Street Closure for Construction Application

Street Closure for Construction Application
APPLICATIONS MUST BE SUBMITTED AT LEAST SEVEN (7) BUSINESS DAYS PRIOR TO THE REQUESTED CLOSURE DATES.

LATE SUBMISSION MAY REQUIRE RESCHEDULING.
Applicant's Name:*

First NameLast Name
Company*
Applicant Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Email:*
example@example.com
Is the Contractor the Same as the Applicant:*
Contractor Name:*
Company:*
Contractor Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contractor Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Contractor Email:*
example@example.com
Project Location/Address of Closure*
LocalCollectorMinor ArterialMajor ArterialAlley
Map of Street Classifications
Partial Closure (lane reduction)Full Closure
YesNoOther
Have you been contracted by the City of Dickinson or NDDOT to do this work?*
Length (linear feet) of Closure:*
Explanation of Project and Traffic Control Measures to be used:*
Please provide on traffic control plan:
- CANNOT BE HAND DRAWN
- STREETS MUST BE LABELED
- Proposed detours
- Locations of traffic control devices & signs
- Must clearly show start and end of closure
Traffic Control Plan/ Detour Route (attach): *

Applications with missing information will be rejected
Cancelof
Dates of Street Closure

7 Day Maximum
Start Date:*

MonthDayYear
Date
End Date:*

MonthDayYear
Date
I agree to abide by the laws, ordinances, and regulations pertaining to this permit. Barricades and Traffic Control Measures are the responsibility of the owner/contractor.

CLOSURE CANNOT BEGIN UNTIL NOTIFICATION OF APPROVAL OF THIS APPLICATION

Fee Schedule: (City will Determine Fee)

	Full Closure	Partial Closure
Local Street	$100	$50
Collector Street	$500	$100
Arterial Street	$1,000	$250

Fees

Signature*

Clear
Date*

MonthDayYear
Should be Empty:

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Street Closure for Construction Application

Dates of Street Closure