Fillable Water-Sewer Permit 2019.sflb.ashx

Fill Online, Printable, Fillable, Blank Water-Sewer Permit 2019.sflb.ashx Form

Use Fill to complete blank online CITY OF ALBANY (NY) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Water-Sewer Permit 2019.sflb.ashx

On average this form takes 15 minutes to complete

The Water-Sewer Permit 2019.sflb.ashx form is 20 pages long and contains:

  • 0 signatures
  • 40 check-boxes
  • 42 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Albany

BROWSE CITY OF ALBANY (NY) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Rev 2019-08-01 Page 1 of 3
Water and Sewer Permit Instructions 2019
WATER AND SEWER PERMIT INSTRUCTIONS FOR APPLICANTS
No person shall uncover, or make any connection with or opening into, use, alter, or disturb any
public water or sewer line of appurtenances thereof, without first obtaining a written permit from
the Department of Water And Water Supply.
To apply for a water or sewer permit, the applicant shall file a completed permit form with the
Department of Water and Water Supply. The following shall be provided with the completed permit
form at the time the application is filed:
• Plans, specifications, or other information as required by the Department;
• Permit and Inspection Fees;
• Certificate of Insurance; and
• Performance Bonds
The attached pages contain information regarding the submittal requirements. Please note that if the
water or sewer work (or any work) is located within the City’s right-of-way (i.e. street, curb, sidewalk,
lawn, etc.), a City of Albany Street and Sidewalk Opening Permit is required. The Street Opening
permit application is available at the City of Albany Department of General Services.
Applicants must plan for adequate time for review and approval by the City, and any other involved
agencies. Generally, the greater the scope, the longer the permit review and approval process will
take. A telephone call to the Department of Water and Water Supply, well in advance of any
scheduled work can provide early guidance. It is important that all applicants read, understand and
comply with the City’s requirements.
Individuals with questions about permit requirements or the application process may contact the
Department of Water and Water Supply, Monday through Friday, between 8:30 a.m. and 4:30 p.m.
KATHY M. SHEEHAN
CITY OF ALBANY
D
EPARTMENT OF WATER & WATER SUPPLY
10
NORTH ENTERPRISE DRIVE
A
LBANY, NEW YORK 12204
T
ELEPHONE (518) 434-5300
FAX (518) 434-5332
J JOSEPH E. COFFEY, JR, P.E.
M
AYOR
C
OMMISSIONER
Rev 2019-06-26 Page 2 of 3
Water and Sewer Permit Instructions 2019
Excavations for water and sewer services (General requirements)
• The water and sewer permittee is responsible with EXCAVATION STANDARD 29 CFR PART
1026 SUBPART (P) of the current OSHA regulations, prior to any Water Department staff
entering the excavation.
• The contractor must provide a form of egress from the excavation.
• The contractor must supply a pump for dewatering purposes.
• The Water Department staff must inspect all water and sewer service work prior to backfilling
the excavation.
Requirements for New Water Service Taps
• All water service taps are made by Water Department Staff
• Schedule time and date for the tap with Water Department Dispatcher 518-434-5322 at least
48 hours in advance).
• All existing water services and branches at the water main must be terminated by the
contractor at the property owners’ expense before a new service can be established
Taps up to and including 2” in diameter:
• The City of Albany does not supply any corporation stops, tap bend connectors, or tap
saddles. Depending on the size of the tap to be installed, saddles may not be needed. Water
Department staff will make the determination. The contractor performing the work must
provide all plumbing supplies including the corporation stop and gooseneck. The City of
Albany has standardized on using the flowing corporations stops :
o Ford F 600 for ¾”
o Ford F-B 600 for 1 inch, 1 ½ inch and 2 inch
• The City currently uses manual and battery operated tapping equipment
Taps larger than 2” in diameter:
• The contractor must supply stainless steel tapping sleeve for all wet cuts. No other type of
sleeve will be allowed on the City of Albany owned water mains.
