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COLORADO DEPARTMEM17 OF 1RAK3PORTATIM <br /> UTILITY PERMIT <br /> PERBUr EE APPLICANT DRPARTNMWUSEONLY <br /> New: Cripple Creek&Victor Gold Mining Black Hills EneMy Date Issued <br /> Jodi Keel Warren Heifner Pennit# 2140070-U Milepost <br /> Address: 100 North 3rd street 3110 Ut@X Lane S.H.# 67 46.00 <br /> Victor,CO Canon City,CO 81212 Region 02 <br /> Section 04 <br /> Tblephone:(719)689-4128 (719)646-581 i 1 Paant Mice Davis <br /> CR TO PBRNIIT IM For uoderpvand lack*location kbnmhm%contact tits Utility Notification Center of Cotarado(MC%Pursuant to 9-1.5.103 <br /> C.R.B.yea oW not make or begin excavation wkhout first notMbg the UNCC and K nary,then notTjiug the der two members having underground <br /> Ja cUidee ho tine area of sack excavation.Notification shalt also be given to true CDOT regional peradtting error,or as offierobe directed by ibis Permit's Special <br /> Provlsimrs.Notice of the cast,esteat and duration of UN excavation work gimp be given at had two business days prior theeto,not including tine day <br /> or ac notice.The UNCC maybe called at l-SW922-IM. CDOT sball be called at(719)231-W96. <br /> AcTrym DESC8IP'ITt]rl Permitted <br /> PURPOSL ®Installation 0 Adjustment ❑Ronoval ®Maintenance of existing Facifity <br /> FACELXrY (Type,size,class of hinsnnutant,design pnssureor etc.)Electric line service upgrade aver the roadway <br /> DPSCRRInON OF WORK Crossing 19 meet or exceed CDOT/NESC requirements for high voltage oonductem Qver the <br /> roadway <br /> NATURE OF DWAiLATION ❑Longitudinal(ParalkD ❑ TSansverse(Crossing) <br /> (]Buried ®AcriW/hound-mounted MAttneb.To Hop.W.No. <br /> LOCATR)N._2070'West of West Victor Ave.in Victor,west of mm 46 <br /> County: Teller Cityrrowu:_ MCI= Project Info: r a <br /> AbDrnONAL REMARKS Contact Mark Nusskem(719-W-5433)or Email h1ark.Nusskem@state.co.us at least 48 hours prior to <br /> starting permitted work. <br /> SPECIAL PROVISIONS(emplefed by the ment The Special Provisions are terms and aoudiHoms of tide Dennit. <br /> Any*wk shall tmly be in accordance with the approved plans and special provisions as set forth in this permit and its attachments. <br /> The®OTinspectoris_Marla J.NWSkem Thkphone: 719-546-5433 ,. Fax:719-546-5433 <br /> Work is to be oompleted on or before: 10/31/2014 or within days,(as applicable) <br /> Work time restrictions: No work in adverse MMather conditians <br /> Designated minimurn cover is Designated overhead clearance is. <br /> (ALSO SEE ATIACEED STANDARD PROVISIONS,AND ADDrf10KAL SPP.CIAL FROVLSIONS� (1RAMC C0NJROLMUST C WFi0iRM TO THE MV") <br /> Other REVIEW ATTACHED STANDARD and SPECIAL PROVISIONS.CONTRACTORS AND SUBCONTRACTORS <br /> ARE BOUND TO THESE REQUIREMENTS.Copy of permit must be on site.Traffic control Is essential for the <br /> Permittee Is prohibited hun commencing soy workwithin highway ROW prior to Isinmttae eta fitly ended and validated pelt, Permit,. <br /> plan exhibit,insurance eerLlficate(s),and iraM control plan must be available on site during work. fth vlsibitity vests are required at all <br /> tmnes daring working hours. <br /> 1.Your regmst to use m4lbr ocaapy state bigbwav system rights of way as described above is graded suI3led to the terms mud conrtidamm d this permit, <br /> including the Standard sad special Prorissns as shown on the peradt and all attachments hereto. <br /> 2.To Are extent authorized by lair,Permdtee hereby assuaocs,releases and arm to indamafty,defend,proteek and surd the State of Colorado banmlew from <br /> and against airy lore and/or danuges to the pro of tine State of C4lero,dried parties ar tie Pcntuitt+oa's hoodHiies,sal tall lobs and/or dsorage on mcaom+t <br /> of hllmry to or deatir of nW petgan whomsoenr,a at arq dive,csmad by er growing od of the aernpation of Cslarado State lBghway rl�nu or way by <br /> Peanktee'e racitides sr a�thereat,including but sot limited to fastaAatkn,adjmtatent,reiogttimr,uaabrtetmnce or operatiap,or renwvai of esi <br /> facilities,unless strclr lass damage arises fora the sole nagiigence ar wIDibl conduct oPtine State of C.olnrado orlb employees or agenfe. <br /> 3.Failare by the Penaifte to comply with any of the included terms or conditions nay sabded tits pelt to auqmuton or cancellation,at the discretion of fhb <br /> Deparound ofTtamportation. <br /> 4.B�RMrr is NOT VALm iw-n , FULLY Fmx)aSSD BY ALL PARTIES, WITH DATE OF ISSUE AFFMW BY AN AUT11GYMM <br /> NTA'I'1V13 OF THE DEPARTM1r M. A FULLY==1W COPY OF THIS PnMrf MUST BE ON FHX AT THE TRANSPORTATION <br /> N OFMCL <br /> L hi accepting this permit the undersigned,rgwesenting the Pcesnittec,verb that he or she has the naWmity to sign for and bind We Pamittee,and that he or <br /> she Gas read,understands and accepts all the included coaditimns. <br /> Attested , Signatur � � �5� <br /> ------ ------�'�-' _--- te <br /> - -- ----- ---- ---...3-- <br /> ---------- ,---. ---.---- - ----------------...-. .......................... <br /> Title fir. Pro�c.t �rti.ecr• i Title �itvrrawnV.AM J WwOAS <br /> Print Name: J c�64-11 i e: wt thtr <br /> COLORADO DEPARTMENT OF TRANSPORTATION By Date <br /> Chief Engineer g� s n Designee T 7 <br /> Distrilhoon: Region Fie(Original] Mtee Landscaping Supvy <br /> Permittee/Ap*ant Inspector MarkJ.Nusskem CDOTFomp0333 01i09 <br /> Mice Patrd Super. Mike Davis y Picrrtous version are absolete sod dnnold nabs used. <br />