RequestTracker Forms • Right of Way Construction Permit

Right of Way Construction Permit

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Please complete the Town of Avon Right of Way Permit Application below.
Make sure to have the following ready to upload at the end of the form...
- Upload Documents showing $2000 Bond (Single) or $10,000 Bond (Blanket) Naming the Town of Avon as "Additional Insured" (required)
- Upload Documents showing Map/Image of area (required)
- Upload Documents showing Traffic Plan (if required)

Todays Date*

Right of Way (ROW) Inspection and Administration Fee: $200 + $0.50 per linear foot if the length is greater than 100 feet

Your Name*

Your Phone Number*

Your Email*

Please provide the following address information based on the LOCATION for the permit.

Street Number*

Street Name*

Address Line 2

City*

State*

Zip Code*

Sub-Contractor Information

Sub-Contractor Business Name or Individual Name

Sub-Contractor Address

Sub-Contractor Phone Number

Location of Work (Address or Nearest Intersection).
If you don't have the exact address, please provide the closest intersection.

Work Details and Location

Type of Work (check all that apply)*

	Cut
	Bore
	Trench
	Water

	Gas
	Electric
	Sewer
	Other

Utility Company (e.g. Centerpoint, AT&T, Citizens, etc.)

If "Other" was selected above, please explain

Lineal Feet Within Avon Right Of Way*

Approximate Start Date*

Approximate Completion Date*

As a condition of this permit you will be required to relocate the proposed facilities at the time and to a place approved by the Town within 60 days of notification to proceed with relocation. The Cost of relocation will be at the permit holder / Utility’s expense. If relocation isn’t completed within 60 days the Town reserves the right to remove or relocate the facility. The expense incurred by the Town to perform all related work to relocate or reconnect will be at the expense of the permit holder / utility. The Permit holder agrees to reimburse the Town within thirty (30) days of its receipt of notice of the amount of such expense.

This permit is not intended to replace permission of property owners. It is the permit holder’s responsibility to confirm that all work taking place is within the Right of Way and that it has received all other applicable licenses, permission and authority to perform the work.

The permit holder shall have permit on site during construction and should be able to show the
permit to inspector from the Town or to residents who inquire to the activity taking place.

NOTE TO APPLICANT

1. Bond amount will be determined by staff and is required before starting. (Minimum $2000 Bond (Single) or $10000 Bond (Blanket))

2. Beginning work without a permit or working without an inspection triggers a multiplier for the permit fee. The multiplier for the first offense is 2, second offense is 3 and so on. For example, The fee for a first offense for a calculated permit fee of $285.00 would be: $285.00 x 2 = $570.00; the second offense for the same calculated permit fee of $285.00 would be: $285.00 x 3 = $855.00; and so on. In addition to these fees, any work performed without the Town inspection personnel present may be required to be removed and reinstalled with inspection by the Town.

3. No open cut of pavement is allowed without written approval on the permit. Any approved open cut of pavement shall be repaired in compliance with the Town of Avon Standard Drawings. The limits of paving over the open cut shall be edge of pavement to edge of pavement, 50 LF longitudinally from the edge of the trench in both directions. If the edge of trench is less than 50 LF from an intersecting road, the projected edge of pavement of the intersecting road will be the limit in that direction. The pavement tie-in detail shall be inspected prior to paving. No trenches are to be left open overnight. Trenches must be paved within seven (7) days of projected start date or actual start of work, whichever is earlier. If work is not completed as specified above, a new permit must be obtained, with a new projected start date. Any work not completed within 28 days will be subject to a $200 per day fee, not as a penalty, but for daily inspection and administrative costs.

4. Road closures along with traffic control plans are to be communicated in writing 72 hours before the closure is to take place, which will be emailed to smoore@avonindiana.gov and bporter@avonindiana.gov. This Permit conveys no right to occupy any street or public right of way, either temporarily or permanently, unless prior written approval from the Public Works Director has been issued. In order to arrange an inspection for us to verify the proper installation of traffic control devices and witness flagger operations, the actual date and time of the closure needs to be requested in writing 72 hours in advance of the closure. By doing this we are able to review for conflicts with school bus traffic and emergency vehicle routes. Once approved, we are then able to coordinate with schools/emergency dispatch and schedule staff for the inspection.

5. Barricades or flaggers (if necessary) are required.

6. “Road Closed” and/or “Road Construction Ahead” signage is required.

