2010-07-07_PERMIT FILE - M2010048

Home Browse Search

18) Check with the issuing authority to determine which of the following documents are required to complete the review of your application. a) Property map indicating other access, bordering roads and streets. e) Subdivision, zoning, or development plan. b) Highway and driveway plan profile. f) Proposed access design. c) Drainage plan showing impact to the highway right-of-way. g) Parcel and ownership maps including easements. d) Map and letters detailing utility locations before and after h) Traffic studies. development in and along the right-of-way. i) Prof of ownership. 1- It is the applicant's responsibility to contact appropriate agencies and obtain all environmental clearances that apply 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 ntact information for agencies administering certain clearances, information about t s co Information Summary presen prohibited discharges, and may be obtained from Regional CDOT Utility/Special Use Permit offices or accessed via the CDOT Planning/Construction-Environmental-Guidance webpage httR://www.dot.state.co.us/environmental/Forms.asp. 2- All workers within the State Highway right of way shall comply with their employer's safety and health policies/ and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not procedures , limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926 - Safety and Health Regulations for Construction. Personal protective equipment (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection, At i a on. gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulat respirators , all workers in the State Highway right of way, except when in their vehicles, shall wear the following personal minimum , protective equipment: High visibility apparel as specified in the Traffic Control provisions of the documentation accompanying the Notice to Proceed related to this permit (at a minimum, ANSI/ISEA 107-1999, class 2); head protection 1-1997 standard; and at all construction sites or whenever there is danger of injury to ANSI Z89 . that complies with the feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, and 1926.96. If required, such footwear shall meet the requirements of ANSI Z41-1999. Where any of the above-referenced ANSI standards have been revised, the most recent version of the standard shall apply- 3- The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access Board under the American Disabilities Act (ADA). These guidelines define traversable slope requirements and prescribe the use of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Plans and can be found on the Design and Construction Project Support web page at: <http•//www dot.state.co.us/DesionSupport/>, then click on Design Bulletins. If an access permit is issued to you, it will state the terms and conditions for its use. Any changes in the use of the th the terms and conditions listed on the permit may be considered a violation of the t i t wi en s permitted access not cons permit. The applicant declares under penalty of perjury in the second degree, and any other applicable state or federal rovided on this form and submitted attachments are to the best of their knowledge ti n ll i f h p orma o n at a laws, t true and complete. I understand receipt of an access permit does not constitute permission to start access construction work. Applicant or Agent for Permittee signature Print name Date 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 authorized representative (or other acceptable written evidence). This signature shall constitute agreement in most erty owner the ro it is issued If i i , p p , a perm ng. t with this application by all owners-of-interest unless stated in wr cases, will be listed as.the permittee. Property owner signature Print name Date Previous editions are obsolete and may not be used Page 2 of 2 CDOT Form #1137 01/10