Honesdale Borough Chapter 179 -Streets and Sidewalks Application for Permit Permit #

Date work is scheduled to begin:

Approximate date when work will be completed:

Check Each Applicable Category: Application Fee

Supplement Fee (each 6-month time extension) (each submitted change)

Inspection Fees 1)Surface Openings - -This fee is calculated on the total linear feet of the opening being permitted with different areas of the right-of-way. Total linear feet of opening (each 100 feet increment or fraction thereof): $ 40.00 $ 80.00 Opening in shoulder Opening in pavement $ 20.00 Opening outside pavement and shoulder If a longitudinal opening simultaneously occupies two or more highway areas identified above, only the higher fee will be charged. Linear distances shall be measured to thenearest foot. 2)Surface opening of less than 36 square feet - for example, service connections performed independently of underground facility installation, pipe line repairs -- (each opening): $ 60.00 Opening in shoulder Opening in pavement $ 20.00 Opening outside pavement and shoulder If an opening simultaneously occupies two or more highway areas identified above, only the higher fee will be charged. 3)Aboveground facilities -for example, poles, or guys or anchors if installed independently of poles Up to 10 physically connected aboveground facilities (each continuous group) Additional aboveground physically connected facilities (each pole with appurtenances) 4)Crossings (for example, overhead tipples, conveyors or pedestrian walkways and undergrade $ 160.00 subways or mines) 5) Utility Sketch: All work will be completed as described and shown on the attached utility sketch. Payment The total permit fee will be calculated and all payments will be made by check made payable to: Borough of Honesdale, 958 Main Street, Honesdale, PA 18431

Non-emergency test holes in pavement or shoulder (each hole) $ 10.00

Honesdale Borough Chapter 179 -Streets and Sidewalks Application for Permit Permit #

To Be Completed By Honesdale Borough Official:

If the Borough anticipates that the cost of viewing the required application information or inspectingthe permitted work will exceed the application or inspection fees listed by a significant amount, the following additional fees will be assessed:

1) Additional Application Fee The Borough will estimate the additional amount of salary, overhead and expenses and prepare a reimbursement agreement for execution by the applicant. Borough review of the permit application will commence on the effective date of the agreement.

2) Additional Inspection Fees If the Borough determines that the permitted work is of sufficient magnitude or importance to warrant assignment of one or more persons to inspect the permitted work on a more than spot inspection basis, the permit will SO indicate and the permittee shall be charged for additional salary, overhead and expenses incurred by the Borough for inspection.

3) Charge Calculation The charges will be calculated either on an actual cost basis or a standard unit cost basis.

4) Invoices The Borough will provide an itemized invoice for additional fees owed to the Borough.

Restoration shall be competed pursuant to Chapter 179, streets and sidewalks, Article IV, excavation, Section 179-23 J, but in every instance, full and complete restoration, mill and pave shall be completed within ninety (90) days of project completion.

Utility Sketch Utility Sketch Approved as Submitted.

Borough Official Signature - Date Reason for Denial:

(Ft. North, South, East, West)

Honesdale Borough / Utility Sketch - Surface Opening

Telephone:Distance (feet) to Nearest Intersection:

Typical SectionShow Location and Size of Line and Depth of Facility

Type of Pavement:BituminousConcreteStabilized

Concrete w/ Bituminous Surface

7. All backfill material must be in compliance with Chapter 179 of the 4. Submit at least three sets of plans as detailed in Chapter 179 of the 1. Show location and dimensions of surface openings (sketched2. Show related highway features (poles, inlets, guiderail, pipes,8. The permittee shall notify the Borough at least one business day in proportionallymanholes, mains, laterals, bore pits, etc3. Show intersection when applicable.Code of the Borough of Honesdale.6. All Openings must be saw-cut and work done in accordance toChapter 179 of the Code of the Borough of Honesdale.Code of the Borough of Honesdale.advance of the backfilling of and excavation permitted.9. Restoration must be done in accordance with Chapter 179 of theCode of the Borough of Honesdale. 5. Submit a detailed Traffic Control Plan.

Note: - Except for permits issued for emergency repairs, no permits

will be issued between November 1 of a given calendar yearand April 1 of the subsequent calendar year.

SCOURS 408INFORMATION OF STAPLE WEETMARIERA THE NOOR 8 MAA

ph: 670.868.0275 Pottsville, PAph: 570.628.5855Mountain Top, PA 45. Fourth StreetReading, PA 19603ph: 610.373.6667be 610.373.7537www.entecheng.comNAME

Pottsville, PAph: 570.628.5655Mountain Top PAph: 570.868.0275 Entech Engineering Inc.4S. Fourth StreetReading, PA 19603ph: 610.373.8667he 610.373.7537www entechang.cNAME

BOUROUGH OF HONESDALESTREET OPENING PERMITDRAWING NO.DATE:02/06/2008SK-003NONE

12" WIDE BITUMINOUS SEAL.PG 64-22 (TYP

NOTE: EXISTING 4" WIDESHALL BE REPLACED DOUBLE YELLOW LINESIF DISTURBED.

Mountain Top, PA Poltsville, PAph: 570.628.5655ph: 570.868.0275 4 S. Fourth StreetReading, PA 19603ph: 610.373.6667fx: 610.373.7537www.antechang.comNAME