Road Opening Permit Application

APPLICATION FOR ROAD OPENING PERMIT

Application for permission to make any opening or cause any opening to be made in any in any public street, boulevard, highway, public alley or sidewalk in the Borough of Prospect Park for the purposes of making any connection with any sewer, water, or gas main, pipe or conduit or for the erections of any pose for any other purpose.
Date:

MonthDayYear
Date
Name:
Company/Organization:
Address:
Phone Number:
24-Hour Emergency Phone Number:
Location of Opening:
Block
Lot
(Attach drawing showing curbs, drainage structures, driveways, property lines and any other relevant information. Include measurements from street intersections, utility poles or other landmarks.)
Length and Width of Opening:
Number of Square Yards of Surface to be Opened:
Cubic Content of Surface to be Excavated:
Purpose of Road Opening/Work:
Proposed Date of Commencement:

MonthDayYear
Date
Estimated Date of Completion:

MonthDayYear
Date
Additional Comments:
Application Submission Requirements:
1. Plan of proposed work. Include precise locations and depth of proposed utility installation; limit and extent of disturbance and critical existing site features. Also include location(s) of all existing utilities in the area of proposed construction obtained from the appropriate utility company. (2 copies)
2. $300.00 Permit Fee
3. Performance Bond of at least $1,000 to be released when all construction work is completed to the satisfaction of the Director of Public Works or the Construction Subcode Official and no defects or repairs exist within an eighteen-month period. OR
4. Bond of Utility in Lieu of Deposit of $2,000 without separate surety, naming the Borough of Prospect Park as obligee, conditioned upon compliance with the applicable provisions of this article with respect to each opening to be made by such public utility corporation in the Borough, which bond shall further provide that the obligation thereof shall be a continuing obligation to the full amount of the said bond for each opening.
  (FOR PUBLIC UTILITY CORPORATIONS ONLY)
Applicant/Agent of Applicant Signature
Owner of Premises/Agent of Owner Signature
Note: The person or corporation to whom any road opening permit is issued shall be fully responsible for providing proper signs, guards or lights or other safety devices to protect persons or property against injury and damage until the surface of the street is fully restored to its former condition.

The applicant shall indemnify and save harmless the Borough, its employees officers and agents, from any loss, cots or damages sustained by any person or persons by reason of such excavation or opening or by reason of the manner in which such excavation or opening is made, guarded or protected.
*Office Use Only*
Date Application Received:

MonthDayYear
Date
Date Permit Issued:

MonthDayYear
Date
Performance BondBond of Utility
ApprovalDenial
Signature
Date

MonthDayYear
Date
YesNo
Date Paid:

MonthDayYear
Date
Amount Paid:
ApprovalDenial
Signature
Date

MonthDayYear
Date
Should be Empty:

APPLICATION FOR ROAD OPENING PERMIT

*Office Use Only*

Office Use Only