Enter the subcontractor details in the grid below:

Project Address or Location

Project Information

Date of Final Patch

Contractor Phone # *

City *

License Number

Applicant Information

Contractor State *

Email *

Detailed description of work to be done

Mailing Street *

Contractor Email *

Name *

Date of Cut

General Contractor Name *

Subcontractors must be licensed with the Town of Columbine Valley and provide proof of liability and workman's compensation insurance with the Town of Columbine Valley listed as certificate holder.

Contractor Field Contact Name *

Contractor City *

Contractor Mailing Street *

Contractor ZIP *

Date of Temporary Patch

ZIP *

Subcontractor Information

Contractor Field Contact Email

State *

Phone # *

Contractor Information

Contractor Field Contact Phone # *

2. The permanent asphalt patch shall have all seams removed using infrared technology. The patch shall be tacked to all existing asphalt edges and have a minimum thickness of 6 inches after compaction. The top lift shall be a minimum of 2 inches thick after compaction and use a maximum aggregate size of 0.5 inches. The seam shall be heated and patched to a minimum depth of 2 inches from the surface of the street. The patch shall be sloped, crowned and leveled to match the existing pavement.

To maintain the integrity of a new asphalt surface, there are additional requirements when cutting into surfaces that are less than 2 years in age.
The following sections of street have been repaved within this time frame.

4. The Town shall approve or deny the permanent patch after the infrared seal has been applied. The 1 year warranty period starts after The Town approves the patch.

New Surface Cuts for obtaining all Street Cut and Right of Way Permits

* Fairway Lane – From 39 Fairway Lane to Brassie Way – May 2019.

Any cut made into the above listed sections of street will have the additional following requirements.

3. The Town shall be notified of the date and time of the infrared seal prior to the seal being applied.

1. All backfill above the base layer shall be a flowable backfill and a copy of the batch ticket shall be provided to the town. No compacted soil or granular fill shall be used as a backfill. Flowable backfill is defined as a self-compacting, self-leveling cementitious material that is in a flowable state at placement. The mixture is capable of filling all voids and hardens in a matter of a few hours without the need for compaction in layers.

3. Once a street cut application is reviewed and approved, the applicant will be notified. However, the permit itself will be issued no more than 48 hours in advance of commencement of work. In the event of a holiday, your permit will either be issued before commencement of work or the day of the project. This will be determined on a case by case basis. In the event applicant fails to commence work within 48 hours after issuance of permit the permit shall be considered void and have no legal force and affect.

2. All contractors and subcontractors are required to be licensed with the Town and shall provide proof of liability and workman’s compensation insurance. The contractor responsible for the permit must provide a 2-year minimum, $5,000 performance bond. These documents may be faxed to 303-795-7325 and have the Town of Columbine Valley listed as the certificate holder.

7. Repairs: The work site shall be returned to a condition equal to or better than original, within the limits of careful, diligent workmanship, good planning, and quality materials. The repairs shall be accomplished in the least possible time and with the least disturbance to the normal functioning of the street Right of Way or other property. Repairs of damage caused to existing facilities as a result of work carried out under a valid permit shall be the responsibility of the applicant.

Terms and Conditions

8. Notification of completion: Applicant shall notify the Town of Columbine Valley by phone (303) 795-1434 or email: jhayden@columbinevalley.org of the work completion. Applicant shall notify the Town upon completion of work, As soon as the Town received the notification and the work is approved by the town, the permit will be assigned a date which will begin a one year warranty period. If the work is not approved, a repair list will be issued. The warranty period begins after work completion and approval.

4. The applicant is responsible for obtaining locates of any utilities in the public right of way or easement.

1. A drawing or sketch of the project site is required and must include project address and street name. A drawing or sketch of the traffic control plan, compliant with MUTCD control must be provided. Both drawings may be combined into 1 drawing.

9. Stop Work Orders: A stop work order will be issued to any person or company working without a permit (except for emergency repair work) or if the work is permitted and the work is not in conformance with the standards set forth by the Town. The Town may initiate any required repairs and bill the responsible contractor. The minimum charge will be $500.00 for administrative costs plus any additional costs such as labor, materials, equipment and engineering.