• The contractor must clean the water main in the area to be tapped.
• All we sleeves and valves must be pressure tested to 150 psi. This test must be witnessed by
the City of ALBANY Water Department staff.
• The contractor must supply the water test pump.
• The contractor must supply an air compressor capable of obtain a continuous are pressure of
125 psi for the purpose of supplying air to the drilling machine used by the City of Albany
Water Department staff.
• The contractor must supply a backhoe with an experienced operator to assist in lowing and
raising the drilling machine in and out of the excavation.
• When the outside temperature is below 32 degrees Fahrenheit, the contractor must supply an
approved heat source to protect the equipment from freezing.
Rev 2019-06-26 Page 3 of 3
Water and Sewer Permit Instructions 2019
Requirements for new sewer service laterals
• The contractor supplies all the material to construct the sewer lateral including the saddle for
the sewer main
• The contractor will do all installation work for the lateral including the connection to the
sewer main. All City Code requirements will be adhered to.
Requirements for inspection of service
• The excavation will not be backfilled until the water and/or sewer service has been inspected
by the Department of Water staff.
• The contractor will schedule the final inspection of the service with the Water Department
Dispatcher at 518-434-5322, giving the Department as much advance notice as possible. The
department will endeavor to conduct the inspection within 4 hours of being notified.
Inspections will be scheduled during regular operating hours, Monday through Friday. In case
of emergency or special circumstances pre-approved by water Department management,
inspections may be conducted during holidays and weekends.
• It is the responsibility of the contractor to ensure that a Department representative is present
for the require inspection. If the contractor backfills the trench prior to the Department
representative’s inspection, the Department will require the contractor, at the contractor’s
sole cost, remove all work up to appoint, at the Department’s discretion.
• If the contractor is not ready for an inspection at the time set by the Department, the
contractor must contact the Department Dispatch a minimum of one (1) hour prior to the
scheduled inspection to reschedule the inspection. IF the inspection is scheduled for another
day, the contractor shall comply with all City regulations and procedures to protect the area.
Attachments:
Albany Water Board Fees (Pages 1-4)
City of Albany Water and Sewer Permit Performance Bond
Example of Performance Bond (2 pages)
City of Albany Water Department Certificate of Insurance Requirements
Water and Sewer Permit Application Checklist (Form 1)
Water and Sewer Permit Application (Forms 2 thru 4)
Water and Sewer Permit Sketch Example
Trench Excavation and Back Fill Requirements
Trench Excavation and Back Fill Detail
City of
Albany
Water and Sewer Permit
Performance
Bond
Requirements
SURETY BOND
(
PERFORMANCE
)
Bond#
Amount
$10,000.00
KNOW ALL MEN BY THESE PRESENTS, that we,
as Principal; and the
duly authorized to transact business in the State
of New York, having an office and usual place of business at
as Surety, are held and firmly bound unto City of Albany, City Hall, Eagle
Street,
Albany, New
York in the sum
of Ten
thousand and no\100 Dollars ($10,000) for
the
payment of which,
well and truly to be made, we bind ourselves, our heirs,
executors,
administrators, successors
and assigns, jointly and severally, firmly by these
presents.
Signed and sealed with our seals this day of
,
20
.
WHEREAS, the above bounden Principal has received and will apply from time to time for
permits for the purpose of water, sewer and site restoration work
.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH that
if the
above
bounden Principal shall indemnify and save harmless the said City of Albany
from
all liability,
damages, and expenses of every kind and nature, resulting directly,
or
indirectly to persons or
property and arising from and in consequence of any license
or
permit, and shall well, truly
and faithfully perform the duties and privileges pertaining
to
any license or permit, and shall
perform all required water, sewer, and site restoration
