Road Work Permit Application

Road Work Permit Application

A permit is required to work inside of the City limits of Brentwood on Streets, Right-of-Way or Utilities. Approval of the application below is required before any work may commence.
Please allow a minimum of 72 hours for your application to go through the approval process from the date of your submission. Requests received less than the 72 hour project start date will delay your ability to start any work.

YOU MAY NOT START ANY PORTION OF YOUR PROJECT WITH OUT AN ACTIVE PERMIT. YOUR JOB WILL BE SHUT DOWN WITHOUT A PERMIT.

Permit Applications shall include the following:
1. Detailed plans using an aerial overlay to show building envelopes, right-of-way, and edge of pavement.
2. Where a traffic control plan is required, it shall be submitted with the permit application.
3. Emergency Contact information (Company Name, Representative, Phone, and Email Address)
4. Anticipated work schedule and duration.
5. Work within a State (TDOT) or Williamson County right-of-way shall include approval from the appropriate agency prior to submitting a permit application.
TERMS AND CONDITIONS FOR ANY ROAD WORK PERMIT THAT YOU ARE APPLYING FOR
DEFINITIONS

Road work that does not involve disturbing the surface of the street section in and/or around the ROW. .

Bore: A trenchless method to avoid the need for a traditional open-cut excavation to access or install underground infrastructure without disturbing the section.

Potholing: Non-cutting method to assist in identifying the location, depth, and type of burried utilities (like water lines, gas lines, electrical cables, etc.). Can be done using water pressure (hydro-excavation) or air pressure (air-excavation).

Road work that involves disturbing the surface of the street section in and/or around the ROW.

Open Cutting: Will not be the default method of accessing any hand hold, water line, gas line, electrical or fiber lines. Boring must be the first method and if proven to be unsucessful by the Director of Public Works, a cut permit may be issued.
Type of Permit you are applying for:*

Bore - ROW (right of way), pot hole to access established lineOther- this includes aerial, closures, maintenance, etc.
Type of Bore Permit you are applying for:*

BorePot Hole
Fee Structure for Bore or pot hole: First 100 linear feet =$100, each additional linear foot =$ .50*

I understand that I will be charged a fee for this permit based upon the structure above.
Bond Structure for Bore or pot hole: $25 per linear foot*

I understand that I will be charged a bond for this permit based upon the structure above.
This project will be covered by the following bond:*

We will be using our own company bondWe are authorized to piggy back off of:
This project will be covered by the following bond:*

We will be using our own company bondWe are authorized to piggy back off of:
Other:*

AerialLane ClosureInspectionMaintenanceSidewalk Closure
Fee: $0.00, Bond Structure: $25 per linear foot (covers any damages to curbing, street, landscape, etc.)*

I understand that I will be charged a bond for this permit based upon the structure above.
This project will be covered by the following bond:*

We will be using our own company bondWe are authorized to piggy back off of:
Name of Contracted Company responsible for project:*
Address of contracted company listed above:(include city, state and zip)*
Contact Name for questions regarding this application:*

First NameLast Name
Contact Phone No:*
Please enter a valid phone number.
This Phone No. is a:*
Project onsite Field Supervisor Name:*

First NameLast Name
Field Supervisors Cell Phone Number:*
This person must be available for any onsite project questions or concerns.
Email Address where INVOICE will be sent for payment:*
example@example.com
Email Address where PERMIT will be sent:*
example@example.com
Project Information
Street/House Number:*
IF no # available, put 0000
Street Name:*
IF the street you are looking for is not listed, it is not inside of the City limits of Brentwood and does not need to be permitted through our office. Please always call our office to verify this.
Closest Cross Street:*
Have ALL affected home/property owners been properly notified of the project and anticipated impacts:*

Yes they have beenWe are in the process but will be completed before the start of the projectThis project will not affect home/property owners
Purpose of work:*

ConnectInstallRepairReplaceRemoveRetireRewrapSplice
Utility or Service: (If you are unsure which one applies to your project, contact Jamie at 615.507.2763 for clarification)*

ADACableGasFiberSewerWater
Type of Work*

CommercialDriveway ExtensionNew DevelopmentNew DrivewayPrivate Property (will not be in ROW)ResidentialResurfacingUtilityOther
Length (in feet) or area of job:*
What is your TNOC Ticket Number?*
Anticipated Start Date:*

MonthDayYear
Anticipated Completion Date:*

MonthDayYear
Job Plan: Make sure your document clearly shows where you will be working, dimensions/lengths, approximate distance from the curb, etc. NO HAND DRAWN PLANS WILL NOT BE CONSIDERED.

These plans MUST clearly show the ROW and edge of pavement in relation to the work being done.
Cancelof
If your job plan is multiple pages, please indicate what page number we should start looking at in reference to this job to help expedite the search.
TDOT Permit:*

Cancelof
What hours will you be working at this location?

Depending on the job location, you may be restricted during peek hours, which are 5am to 9am and 4pm to 9pm, M-F. If this is a TDOT route you will restricted to their work hour schedule as well as the City's.
Daily Start and End Time:*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Will you be working on the weekend?*

YesNo
Does this job require a lane closure?*

YesNo
Aerial permits require that a Traffic Control Plan be attached in order to be considered for approval. Description of the traffic pattern clearly marked and all flags identified. NO HAND DRAWN PLANS WILL BE CONSIDERED.*

Cancelof
Traffic Control Plan: Description of the traffic pattern clearly marked and all flags identified. NO HAND DRAWN PLANS WILL BE CONSIDERED.*

Cancelof
All jobs, regardless of length, location, duration or reason, require that a current and valid Certificate of Insurance (COI) be on file with the office prior to the start of any work. If you are unsure if you have one on file with us, please contact Jamie Booker at 615.507.2763 or you may email at jamielee.booker@brentwoodtn.gov
- Bores and Cuts require a work or performance bond to be on file with the office prior to any work being started.
- Inspections, Maintenance, Lane Closure, Sidewalk Closure and Arial permits require a bond only. If any damages occur to landscaping, pavement, curbing, etc., you are responsible for those damages and will be required to correct any issues or you could be assessed a fee for those damages.
I understand the above statement and will ensure that the correct COI and Bond will be on file with the City prior to the start of the applied for project.*

Yes
Please feel free to add any notes here that may help with the approval process:
Signature*

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Road Work Permit Application

Please allow a minimum of 72 hours for your application to go through the approval process from the date of your submission. Requests received less than the 72 hour project start date will delay your ability to start any work.

Permit Applications shall include the following:

TERMS AND CONDITIONS FOR ANY ROAD WORK PERMIT THAT YOU ARE APPLYING FOR

Project Information

What hours will you be working at this location?