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Encroachment Permit Application - Utility Companies 7.1.20Please submit to the Engineering Department (805)773-4656 For questions or submittal of requirements email mkacsinta@pismobeach.org rev. 7/1/2020 ADDRESS OF PROJECT LOCATION: UTILITY COMPANY: ADDRESS: CITY/STATE/ZIP: CONTACT PERSON: TELEPHONE#: Please circle type of telephone: Cell / Office / Home Is the utility company hiring a 3rd party contractor to perform the work or install traffic control? Yes / No (If yes, please fill out contractor information below – insurance certification will be required) CONTRACTOR: ADDRESS: CITY/STATE/ZIP: CONTACT PERSON: TELEPHONE#: CONTRACTOR LICENSE #: LICENSE TYPE: CONTRACTOR LICENSE EXPIRATION: CITY BUISNESS LICENSE #: START DATE: ________________END DATE:__________________USA #:________________________ DESCRIPTION OF WORK: Please indicate how the project will affect City infrastructure (i.e. remove and replace sidewalk panel(s), trench into roadway, and/or traffic control) ENCROACHMENT PERMIT SUBMITTAL CHECKLIST (to be filled out by City Employee) All of the following items must be submitted prior to issuance of encroachment permit: ❑ Application (All information completed) ❑ Permit Fee of $218 (Surface), $477 (Subsurface), $67 (Minor; not requiring inspection), $1,033 (Annual; routine maintenance less than 30 sqft), No Fee (work performed under annual permit) or $1,033 (Large projects up to 300 sqft of trenching; +$2/linear foot for additional linear feet) ❑ USA Number ❑ Start and End Date of Project (This may be updated at a later date if necessary) ❑ Proof of Liability Insurance in the amount of $1,000,000.00 naming the City of Pismo Beach as additionally insured ❑ Liability Insurance endorsement sheet ❑ State Contractors License Number and Expiration ❑ Business License with the City of Pismo Beach (Annual Fee Contact Finance Dept.) (One-time Fee $14) ❑ Traffic Control Plan/Pedestrian Control Plan ❑ Signature of Applicant or Contractor on City Approved Permit UTILITY COMPANY ENCROACHMENT PERMIT APPLICATION ENGINEERING DIVISION Please submit to the Engineering Department For questions or submittal of requirements email mkacsinta@pismobeach.org rev. 7/1/20 REQUIRMENTS 1. Encroachment Permit Requiring Inspections: Fee $218 (Surface); $477 (Subsurface); $1,033 (Annual); $1,033 (Large Projects up to 300 sqft, + $2/foot for each additional linear foot) Encroachment Permit Not Requiring Inspections: Fee $67 (Minor) 2. Security Bond (See dollar amounts specified below) 3. USA Number 4. Start and End State of Project (This may be updated at a later date if necessary) 5. Proof of Liability Insurance in the amount of $1,000,000 naming the City of Pismo Beach as additionally insured with endorsement sheet attached. 6. State Contractors License Number and Expiration Date. Contractors may only perform work in which their license specializes General (A: Any Work); Concrete (C-8); Earthwork and Paving (C-12); Parking and Highway Improvement (C-32); Pipeline (C-34) 7. A Business License with the City of Pismo Beach. 8. Traffic Control Plan/Pedestrian Control Plan. 9. Signature of Applicant or Contractor stating that they have read “The Permit” statement under the general provisions and understand the permit requirements. CALL FOR AN INSPECTION: 24 Hour Advance Notice for all Inspections (805) 773-4656 ALL WORK MUST CONFORM TO CITY STANDARD DRAWINGS – Ask for a copy today! ❑ Notification once traffic control is set up ❑ Prior to placement of dumpster/storage container in street ❑ Upon removal of dumpster/storage container in street ❑ Prior to backfill in trench ❑ Prior to Water Main connection ❑ Prior to Sewer Man connection ❑ Prior to Asphalt/Concrete pour (95% compaction test or 2 sack slurry report due at this time) ❑ Prior to Concrete pour (95% compaction test due at this time; rebar set) ❑ Prior to completion of work for Final Inspection ❑ 30 after Final Inspection for Bond Release Inspection SECURITY DEPOSITE BONDS REQUIRED* All bonds subject to release 30 days after final inspection (Contractor/Owner responsible for calling (805)773-4656 for a bond release inspection) Minor Encroachment Permits Minimum Bond = $500.00 Surface Encroachment Permits Minor Sidewalk = $1,000 (<20’) Driveway Approach (<16’) = $1,500 Major Sidewalk = $1,500 (>20’) Drive Approach (>16’) = $1,500 + $50 / per foot over 16’ Unimproved City Right-of-Way = $1,000 Subsurface Encroachment Permits Water (up to 2 inches) or Sewer Lateral (up to 4 inches) = $2,500 Water Main (over 2 inches) or Sewer Main (over 4 inches) = $5,000.00 Street Crane = $1,000.00 minimum ENCROACHMENT PERMIT REQUIREMENTS & INSPECTIONS