5. Patching: The applicant shall place a temporary cold mix asphalt patch or approved flow fill patch immediately after backfill and compaction are completed for each seperate cut included on the permit. The patch shall be a minimum of 4 inches thick and shall be applied before leaving the job site. The temporary patch shall be maintained until the permanent hot mix asphalt patch is applied. The permanent patch is required within 7 calendar days of the street cut, weather permitting. The permanent patch shall be 2 inches thicker than the existing asphalt with a minimum thickness of 5 inches.

Street Cut and Right of Way Use Permit

Town of Columbine Valley

10. Emergencies: In the event of an emergency street cut, all efforts to alert The Town shall be made. Please call (303)-795-1434 during business hours. If after hours please leave a message for extension 1015. In addition, please email jhayden@columbinevalley.org with applicable information. A permit application is still required even if after the fact. In the event of an emergency situation, notification must be reported and permit applied for within 72 hours.

6. Backfill: The preferred material for backfilling is a flow/flash fill mix. These materials do not require compaction testing, but a copy of the batch ticket must be provided to the Town inspector either on site or at the Town Hall. An alternative backfill material is to use native soil compacted to 95% proctor density. This method of backfill requires the contractor to coordinate with a geotechnical engineer and arrange for multiple tests of the soil layers (or lifts) as the trench is backfilled. A copy of the geotechnical report shall be sent to the Town before the repair will be considered complete.

11. All work must conform to the approved construction plans and the requirements of the Arapahoe County Infrastructure Design and Construction Standards or the most current publication of Colorado Department of Transportation (CDOT) standards. If there is a conflict, between the two, then Arapahoe County Standards shall control.

No Yes

No Yes

No Yes

No Yes

Check Credit Card

No Yes

No Yes

Owner Signature *

Certification

The following documents are required to process the permit and must be attached with the application. Please note that your application will NOT be processed until you select 'Yes' for the Construction Plan and Traffic Control Plan options.

Application fees are non-refundable and MUST be paid before an application will be reviewed.

Amount Due

Do you have a Bond on file with the town? *

Please note that failure to submit required documents may delay your application.   This is the responsibility of the applicant.   Select 'Yes' to confirm that you have read and understand this requirement.

Project Site Drawing *

If applying by email you only need to submit a digital copy of plans, if applying in person or via mail you will need to submit both digital and hard copies of plans

I understand that this permit is granted under the terms and conditions set forth in the policy and procedures of the Town of Columbine Valley as set forth as part of this application and the special terms and conditions attached hereto. I understand that approved construction plans and the Town of Columbine Valley Construction Standards shall be the basis for acceptance of facilities or repaired under this permit. I understand that upon completion of the work described herein, we shall notify the Town by phone or email. The work will be inspected and approved if acceptable. The permit will be assigned a date which will begin a one - year warranty period. If the work is not approved a repair list will be issued.

Fee

How do you intend to make payment?

Attachment

Traffic Control Plan *

Construction Plans *

Do you acknowledge this statement? *

All work must conform to the approved construction plans and the requirements of the Arapahoe County Infrastructure Design and Construction Standards or the most current publication of Colorado Department of Transportation (CDOT) standards. If there is a conflict, between the two, then Arapahoe County Standards shall control.

Your will need to provide a visual representation of your intended project. This can be a sketch, drawing or engineer plan. The construction site must be marked clearly with address and street names to verify location. Your drawing should also indicate the measurements of the street cut (s).

Policies and Procedures for obtaining all Street Cut and Right of Way Permits

The fee for this permit is $500 and is due when the application is submitted. The fee is non - refundable.

The contractor responsible for the permit must provide a 2 -year minimum, $5000 performance bond. Permit applications will not be reviewed without the bond.

ALL APPLICANT AND CONTRACTOR INFORMATION MUST BE FILLED OUT COMPLETELY

Your permit application cannot be considered if there is any missing information/documentation. Do not submit an application until you are able to provide all required information.

A drawing or sketch of the traffic control plan of the construction site, compliant with MUTCD control, must be provided in detail.