work, then this obligation to
void, otherwise to remain in full force and
effect.
And shall further indemnify, save harmless and pay the City of Albany any
damages,
loss,
charges, or expenses which, in any way, be sustained or incurred by it in relation to or in
connection with any and all such claims, suits, or proceedings at law or in
equity.
This bond takes effect , 20 ____
and expires on , 20
Rev 2019-06-26
Water and Sewer Permit
Certificate of Insurance
Requirements
Before a permit is granted, the applicant shall provide a certificate of insurance of a duly
authorized insurance company, in the sum of one million dollars ($1
,000,000)
designatin
g
the City as additional insured and evincing coverage to indemnify and
save
harmless the
City of Albany from all loss, damage, cost, and liability whatever which
the
City may
sustain or incur by reason of any accident, act or omission of the person
to
whom such
permit is granted or any person employed by him while engaged in
such
employment and
performing any of the work done under or pursuant to such
permits.
The applicant shall also provide proof of coverage for compensation and
disability
insurance.
City of Albany
Department of Water and Water
Supply
10 North Enterprise
Drive
Albany, New York
12204
(518)
434-5300
KATHY M. SHEEHAN
CITY OF ALBANY
D
EPARTMENT OF WATER & WATER SUPPLY
10
NORTH ENTERPRISE DRIVE
A
LBANY, NEW YORK 12204
T
ELEPHONE (518) 434-5300
FAX (518) 434-5332
JOSEPH E. COFFEY, JR, P.E.
M
AYOR
C
OMMISSIONER
Revised 2019-06-26 Form 1 of 4
WATER & SEWER PERMIT APPLICATION CHECKLIST
The following checklist has been made available to ensure that the permits submitted to the Water Department
are reviewed in a timely manner. If the sketch submitted does not have enough information (see Form 4 below),
the application will not be approved.
☐ Water/Sewer Permit Completely Filled Out
Form 2 - Permit Application
☐ Property Owner’s Name & Phone Number
☐ Applicant’s Name, Address, & Phone Number
☐ Contractor’s Name, Address, & Phone Number
☐ Location of Work
☐ Purpose of Work
Form 4 – Water & Sewer Service Permit Sketch (OR Attach Design Engineer’s Plans)
☐ Location (Street Address)
☐ Location of Utilities
☐ Describe Type of Work (Diameter, Material, Length, etc)
☐ Show Location of Site Features (Buildings, Driveways, Manholes, etc)
☐ Describe Backfill Operations (Compaction Method)
☐ Original Bonds – Must be on City of Albany Form
☐ Notarized
☐ Raised Stamp/Seal
☐ Liability Insurance
☐ Worker’s Compensation Insurance (If Applicable)
☐ Payment (Check or Credit Card ONLY) – See Rate Sheet for Fees
☐ Call DIG SAFE NY 72 Hours in Advance
**Water and Sewer Permit Approval Must Be In Hand Before Work Starts**
Permit No. ____________
KATHY M. SHEEHAN
CITY OF ALBANY
D
EPARTMENT OF WATER & WATER SUPPLY
10
NORTH ENTERPRISE DRIVE
A
LBANY, NEW YORK 12204
T
ELEPHONE (518) 434-5300
FAX (518) 434-5332
JOSEPH E. COFFEY, JR, P.E.
M
AYOR
C
OMMISSIONER
Revised 2019-08-01 Form 2 of 4
WATER AND SEWER SERVICE PERMIT APPLICATION
Service Address: Application Date:
Property Owner’s Name: Property Owner’s Phone:
Applicant’s Name: Applicant’s Phone:
Applicant’s Address: Applicant’s E-Mail:
Are Stamped & Approved Plans by Department of Planning Attached? ☐Yes ☐No ☐ N/A
Will work occur in ROW, sidewalk, or street?
YES – STREET OPENING PERMIT REQ’D
NO
Water Service: (Check at least 1 in each column) Proposed Start/End Dates:
☐
Residential
☐
New Service
☐
Domestic
☐ Commercial
☐ Service Rehab
Size & Work Type
☐ Fire Protection
☐
Industrial
☐
Termination
Is Contractor the same as Applicant? ☐YES ☐NO – FILL OUT BELOW
Contractor’s Name:
Phone:
Contractor’s Address: Email:
Sewer Service: (Check at least 1 in each column) Proposed Start/End Dates:
☐
Residential
☐
New Service
☐
Sanitary Sewer
☐ Commercial
☐ Service Rehab
Size & Work Type
☐ Storm Service
☐
Industrial
☐
Termination
Is Contractor the same as Applicant? ☐Yes ☐No – FILL OUT BELOW
Contractor’s Name: Phone:
Contractor’s Address: Email:
To the best of my knowledge the above information is true and accurate. I have read and understand the
provisions of the Code of the City of Albany concerning use of its water and sewer systems and shall comply with
said Code. I will be responsible for excavation, removal, and
backfill as required to restore to City
