PERMFILE125587

• Permit No: M2006021
• IBM Index Class Name: Permit File
• Doc Date: 12/19/2006
• Doc Name: County Use by Special Revierw and CDOT Access Permit
• From: QED
• To: DRMS
• Media Type: D
• Archive: No

DEC-19-2006 11:07R FROM: QED RSSOCIRTES
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970-416-0601 T0: 13038328106
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1s) Check wtlh the iswinq aulharay Io determine vfilCh of the following dnctmlents are required to complete the review o1 your apptxabon.
~a)Properfymap intliwtu~godteracceas, aordednq roetls atro streets. fie) Subdlvistan, zoning, ordevetbpremptan
~ IQ Mtghway end drNeway plan profile. / ~ Preposca aoereCeagn.
.+IR cl Oramage p4in.^.hovnng impact fo eve highwayngMvr-way /99) Pnrrefand own2Bhip maps mtlmm~g easemertfa
U IA d) Map and tellers dHading ubGly locations before and Baer l/) Tremc stud(as.
development m ercl amng the nght-ot-way, ) Proof of tPdnerstnp
1- tt is the applicant's responsibility to contact appropriate agencies and obtain all environmental clearances that appy
to their activities. Such clearances may include Corps of Engineers 404 Permits or Colorado Discharge Permit System
permits, or ecological, archeological, historical or cultural resource clearances. The CDOT Environmental Clearances
Information Summary presents contact Information for agencies administering certain Gearani~s, information about
prohibited discharges, and may be obtained from Regional CDOT Utility/Special Uso Permit ofrces or accessed via the
CDOT Planning!Construction-Environmental-Guidance webpage htto~i~,ot state co uslenvlronmental(Forms asQ.
2- All workers within the Stale Highway right of way shall comply wkh their employer's safety and health policies)
procedures, end all applicable U.S. Occupational Safety and Heaflh Administration (OSHA) regulations -including, but not
limited to the applicable sections of 29 CFR Part 1910.Occupational Safety and Health Standards and 29 CFR Parl 1926
- Safety and Health Regulations for Construction.
Personal protective equipment (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection,
respirators, gloves, etc.) shall be wom as appropriate for the work being pertormed, and as specked in regulation. At a
minimum, all workers in the Stale Highway right of way, except when in their vehicles, shall wear the following personal
protective equipment High visibility apparel as specified in the Traffld Contraf provisions of the documentation
accompanying the Notice fo Proceed related to this permit (at a minimum, ANSIflSEA 107-1999, class 2); head
protection That complies with the ANSI 289.1-1997 standard; and at all construction sites or whenever there is danger of
injury to feet, workers shall comply wdh OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95,
and 1926 96 If regmred, such footwear shall meet the requirements of ANSI Z41-1999.
Where any of the above-referenced ANSI standards have been revised, the most recent vereion of the standard shall
apply.
3- The Permiltee is responsible for complying with the Revised Guidelines that have been adopted by the Access 8aard
under the American Disabilities Acl (ADA). These guidelines define traversable slope requirements and prescrfie the
use of a defined panern of truncated domes as detectable warnings at sht:et crossings. The new Standards Plans and
can be found on the Design and Construction Project Support web page at:
< •! ~ ._doc.¢t~a_cau5(q~igtts~t].tf~• then click on Design Bulletins.
If en access Dermit is issued to you, it will state the terms and conditions for its use. Any changes in the use of the
permitted access not consistent with the terms and conditions listed on the permit may be considered a violation tN the
permit.
The applicant declares under penalty of perjury in the second degree, and any other applicable State or federal
laws, that all information provided on this Corm and submitted attachments are to ttre bP-st of their knowledge
true and complete.
f understand receipt of an access permit does not constitute permission to start access conafiuctfon work.
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If the applicant is not the owner of the property, we require this application also to be signed by the property owner or
their legally authonzed representative (or other acceptable wrdten evidence). This signature shall constitute agreement
with this application by all owners-of-interest unless stated in writing. N a permit is issued, the property owner, m most
cases, wilt be listed as the permiftee.
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Pmvtous edifiona sro abeelplo and may not be uaaa Pago x or x eDOT Fem. s+v tLa4