TRENCH PERMIT AND LICENSING REQUIREMENTS
PERMIT #:________________ DATE:____________
A. TRENCH PERMIT
1. In accordance with the provisions of Chapter 236, Section 9-12, of the NH Revised Statutes Annotated and amendments thereto, permission is requested to disturb the Main Street in the Town of Bradford for the purpose of connecting the water discharge line to the Department of Transportation catch basin at Main Street and Route 103.
2. I/We,_____________________________________________________(name and address), agree to conform to the following provisions, instructions and regulations in processing the work under this request and to any additional instructions issued by the Road Agent or his representative, during the process of the work.
3. In areas where the pavement is to be excavated it shall be neatly and uniformly cut with square edges by machine at each side of all trenches. Every precaution shall be used to prevent undermining the remaining pavement, utilizing shoring procedures as required to prevent cave-in and to protect the remaining pavement. It is recommended that all trenching conform to OSHA Regulations. Any undermined areas that inadvertently develop shall have the projecting pavement cut square and removed. Excavation and handling of material shall be performed in a manner as will minimize disturbance beyond the trench limits. Any blasting shall be performed only by a blaster licensed by the State of New Hampshire. Necessary arrangements shall be made by the requesting party for coordination of protecting overhead wires.
4. All other excavation shall be performed in a manner as will produce the minimum possible safe width of disturbed area. Sheeting shall be used as required to prevent cave-in.
5. Within the paved areas (as described in NHDOT Standard Specifications), material equal to the existing gravel course, shall be placed in layers not exceeding twelve inches (12″) loose depth and thoroughly compacted. A minimum of 12″ of 1 1/2″ crushed bank run gravel will be placed immediately below pavement. An approved bituminous material shall be placed and carefully graded and rolled to the adjacent pavement grade. As per specifications, results of proctor density testing shall be provided prior to commencement of work and as conducted during the course of the project.
6. In other areas the present surface type shall be restored by placing similar material on top of trench to a depth equal to that existing before excavation. Any existing grass land additionally shall be fertilized and reseeded with like vegetation that must grow and flourish. Any asphalt or concrete sidewalk shall have surfaces of equal depth, kind and quality placed.
7. Maximum length of trench to be open at one time shall be not more than ________ feet and no more than ________ feet left open at night.
7a. Suitable unrestricted ingress and egress to properties abutting the highway shall be maintained at all times. Two way traffic nights, weekends, and holidays shall be maintained at all times. Sidewalk traffic shall be provided for by means of an alternate protected route if sidewalk is blocked due to work being done.
8. Traffic must be maintained during the performance of the work. Any detours must be planned and agreed to by the Selectmen and Police Chief. Work zones shall be protected by suitable barricades, standard warning and advance warning signs, flags during the day and proper lighting at nights as described in the 1988 Manual for Uniform Traffic Control Devices. Uniformed special traffic officers or flag persons shall be provided whenever two way-traffic cannot be maintained, and at the request of the Police Chief during any time that he deems them necessary for the protection of the public.
NOTE: Every effort should be made to route diverted traffic with well-marked lanes. Qualifications of flag persons may be required by the Police Chief. Should a uniformed police officer be required for traffic control, arrangements must be made through the Police Chief. All signs shall be kept in good repair at all times.
All work zone, traffic control zone plans must be approved by the Road Agent and Selectmen prior to work starting. They must be adhered to or all work will cease as public safety is of prime importance and takes precedence.
NOTE: Any repairs, replacements or corrections to traffic control zones required for public safety will be made by the Town of Bradford at a cost to the applicant of 125% for materials, labor, etc.. Work will not continue until payment has been received in full and accepted by the Town of Bradford, or unless allowed to proceed for safety reasons by the Board of Selectmen.
9. During the weekends and holidays, and non-work days during the hours the job is inactive, a stand-by crew shall be available in case they are needed as agreed after review with the Road Agent for the protection and maintenance of traffic. One or more telephone numbers which will reach the stand-by crew, shall be furnished to the following people:
A. Police Chief
B. Road Agent
10. Any future distortion along the trench lines, due to settlement or other causes attributable to the construction, shall be corrected as required during the period of three (3) years following the acceptance of the project by the Owners, based upon a mutually agreed upon record of the road system disturbance (photos, measurements, etc.).
11. I/We the Contractor agree to save harmless the Town of Bradford from any and all claims arising from the construction of the work, or form trench settlement or other deficiencies of the construction attributable to the said construction for a period of three (3) years following the acceptance of the project by the Owners .
12. I/We the Contractor agree to assume such additional cost as the Town may incur by reason of failure to perform this work in the manner prescribed above and in accordance with said plans and specifications, and are familiar with the penalty imposed by Chapter 236 Section 14 RSA and amendments thereto.
13. Said permission may be conditioned upon the filing with the Selectmen of a Performance Bond or acceptable surety to secure the repair of said roads, streets, or highways damaged as a result of said operations in any amount and surety sufficient to cover the estimated costs of repairs as determined by the Selectmen and Road Agent. Said Bond shall be approved by the Town and conditioned upon the completion and guarantee of said repairs within a period specified by the Selectmen and expressed in said Bond.
14. I/We, the Owner, agree to save harmless the Town of Bradford from any and all claims arising from the construction of said Main Street and its appurtenances. A certificate of insurance shall be provided to the Town of Bradford. It must in full force throughout work scheduled and must name the Town of Bradford as an additional insured party for any claims that may arise from the work/actions resulting from the area covered by this permit.
15. Permission for the above-described construction, is granted, subject to the instructions, regulations, conditions and agreements above. It is void and to no effect pending filing of said Surety Bond with the Selectmen of Bradford.
16. In case of an emergency that requires excavation of any street or sidewalk in Town, the following must be notified: Bradford Police, Road Agent, and Dig Safe. The following business day a complete Trench Permit must be filled out and all of the conditions must be met.
17. Work to begin:__________________________________
Work to end:_________________________________
18. Dig Safe Approval #_______________________ Date: ______________________
19. Certificate of Insurance to be provided before work begins. The Town ofBradfordis to be named as an additional Insured for each location as it applies to this project.
Company Affording Coverage________________________________________
B. Licensing Requirements
In accordance with the provisions of Chapter 231, Sections 160-182, of the NH Revised Statutes Annotated and amendments thereto, any person, co-partnership or corporation desiring to erect or install any telegraph, television, telephone, electric, light and electric power poles and structures and underground or pole supported conduits and cables must also obtain a license from the Town of Bradford Selectmen.
THE FOLLOWING TOWN OFFICIALS MUST BE NOTIFIED NOT LESS THAN FIVE (5) WORKING DAIS BEFORE CONSTRUCTION BEGINS:
1. Selectmen’s Secretary _________________________________
Telephone: 938-5900 Signature
2. Road Agent Telephone: 938-5916 Signature
3. Police Chief Telephone: 938-2522 Emergency: 938-2422 Signature
Uniformed officer required: at a rate of $____________
Yes______ No_______
Flag person required:
Yes______ No_______
PERMIT HOLDER BRADFORDBOARD OF SELECTMEN
Signature Signature
Address Signature
Date Signature