Road Occupancy Permit Application

APPLICATION/
PERMIT NUMBER
TOWNSHIP OF ESSA
PUBLIC WORKS DEPARTMENT
ROAD OCCUPANCY PERMIT
APPLICATION FORM
(Please Print)
Application Date:
APPLICANT INFORMATION
Phone Number
Applicant Name
Mailing Address
Fax Number
24 Hr. Contact 1:
24 Hr. Contact 2:
Name:
Name:
Phone number (
)
Phone number (
Email address
)
Email address
OWNER INFORMATION
Phone Number (
Utility/Property Owner Name
Mailing Address
)
Email address
ACTIVITY LOCATION
Date of Occupancy (end date)
Date of Occupancy (start date)
A sketch of the specific property/area must be completed.
indicate north
House No.
Road Name
Road Name
…………………………………………………
Boulevard
Road Name
Cut Location
Length
Width
Area
Depth
Road
Shoulder or Boulevard
Sidewalk (draw on map)
ACTIVITY INFORMATION
The purpose of the Occupancy is:
 Excavation  Building  Utility  Sanitary Sewer  Municipal Water  Enclose Ditch
Traffic Restrictions:
 As required
 None
 Lane
 Full
Traffic Plan Provided 
Date:
AGREEMENT
I, the undersigned have read and understood the information provided and agree to abide by all
general conditions, special provisions and all conditions listed on the face and back of this Permit
Application and Permit, if issued.
Authorized
Representative
Signature
Date
Fee $ …………..
Receipt # ……..….
Deposit $ ……….
Sheila Perri, Engineering Development Review Technician
Email: [email protected]
Fax: 705-424-2367
Receipt # ……….
Date
CONDITIONS OF APPROVAL
The following conditions shall apply in all cases when work is intended to be carried out on a Township Municipal
Road Allowance:
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Any person or persons intending to occupy or perform work on Township of Essa property, must first apply to the Public
Works Department for a Road Occupancy Permit. Approval must be obtained from the Manager, or his/her designate,
prior to the commencement of work.
The permit must be in the name of the person or persons performing the intended work, and not in the name of an agent
acting for them. The Applicant must indicate the intended starting date and duration of such closure or occupancy, at
least 48 hours in advance of starting the work described in the permit. Where time extension is required, the holder of
this permit shall apply for such extension at least 24 hours in advance of the stated date of re-opening. Time extensions
must be authorized by the Manager of Public Works or his/her designate, before taking effect. Failure to comply will
render this permit void.
The Applicant and/or the Contractor shall have and/or take out and keep in force, a comprehensive policy of public liability
and property damage insurance acceptable to the Municipality, providing insurance coverage in respect of any one
accident to the limit of at least $1,000,000. exclusive of interest and cost, against loss or damage resulting from bodily
injury to, or death of, one or more persons and loss of or damage to property and such policy shall name the Municipality
as an additional insured thereunder, and shall protect the Municipality against all claims for all damage or injury including
death to any person or persons, and for damage to any property of the Municipality, or any other public or private
property, resulting from or arising out of any act or omission on the part of the Applicant, or any of his servants or agents
during the course of the intended works, and final acceptance thereof by the Manager of Public Works. The Applicant
shall forward a certified copy of the policy or certificate thereof, to the Township of Essa, before the work is started.
The Applicant, his agent or Contractor, shall abide by all Acts, By-laws and Regulations relative to the performance of the
work and the Applicant and/or the Contractor shall provide all necessary excavating and trenching support systems,
shoring, timbering or other devices to conform therewith.
The Applicant and/or Contractor shall provide and ensure that all agents, workmen and servants, are wearing the
prescribed safety equipment, to conform with all Acts, By-laws, and Regulations (ie: hard hats, safety boots, vests, etc.).
The permit becomes null and void if the Applicant and/or the Contractor should fail to meet the requirements of the permit,
in which case, the Manager of Public Works or his designate shall take such action as he deems necessary to reinstate
the site for public protection, at the expense of the Applicant. In all cases, the decision of the Manager of Public Works is
final.
