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<br /> <br />19)CheclcwM lheissufng aulhody todeternJne whlcfi or Otetouowh,g documents ate rewired to compete there of yourappliwtbn. <br />a) Property maP(ndiwdrg odreratxress, eorderingrwds end sheets, e1 SubdMsion. zoning, devetopmant pFan. ' <br />W Hl~twayenddrivawayplanprofile. •) Proposedaxessdes gn. <br />cI Draingge plan ahowingMpaclbrhelu~waydghfW-way. g) Parcel arW oanars rreps boAMtttg easarnertts. <br />~ Map end lellets deteilhtg uddybwtions before and seer N Tralric shafies. <br />devebpment to and alongiba riyM•of-way. i) Ptoofofownerstup. <br />1- it fs the applicants responsiWlity to contact appropr7ate agencies and obtain all envi onmental clearances that appty <br />to their activities. Such clearances may include Corps of Engineers 404 Permits or Col redo Discharge Permit System <br />permits, or ecological, archeological, historical or cultural resource clearances. The C T Environmental Clearances <br />Information Summary presents contact information for agenaes administering certain c earances, information about <br />prohibited discharges, end may be obtained from Regional COOT Ufility/Special Use P rmft offices or axessed via the <br />CDOT PlanninglConstruction-Environmental-Guidance webpage n <br />2- All workers within the Stale Highway right of way shall comply with their employers safety and heekh policies/ <br />procedures, and all applicable U.S. Occupational Safety and Health Atlministration (OS A) regulations -including, but not <br />IimHed to the applcable sections of 29 CFR Part 1910.Occupational Safety and Health Standards and 29 CFR Part 1926 <br />- Safety end Health Regulations for Construction. <br />Personal protective equipment (e.g. head protection, footwear, high visibility apparel, s fety glasses, hearing protect'lon, <br />respirators, gbves, etc.) shell be worn es appropriate for the work being performed, an as specified in regulation. At a <br />minimum, all workers in the State Highway right of way, except when in their vehicles, atl wear the following personal <br />protective equipment: High visibility apparel as specified in the Traffic Control provision of the documentation <br />accompanying the Notice to Proceed related to this permN (at a minimum, ANSIASFJ- 1 7-1999, class 2); head <br />protection that compiles with the ANSI289.1-1997 standard; and at all construction site or whenever there Is danger of <br />Injury to feet, workers shall comply with OSHA's PPE requirements for toot protection r 29 CFR 1910.136, 1928.95, <br />and 1926,86. If required, such footwear shall meet the requirements of ANSI Z41-1999. <br />Where any of the above•referenced ANSI standards have been revised, the most recen version of the standard shall <br />aPp1Y• <br />i 3- The Permittea Is responsible for complying with the Revised (iuldetines that have be n adopted by the Access Board <br />under the American Disabilities Act (ADA). These guidelines define uaversabla slope r quiremants and prescribe the <br />use of a deFlned pattern of truncated domes as detectable warnings at street crossings. The now Standards Plans and <br />- can be of`undon ttie Design and Construction Protect Support web page at: <br /><httu;Nwww.dot.state.co.uslDesJgnSuaoorG>. then click on Design Bulletins. <br />If an access permit Is issued to you, It will state the terms and conditions for its use. An changes in the use of the <br />permitted access not consistent with the terms and conditions listed on the permit may a considered a violation o1 the <br />permit. <br />The applleant declares under penalty of perjury in the second degree, and any oth r applicable state or Federal <br />laws, that all Information provided on this form and submitted attachments are to ha best of their knowledge <br />true and complete. <br />I understand receipt of an access permit does not tonstltuta permission to start a tees construction work. <br />AppdwnYe signature Pdrdriame ~ Oars <br />/~ ~ <br />- / / ~' Alex J. Ariniello 07/26/05 <br />If the app' a Is of the own r of the property, we require this application also to be sig <br />o entative <br />or other ac <br />ble written evid <br />nce} <br />d r <br />e <br />This si <br />ns <br />th <br />i <br />l <br />th <br />t <br />l ed b the property owner or <br />u <br />shall con <br />titut <br />a <br />re <br />m <br />t <br />g <br />epr <br />p <br />. <br />e <br />y au <br />o e <br />( <br />c <br />a <br />e <br />r <br />e g <br />re <br />s <br />e <br />e <br />en <br />with t ' icatlo by all o Hers-of-interest unless stated in writing. H e permit is issu ,the property owner, to most <br />case ill iiste as the ermittee. <br />P e t Date <br /> • <br />~/ <br />• <br />1 <br />Pravbus adipaaa an oeaotats and mry nor 00 utad <br />Paaa2ot2 CCO7 Form a71T 1Ltl1 <br />