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2. 
4. RIGHT-OF-WAY CONSTRUCTION PERMIT APPLICATION
8. APPLICANT (please print or type)
10. Applicants Name*
12. Telephone
13. Contact Name
15. 24 Hr Emergency Number
16. Fax Number
18. Address
19. City, State, Zip
21. Email Addresses

    _{*(List any email addresses where permit should be sent.)}  

25. CONTRACTOR (if different from applicant)
27. Contractor
28. Telephone
30. Contact Name
31. 24 hr emergency number
33. Address
34. Fax Number
36. City, State, Zip
40. FACILITIES OWNER (utility company)
42. Owner
43. Telephone
45. Contact Name
46. Cell Number
48. Address
49. Fax Number
51. City, State, Zip
55. SITE INFORMATION
57. Site Address Or Description of Site*
59. Lot:
60. Block:
62. Subdivision
64. Intersecting Streets *
66. Construction Date*
    Construction Date
    From
67. Construction Date*
    Construction Date
    To
71. WORK DESCRIPTION
    check all that apply
73. Utility

    1. Water
    2. Sewer
    3. Gas
    4. Electrical
    5. Telephone/Fiber Optic
    6. CATV
    7. Other (specify below)
74. Type

    1. Service
    2. Main
    3. Manhole/Handhole
    4. Other (specify below)
75. Purpose

    1. Repair
    2. Replace
    3. New Install
    4. Other (specify below)
76. Method

    1. Open Cut
    2. Boring/Tunneling
    3. Overhead
    4. Other (specify below)
78. Affected Area

    1. Pavement
    2. Grass
    3. Curb/Gutter
    4. Sidewalk
    5. Driveway
    6. Alley/Apron
79. Length & Width of Pavement Cut
81. BRIEF DESCRIPTION OF WORK, INCLUDING REMOVAL OF ANY PAVEMENT, CURB, GUTTER OR SIDEWALK, OR DISRUPTION, MOVEMENT OR CONNECTION TO CITY OR PRIVATELY OWNED UTILITIES*
85. INDICATE THE PROPOSED WORK AND EXISTING UTILITIES ON ATTACHED DRAWINGS, SKETCHES OR ENGINEERING PLANS OF THE SITE. DEFINE THE ENTIRE WORK AREA, INCLUDING ANY REQUIRED TRAFFIC CONTROL PLAN.
87. Upload Files Here*
91. FOR LOCATES CALL: (allow 48 hrs for completion)
    DIG TESS- 1-800-344-8377/ CITY OF CANYON- 806-655-5011
95. GENERAL REQUIREMENTS
97. Application for right-of-way construction permit must be submitted to the Public Works Department a minimum of five (5) business days prior to proposed start of construction. No fees will be assessed for the permit, unless it is lost. If the permit is unavailable at the job site during final inspection of the work, it will be determined to be lost and will require a fee of $25.00 for replacement. The work will not be approved until the Applicant presents a valid permit at final inspection.*

    1. I agree
99. Applicant/Contractor's proof of insurance is attached or is on file with the City of Canyon Public Works or Planning and Development Departments. Insurance requirements will be evaluated on a case by case basis.*

    1. I agree
101. Attach Proof of Insurance Here
     (if not already on file with the City of Canyon)
103. Three (3) copies of plans/drawing(s)/sketch(s) illustrating the proposed work must be filed at the time of application with the Public Works Department showing all proposed improvements and their locations and elevations relative to all existing public and private utilities/infrastructure affecting the issuance of this permit. Upon completion of work, Applicant will have 60 days to furnish "as Built" drawings to the Public Works Department indication deviations or changes made to the original plans.*

     1. I agree
105. Confirmation that all affected underground utilities have been located (Dig Tess confirmation number and verification of "on the ground" markings) will be required prior to issuance of a permit*

     1. I agree
107. Applicant/Contractor to give City of Canyon Public Works Department at least 48 hours notice prior to start of construction.*

     1. I agree
109. A permit will be valid for 90 days from the issuance date below. If the Applicant fails to act upon the permit within this time, an extension or re-application will be required.*

     1. I agree
111. Applicant/Contractor has read and understands all conditions and requirements, whether attached hereto or contained in City codes and ordinances.*

     1. I agree
113. The Public Works Department will inspect the construction and issue acceptance/rejection upon completion. Acceptance / rejection will be noted in writing by the inspector on the permit form. Acceptance by the City does in no way relieve the Applicant of their construction warranty obligations.*

     1. I agree
115. In the event of City rejection of the work, Applicant will have five (5) business days to initiate correction of the substandard or rejected work. If repairs have not been initiated within this time, the City may make the repairs wholly at the applicants expense. Reimbursement to the City for repairs will be due within 30 days.*

     1. I agree
117. The City of Canyon Public Works Department or the Applicant can request a pre-construction meeting attended by all parties / entities involved with the proposed work.*

     1. I agree
119. If the work performed by the Applicant is connected to a project involving a Certificate of Occupancy (CO) from the City of Canyon Planning and Development Department, all disturbed right-of-way areas must meet the conditions of this permit before a CO may be issued.*

     1. I agree
121. In case of emergency where construction in the right-of-way must occur, the Public Works Department will exercise discretion in permitting, but , application for a permit is required the next business day after such constructions begins / occurs.*

     1. I agree
123. WARRANTY OF WORKMANSHIP AND MATERIALS: The applicant shall be responsible for any failure(s) of workmanship and/or materials for a period of one (1) year from the date of completion of all work performed under this permit*