All barricades, signs, signals, flagmen, traffic control devices, detour design and signing shall meet the requirements of
the Ministry of Transportation’s Manual of “Uniform Traffic Control Devices”, and shall be the sole responsibility of the
Applicant and/or the Contractor.
The Applicant and/or the Contractor shall maintain access to all public and private properties for the duration of the work.
Any and all excavated materials may not be piled in such a manner as to obstruct vehicular or pedestrian traffic.
It shall be the Applicant’s and/or the Contractors responsibility to request marking or other location information, to
determine the location and provide safeguards for all utilities, both public and private, in accordance with current
regulations.
Depending on the depth of a sewer lateral or trunk line, and/or watermain, the Applicant and/or Contractor may be
required to provide and operate a proper de-watering system, satisfactory to the Manager of Public Works prior to
excavation being carried out. As well, an additional well point placed in the general area of the works may be required to
monitor the elevation of the water level in relation to the Municipal watermain or sewer trunk line. In all cases, the need
for such de-watering devices shall be determined and approved by the Manager of Public Works.
No sewer or water connections shall be permitted on municipal road allowances after December 1st annually unless
weather conditions are satisfactory to the Manager of Public Works.
The Applicant and/or Contractor shall be required to provide a Letter of Credit, cash deposit, or certified cheque made
payable to and in favour of the Corporation of the Township of Essa for the value of the work, as estimated by the
Manager of Public Works, prior to the work being carried out, to ensure permanent repairs are completed as expeditiously
as possible. The Manager of Public Works may reduce the amount of the deposit or waive the deposit entirely, if in his
opinion the works being undertaken are not likely to result in damages to the travelled portion of the roadway.
The Township of Essa may complete any work required to be done by an Applicant, Owner, and/or Contractor, or may
rectify any action of an Applicant, Owner, and/or Contractor which is contrary to the permit and such work done by the
Township of Essa shall be completed at the expense of the Applicant, Owner, and/or Contractor. The Township of Essa
may carry out any work required to be done and deduct the same from the deposit, Letter of Credit, or certified cheque,
and all forthwith refund the amount by which the sum deposited exceeds the costs of repairs.
The Applicant and/or the Contractor shall pay the Municipality for all engineering and inspection fees associated therewith
and the same may be deducted from the Letter of Credit, cash deposit, or other securities posted with the Township of
Essa.
Clay, in fluid state, frozen material, organic matter, silt or mud shall be excluded from backfill. This may require that part
or all of the excavated material be replaced by sand or crushed stone backfill. The material to a depth of four (4) feet
below the finished road surface shall be kept separate from any material excavated below this depth. These two layers of
material must be replaced in the trench in the same layers from which they were excavated.
Backfill materials shall be compacted in layers, the maximum thickness being six (6) inches except in the case of granular
base course material for which the maximum depth of each compacted layer shall be four (4) inches. If undue settlement
occurs at a later date, an additional charge will be made for repair.
In the travelled portion of the road, if the native backfill exhibits conditions as noted under Item 15 above, and requires
replacement, the trench walls must be excavated to a minimum 2:1 (horizontal-vertical) sloped to a maximum depth of
four (4) feet below the road surface. Likewise the depth of existing granular base course materials shall be replaced in
kind.
Under no circumstance shall any of the previously excavated material from the trenches be used as Class “A” granular
base course material. In addition, if any of the excavated granular base course material becomes contaminated, the
Contractor shall not use it as granular base course Class “B” material.
All sodded areas, ditches, culverts, and driveway entrances shall be repaired or replaced promptly. All surplus material
shall be removed, the area cleaned and returned to its original condition. A temporary patching having a minimum
thickness of two (2) inches shall be placed in all areas where asphalt has been removed.
Final and permanent repair shall be carried out by the Applicant to the satisfaction of the Manager of Public Works. The
decision of the Manager shall be final. The Applicant shall be responsible for the repair for a period of one (1) year from
the date of approval of this Permit.
The foregoing is in compliance with the current policy of the Corporation of the Township of Essa in respect of Occupancy of
Municipal Roads within the Municipality.