Right-of-Way Permit Application

3. 

5. Pursuant to Section 11-1-2 of the Town Code, all applications must be submitted at least 5 working days prior to the start of construction, and shall be accompanied by at least 3 copies of a drawing, map, blueprint, diagram or similar exhibit sufficient to illustrate clearly the location, dimension, method, traffic control, and purpose of the proposed work. First review of application will be completed in typically 10-15 business days for non-emergency work.<br><br> Applicants for the permit may be either an owner or a contractor. However, the work may be performed only by a contractor, utility company, government agency, or property owner under certain circumstances.<br><br> Applicants shall deposit an amount in cash or a performance bond equal to 100% of the cost of the work proposed in the application as a guarantee that the work will be completed in accordance with the permit. The performance bond shall be in favor of the Town and shall state that the applicant will faithfully complete the work described in the application in accordance with the plan, specifications and conditions thereof.<br><br> A certificate of insurance naming the Town an additional insured shall be submitted at the time of application.

   Pursuant to Section 11-1-2 of the Town Code, all applications must be submitted at least 5 working days prior to the start of construction, and shall be accompanied by at least 3 copies of a drawing, map, blueprint, diagram or similar exhibit sufficient to illustrate clearly the location, dimension, method, traffic control, and purpose of the proposed work. First review of application will be completed in typically 10-15 business days for non-emergency work.
   
   Applicants for the permit may be either an owner or a contractor. However, the work may be performed only by a contractor, utility company, government agency, or property owner under certain circumstances.
   
   Applicants shall deposit an amount in cash or a performance bond equal to 100% of the cost of the work proposed in the application as a guarantee that the work will be completed in accordance with the permit. The performance bond shall be in favor of the Town and shall state that the applicant will faithfully complete the work described in the application in accordance with the plan, specifications and conditions thereof.
   
   A certificate of insurance naming the Town an additional insured shall be submitted at the time of application.

7. Applicant

9. Address

11. Contractor

13. Phone Number

14. Email Address

16. Sales Tax Number

17. Contractor License Number

19. Location of Right-of-Way Work

21. The applicant hereby agrees that all work done in the public streets shall be done in accordance with the permit and with the approved details and specifications of the Town and with all other ordinances, rules and regulations of the Town applicable to such work, including, but not limited to Section 11-1-2 of the Town Code which requires that the right-of-way be restored and repaired in accordance with Town standards and specifications and in such manner that it is returned as nearly as practicable to its original condition and to maintain such restoration and repair for a period of not less than 1 year after its completion.

    The applicant hereby agrees that all work done in the public streets shall be done in accordance with the permit and with the approved details and specifications of the Town and with all other ordinances, rules and regulations of the Town applicable to such work, including, but not limited to Section 11-1-2 of the Town Code which requires that the right-of-way be restored and repaired in accordance with Town standards and specifications and in such manner that it is returned as nearly as practicable to its original condition and to maintain such restoration and repair for a period of not less than 1 year after its completion.

23. Signature

    1. Signature

    By checking this box, I authorize my signature.

24. Signature Date
    Signature Date

26. No Open Cuts Without Town Approval

30. Row Permit Fees

32. Base Fee
    $50 per permit

33. Quantity
    -- Select One --12345

34. Fee Total

36. Water Line
    $.50 per lineal foot

37. Quantity
    -- Select One --12345

38. Fee Total

40. Sewer Line
    $.50 per lineal foot

41. Quantity
    -- Select One --12345

42. Fee Total

44. Storm Drain
    $1 per lineal foot

45. Quantity
    -- Select One --12345

46. Fee Total

48. Trenching in Paved Right-of-Way
    $.40 per foot

49. Quantity
    -- Select One --12345

50. Fee Total

52. Other Utility Trenching
    $.10 per foot

53. Quantity
    -- Select One --12345

54. Fee Total

56. Boring
    $2 per lineal foot

57. Quantity
    -- Select One --12345

58. Fee Total

60. Paving
    $.30 per square yard

61. Quantity
    -- Select One --12345

62. Fee Total

64. Curb & Cutter
    $.20 per lineal foot

65. Quantity
    -- Select One --12345

66. Fee Total

68. Sidewalk Ramps
    $.10 per square foot

69. Quantity
    -- Select One --12345

70. Fee Total

72. Driveway (New - Cut Into Existing Curb)
    $200 each

73. Quantity
    -- Select One --12345

74. Fee Total

76. Catch Basin
    $40 each

77. Quantity
    -- Select One --12345

78. Fee Total

80. Manhole
    $40 each

81. Quantity
    -- Select One --12345

82. Fee Total

84. Total Permit Fee

88. Plan Review Fees

90. First & Second Review (Required for Nonfranchise Agreements)
    $150 each permit

91. Quantity
    -- Select One --12345

92. Fee Total

94. Third & Each Subsequent Review
    $75 per sheet

95. Quantity
    -- Select One --12345

96. Fee Total

98. Sewer Line
    $75 per sheet

99. Quantity
    -- Select One --12345

100. Fee Total

102. Total Plan Review Fee

104. Total Permit Fee + Total Plan Review Fee

106. Work to commence within 90 days or permit becomes void. Permit expires in 180 days.<br><br> Call 480-488-3686 to arrange for inspection 24 hours in advance.<br><br> Final inspection is required upon project completion.

     Work to commence within 90 days or permit becomes void. Permit expires in 180 days.
     
     Call 480-488-3686 to arrange for inspection 24 hours in advance.
     
     Final inspection is required upon project completion.

108. Amount Paid

109. By Whom

110. Receipt Number

112. Date Paid
     Date Paid

113. Cash Deposit Amount

114. Bond Amount

116. Expiration Date
     Expiration Date

117. Certificate of Insurance Attached

119. Approved

     Town of Carefree

120. Approval Date
     Approval Date

121. Permit Number

123. Date Work Completed
     Date Work Completed

124. Date Bond / Cash Deposit Refunded
     Date Bond / Cash Deposit Refunded

Leave This Blank:


126. 1. Receive an email copy of this form.
127. Email address

     This field is not part of the form submission.

128. Submit

* indicates a required field