     1. I agree
127. CONDITIONS UNDER WHICH PERMIT IS GRANTED

     GENERAL: The receiver of this permit expressly agrees to do all work subject to approval of the Public Works Department, in accordance with the City of Canyon Standard Specifications, Code of Ordinances and in accordance with all conditions and regulations herein (specifically Chapter 157, City of Canyon Code of Ordinances). Concepts and contents of approved drawing(s) / sketch(s) are to be strictly adhered to. Any unapproved deviation from the approved drawings or standards will be sufficient cause to have the work stopped or reconstructed at the expense of the Applicant. The City reserves the right to reject any application should the City determine that said construction and/or use will present a public health or safety issue or interfere with current or future use of the right of way or is an inappropriate use of the applied for location. A copy of the permit is required on the job site at all times. EXCAVATIONS: It is the intent of the City to prevent or minimize excavations that remain open during the overnight hours. All excavations that must remain open after sundown must be approved by the Public Works Department and be properly marked / barricaded according to approved trench safety and traffic control measures. Approval for overnight, planned, open excavations will not be issued after 3:00 P.M. of the day of the planned opening. Discretionary approval by the City will be used during emergency situations. Excavations shall be properly backfilled in the event that approval is not granted or is not requested prior to the above deadline. No public or private driveways will be allowed to remain blocked overnight, unless agreed to by the affected parties. Excavated material and earth must be stored in a safe manner such that there is minimal disruption to the flow of traffic. Extra or surplus material shall be removed from the right-of-way within 48 hours after completion of the work. Any violation of these conditions will be deemed sufficient cause to refuse further permits to the party or parties violating same, and all repairs deemed necessary will be made by the City. The costs of the repairs will be charged to the party or parties to whom the permit was issued, and all further applications for permits will be refused until payment of these charges is received. EXCAVATION IN PAVED AREAS: One half of the roadway must be kept open to traffic at all times and under all conditions, unless a City approved street closure / traffic control plan is in place. Any pavement removed will be temporarily restored immediately, so that full traffic flow may be restored overnight. The pavement shall be permanently repaired within ten (10) days by the party, or parties making the pavement cut. Pavement repairs for street excavations shall be made as shown in the Standard Details and Standard Specifications, available on the City’s Engineering Division Website (www.canyontx.com). Contractors making such repairs shall be responsible for maintenance of said pavement patches during the warranty period discussed above. Temporary pavement patches may remain in place for extended periods, only due to inclement weather (winter), until weather suitable for paving occurs. All pavement repairs are subject to approval of the Public Works Department or the City Engineer. LANDSCAPED AREAS: All grass, lawns, shrubbery and other landscaping materials must be carefully protected or removed and, upon completion of the work, shall be repaired / replaced to a condition equal to or better than was existing prior to any construction. All landscaping repairs must be approved by the Public Works Department or the City Engineer prior to final acceptance. LOCATE REQUIREMENTS: In order to reduce the disruption and cost of utility damages occurring in the City’s right of way and easements, the Applicant shall prevent damages to existing utilities caused by his work through field verification of the existing utilities. In any case, whether open excavation or through trenchless technologies, verification must be performed prior to the commencement of the Applicant’s work. The Applicant shall verify the location of existing utilities as needed to avoid contact. Existing utilities shall be exposed to confirm location and prevent conflicts with the proposed project construction. In the event that any marked utilities are not found prior to construction beginning, the contractor is required to contact the appropriate entity for assistance in pinpointing the location of the utility before proceeding with any construction activities.  The Applicant shall be held liable for damages caused to the City’s utilities / infrastructure and the existing facilities of other utility companies. UTILITY RELOCATION: In the event that a City utility relocation is required, or should the City require relocation to accommodate any improvements or construction involving the right of way, the Applicant and the utility owner shall assume responsibility and incur the associated costs of relocating the City’s utility. The Applicant and utility owner shall cooperate fully with the City if a utility relocation is required by the City and shall provide all information and perform all relocation in an expeditious manner so as to avoid any delays to City services or the permitted project. ROW Permit-6 OBSTRUCTIONS: Regardless of the right of way width, unnecessary above ground obstructions will be prohibited in the public right of way. Necessary items such as mailboxes, City approved landscaping materials, traffic / street signage and other utility facilities (pedestals, markers, etc.) will be allowed and subject to City approval prior to construction. Any intended, potential obstructions shall be indicated on the plans / sketches submitted with the permit application. APPROVAL / PERMITS FROM OTHER AGENCIES: This permit, when granted by the City of Canyon, in no way releases the Applicant from their responsibility to notify and/or conform to the regulations / requirements of other agencies or companies affected by this construction, including but not limited to obtaining required permits or permission to operate in the right-of-way or other area under the control of another entity. Failure to obtain the proper permits and /or permission from other entities will be grounds for revocation of this permit application.

129. I agree to the above conditions*

     1. I agree
133. CERTIFICATION
135. I certify that I have read and understand the City of Canyon Code of Ordinances as it pertains to construction, site maintenance and restoration in the public rights-of-way, the attached requirments and conditions, the liability to the City of Canyon and: Applicant shall indemnify and forever hold harmless the City of Canyon against each and every claim, demand or cause of action that may be made or come against it by reason of or in any way arising out of the closing, blocking, excavating, cutting, tunneling or other work by the applicant under this permit from the City of Canyon, if such permit is granted, unless otherwise provided in law and; Applicant shall indemnify and forever hold harmless the City of Canyon from responsibility of any re-construction, maintenance, or repair of a private utility or improvement installed or allowed by this permit that is located within any public right-of-way.*

     1. I agree
     2. I disagree
137. Signed*
     Applicant or Authorized Agent
138. Print
140. Title
141. Company*
143. Date*
     Date
149. For City Use
Leave This Blank:


161. 1. Receive an email copy of this form.
162. Email address

     This field is not part of the form submission.

163. Submit Submit and Print

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