7. Call 3172720948 24 hours before backfilling the trench and before paving. The Town reserves the right to inspect all restoration operations. The contractor shall provide density test/ compressive strength reports from a third party for each lift of material placed. Reports shall contain depth and material placed for each lift. Reports shall be available on-site and furnished on-demand or at final inspection.

8. Drawings SHALL be dimensioned to delineate the lineal feet of work within Avon Right Of Way.

DOCUMENTS UPLOAD

Upload Documents showing $2000 Bond (Single) or $10,000 Bond (Blanket)*

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

Upload Documents showing Map/Image of area, as well as exact Right of Way measurements.*

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

Upload Documents showing Traffic Plan

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

APPLICANT CONFIRMATION

All information provided in this Right of Way Construction Permit is correct, and I knowingly complete the information fields below to attest and confirm that.

Applicant Name*

Company Name

Address*

Title*

Today's Date*

STREET CUT REPAIR STANDARDS

Street cuts shall be repaired to the same or better condition as adjacent pavement. Utility appurtenance (pipe, cable, etc.) in trench shall be bedded per manufacturers’ recommendation. Trench shall be backfilled with compacted granular material, per Indiana Department of Transportation (INDOT) Specification Section 211 and/or with Flowable Mortar, Removable (low strength), per INDOT Specification Section 213. Backfill shall be placed up to the proposed subgrade elevation, or, with the Town’s approval, even with the adjacent pavement (temporary). Asphalt and/or concrete SHALL NOT be allowed as backfill material.

Street Cuts in Asphalt Pavement –
Asphalt pavement adjacent to the street cut shall be saw-cut full-depth and removed one foot wide beyond each edge of the trench. Asphalt pavement shall be surface-milled a minimum of five feet wider than the trench (or to the limits of the existing pavement), parallel with Road Centerline, from the saw-cut edge, each side of the trench, for the entire length of the trench, at a minimum depth of one and one-half (1.5) inches. The edges and milled surfaces of the existing pavement shall be tack coated and allowed to cure prior to installation of HMA materials. HMA pavement sections shall then be installed as listed below. Concrete is NOT permitted in asphalt pavement.

Street Cuts in Concrete Pavement –
Concrete pavement adjacent to the street cut shall be saw-cut full-depth and removed to the closest pavement joint adjacent to the trench. Dowels shall be installed per INDOT Standard Drawing 503-CCPJ-07 (if longitudinal trench) or 506-CCPP-01, (if a transverse trench). 1/2” Expansion joint material shall be placed around all interfaces with adjacent fixed objects, full-depth. Concrete pavement sections shall then be installed as listed below. Cured concrete joints shall be sealed with an approved crack seal material.

Local Streets –
1.5” 9.5 mm HMA Surface over
3.0” 19.0 mm HMA Intermediate over
8.0” Compacted Aggregate for Base, No. 53 (stone) over Compacted Subgrade or Flowable Mortar
OR
1.5” 9.5 mm HMA Surface over
6.0” 25.0 mm HMA Base over Compacted Subgrade or Flowable Mortar
OR
Cement Concrete Pavement, Plain, 6.0 inch over 6.0” Compacted Aggregate for Base, No. 8(Stone) over Compacted Subgrade or Flowable Mortar

Collector or Commercial Streets –
1.5” 9.5 mm HMA Surface over
5.5” 25.0 mm HMA Base over
7.0” Compacted Aggregate for Base No. 53 (stone) over Compacted Subgrade or Flowable Mortar
OR
1.5” 9.5 mm HMA Surface over
4.5” 25.0 mm HMA Base over
4.0” 25.0 mm HMA Base over Compacted Subgrade or Flowable Mortar
OR
Cement Concrete Pavement, Plain 7.0 inch over 6.0” Compacted Aggregate for Base, No. 8(stone) over Compacted Subgrade or Flowable Mortar

Arterial or Industrial Streets –
1.5” 9.5 mm HMA Surface over
3.0” 19.0 mm HMA Intermediate over
4.5” 25.0 mm HMA Base over
8.0” Compacted Aggregate for Base, No. 53 (stone) over Compacted Subgrade or Flowable Mortar
OR
1.5” 9.5 mm HMA Surface over
3.0” 19.0 mm HMA Intermediate over 4.5” 25.0 mm HMA Base over
4.0” 25.0 mm HMA Base over Compacted Subgrade or Flowable Mortar
OR
Cement Concrete Pavement, Plain, 8.0 inch over 6.0” Compacted Aggregate for Base, No. 8(stone) over Compacted Subgrade or Flowable Mortar

*Please note that concrete is used for concrete pavement ONLY.

* indicates required fields.

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