specifications/requirements guaranteeing this work for five (5) years.
Applicant’s Signature: Date:
WůĞĂƐĞWƌŝŶƚEĂŵĞ͗ͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺ
KATHY M. SHEEHAN
CITY OF ALBANY
D
EPARTMENT OF WATER & WATER SUPPLY
10
NORTH ENTERPRISE DRIVE
A
LBANY, NEW YORK 12204
T
ELEPHONE (518) 434-5300
FAX (518) 434-5332
JOSEPH E. COFFEY, JR, P.E.
M
AYOR
C
OMMISSIONER
Permit No. ____________
Revised 2019-08-01 Form 3 of 4
WATER AND SEWER SERVICE PERMIT APPLICATION
(FOR DEPARTMENT USE ONLY)
MAINTENANCE DIVISION
Size of Water Main to be Tapped Size of Tap Installed
Size of Sewer Main to be Connected Size of Service Installed
Approved by Date
Comments
METERING DIVISION – See Meter Superintendent
FINANCE DIVISION
Bond ☐Yes ☐No Date Expires
Insurance ☐Yes ☐No Date Expires
Workers Comp. ☐Yes ☐No ☐N/A Date Expires _______________
Water Service Charges Sewer Service Charges Total Water / Sewer Charges
Application Fee
Application Fee
Water Service Charge
Tapping Fee
New Connection Fee
Sewer Service Charge
Meter Fee
Other
Total Permit Charge
New Service
Connection Fee
Amount Paid
Hydrant Fee
Other
Check #
Credit Card Type
Total Water Total Sewer
Permit No. ____________
KATHY M. SHEEHAN
CITY OF ALBANY
D
EPARTMENT OF WATER & WATER SUPPLY
10
NORTH ENTERPRISE DRIVE
A
LBANY, NEW YORK 12204
T
ELEPHONE (518) 434-5300
FAX (518) 434-5332
JOSEPH E. COFFEY, JR, P.E.
M
AYOR
C
OMMISSIONER
Page 1 of 2
Rev 7/2/2019 Water Sewer Permit Package
TRENCHING AND BACKFILLING
1. The Contractor shall comply with the requirements for soil erosion and sedimentation
control and other requirements of governmental authorities having jurisdiction, including
the State.
2. Protect excavations by shoring, bracing, sheet piling, or by other methods, as required to ensure
the stability of the excavation. Comply with OSHA requirements.
3. Underpin or otherwise support structures adjacent to the excavation, which may be damaged
by the excavation. This includes service lines.
4. Contractor shall comply with maintenance and protection requirements as approved by the
authority having jurisdiction.
COMPACTION
1. The bedding material shall be placed in the trench after the trench has been excavated a
minimum of 8 inches below the bell of the pipe to permit the placing of no less than 8 inches
of bedding material.
2. Provide uniform bearing support for each section of pipe at every point along the entire length
except where necessary to excavate for bell holes, pipe joints or other required connections.
Dig no deeper, longer, or wider than needed to make the joint connection properly.
3. The bedding material shall be placed to the full width of the trench. The bedding material
shall be tamped and compacted to form firm and an even bearing surface.
4. Pipe zone backfill shall be placed to not exceed 8 inches in thickness before compaction.
Each layer shall be thoroughly compacted by hand tamping or mechanical means being
careful not to damage the pipe. When the pipe zone backfill reaches 1 foot over the top of the
pipe, the entire surface shall be compacted by mechanical means.
5. The remainder of, if any, of the trench above the pipe zone backfill shall be backfilled with
suitable material in loose lifts not exceeding 8 inches in thickness before compaction. Each
layer shall be thoroughly compacted by mechanical means.
Suspension of Work
1. Whenever work is suspended, excavations shall be protected and the roadways, if any, left
unobstructed. Within or adjacent to private property, material shall be stored at such locations
that will not unduly interfere with traffic of any nature and in no case shall materials be stored
in locations which will cause damage to existing improvements.
Disposal of Material
1. Excess and unsuitable material shall be legally disposed of off-site by the Contractor.
KATHY M. SHEEHAN
C
ITY OF ALBANY
D
EPARTMENT OF WATER & WATER SUPPLY
10
NORTH ENTERPRISE DRIVE
ALBANY, NEW YORK 12204
TELEPHONE (518) 434-5300
FAX (518) 434-5332
JOSEPH E. COFFEY, J R , P.E.
MAYOR COMMISSIONER
CITY OF ALBANY TYPICAL TRENCH DETAIL
SCALE: NO SCALE
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Water-Sewer Permit 2019.sflb.ashx

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 10 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document