sq of pavement surface: _________ Linear feet curb: _________ Linear feet sidewalk: _________
Descripon of warning device to be ulized: _________________________________ Project start /end date: _______/__________
Applicants are required to call DIG SAFE, please include the Dig Safe Permit #:____________________________________________
The following condions apply to this approval, please inial all of the following to indicate you have read all the condions:
_____Unless specically noted below, all projects must adhere to the Richmond Public Improvement Standards and Specicaons.
_____All projects must meet all requirements as set forth in 19 V.S.A., Secon 1111.(c)(1).
_____Give 2 business days’ wrien noce, except for emergencies, to the Town for any construcon in the public right-of-way to
discuss inspecon mes and special condions.
_____Apply in wring regarding requests for any public road closure. [Wrien approval from Town of Richmond is required.]
_____Maintain the following work hours: 7:00 AM to 5:00 PM, unless other hours are approved.
_____Agree to pay any engineering fees incurred by the Town for any special inspecons deemed necessary.
_____For road openings, the Town reserves the right to require a cash escrow, to be returned aer 6 months if the disturbed road
area passes inspecon. The escrow amount represents approx.10% of the esmated cost: $250 minimum/$1000 maximum.
_____Supply all signs, agging and safety equipment for temporary trac control in accordance with MUTCD.
_____Keep starter and receiving pits a minimum of 10 feet from the end of any road pavement.
_____Do not leave any materials on the traveled poron of a road overnight.
_____Do not leave open excavaon during overnight hours (5:00 PM to 7:00 AM, unless otherwise noted below).
_____Use vibratory compacon equipment during the backll process.
_____Trench or excavaon backll for the road must be the same type of material that that was removed. Use NO frozen backll.
_____Avoid disturbance of all road-crossing culverts.
_____Restore roads, ditches, culverts, water lines, sewer lines, stormwater lines, and any other public infrastructure to the condion
found at the start of construcon.
_____Remove and reinstall speed limit sign(s) in the same locaon
_____The Town, including the Police Department, reserves the right to rescind, without advance noce, any permission to close, ob-
struct, or excavate within a public right-of-way if the public interest and/or safety so requires.
Applicaon created July 2017
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