HomeMy WebLinkAboutPERMIT 621 Big Thompson Ave State Highway Access Removal of Access 2010-04-163q-COLORADO DEPARTMENT OF TRANSPORTATION
V Issuing authorityapplicationSTATEHIGHWAYACCESSPERMITAPPLICATIONacceptancedate:
Instructions:-Contact the Colorado Department ot Transportation (CDOT)or your local government to determine your issuing authority.-Contact the issuing authority to determine what plans and other documents are required to be submitted with your application V.-Complete this form (some questions may not apply to you)and attach all necessary documents and Submit it to the issuing authority.Please print -Submit an application for each access affected.or type -If you have any questions contact the issuing authority.
-For additional information see CDOT’s Access Management website at http:/iwww.dot.state.co.uslAccessPermitslindex.htm
1)Property owner (Permittee)2)Agent for permittee (if different from property owner)Safeway Stores 46,Inc.,do Dan Clayton Kathleen L.Krager,Krager and AssociatesStreetaddressMailingaddress6900SouthYosemiteStreet1390StuartStreet
City,state &zip Phone#City,state &zip Phone#(required)Centennial,Co 80112 303 843 7561 Denver,CO 80204—1243 J 303 446 0269
E-mail address E-mail address if availabledan.clayton@ safeway .corn kkrager@ kragerandassociates .corn
3)Address of property to be served by permit (required)
621 Big Thompson Avenue,Estes Park,CO
4)Legal description of property:If within jurisdictional limits of Municipality,city and/or County,which one?coUnty subdivision block lot section township range
5)What State Highway are you requesting access from?“J6)What side of the hi hway?SR 34 N OSEEW
7)How many feet is the proposed access from the nearest mile post?Jlow many feet is the proposed access from the nearest cross street?
feet UN cjs GE flW)from:431 feet L:INQSQEW)from:Steamer Drive
8)What is the approximate date you intend to begin construction?
5/24/2010
9)Check here if you are requesting a:
new access Qtemporary access (duration anticipated )lElimprovement to existing accesschangeinaccessusejremovaIofaccessrelocationofartexistingaccess (provide detail)
10)Provide existing property use
Residential
1 1)Do you have knowledge of any State Highway access permits serving this property,or adjacent properties in which you have a property interest?Elno flyes,if yes -what are the permit number(s)and provide copies and/or,permit date
12)Does the propertyownerown or have any interests in any adjacent property?J no yes.if yes -please describe.
Safeway Grocery Store
13)Are there other existing or dedicated public streets,roads,highways or access easements bordering or within the property?Q no yes if yes -list them on your plans and indicate the proposed and existing access points
14)If you are requesting agncultural field access -how many acres will the access serve?
15)If you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of eachbusiness/land use square footage
___________
business square footage
15)If you are requesting residential developement access,what is the type (single family.apartment.townhouse)and number of units?.._______type number of units type number of units
17)Provide the following vehicle count estimates for vehicles that will use the access.Leaving the property then returning is two counts
Indicate if your counts are 5 n’passenger cars and light trucks a peak hour volumes lr,css at pea’p0_s anpeakhourvolumesoraveragedailyvolumes.
#of single unit vehicles us excess sf30 ft n of farm vehicles (field equipment:Total count of all vehicles
0
Previous editions are obsolete and may not be used Page 1 of 2 COOT Form #137 12/04
18)Check with the issuing authority to determine which of the following documents are required to complete the review of your application.
a)Property map indicating other access,bordering roads and streets.e)Subdivision,zoning,or development plan.b)Highway and driveway plan profile.
f)Proposed access design.c)Drainage plan showing impact to the highway right-of-way.g)Parcel and ownership maps including easements.d)Map and letters detailing utility locations before and after h)Traffic studies.development in and along the right-of-way.
i)Proof of ownership.
1-It is the applicant’s responsibility to contact appropriate agencies and obtain all environmental clearances that applytotheiractivities.Such clearances may include Corps of Engineers 404 Permits or Colorado Discharge Permit Systempermits,or ecological,archeological,historical or cultural resource clearances.The CDOT Environmental ClearancesInformationSummarypresentscontactinformationforagenciesadministeringcertainclearances,information aboutprohibiteddischarges,and may be obtained from Regional CDOT Utility/Special Use Permit offices or accessed via theCDOTPlanning/Construction-Environmental-Guidance webpage http:llwww.dot.state.co.uslenvironmentallForms.asp.
2-All workers within the State Highway right of way shall comply with their employer’s safety and health policieslprocedures,and all applicable U.S.Occupational Safety and Health Administration (OSHA)regulations -including,but notlimitedtotheapplicablesectionsof29CFRPart1910-Occupational Safety and Health Standards and 29 CFR Part 1926-Safety and Health Regulations for Construction.
Personal protective equipment (e.g.head protection,footwear,high visibility apparel,safety glasses,hearing protection,respirators,gloves,etc.)shall be worn as appropriate for the work being performed,and as specified in regulation.At aminimum,all workers in the State Highway right of way,except when in their vehicles,shall wear the following personalprotectiveequipment:High visibility apparel as specified in the Traffic Control provisions of the documentationaccompanyingtheNoticetoProceedrelatedtothispermit(at a minimum,ANSI/ISEA 107-1 999,class 2);headprotectionthatcomplieswiththeANSIZ89.1-1 997 standard;and at all construction sites or whenever there is danger ofinjurytofeet,workers shall comply with OSHA’s PPE requirements for foot protection per 29 CFR 1910.136,1926.95,and 1926.96.If required,such footwear shall meet the requirements of ANSI Z41-1999.
Where any of the above-referenced ANSI standards have been revised,the most recent version of the standard shallapply.
3-The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access BoardundertheAmericanDisabilitiesAct(ADA).These guidelines define traversable slope requirements and prescribe theuseofadefinedpatternoftruncateddomesasdetectablewarningsatstreetcrossings.The new Standards Plans andcanbefoundontheDesignandConstructionProjectSupportwebpageat:<http:!Iwww.dot.state.co.uslDesignSupportl>,then click on Design Bulletins.
If an access permit is issued to you,it will state the terms and conditions for its use.Any changes in the use of thepermittedaccessnotconsistentwiththetermsandconditionslistedonthepermitmaybeconsideredaviolationof thepermit.
The applicant declares under penalty of perjury in the second degree,and any other applicable state or federallaws,that all information provided on this form and submitted attachments are to the best of their knowledgetrueandcomplete.
I understand receipt of an access permit does not constitute permission to start access construction work.
Appcanss nature Phnt name
Kathleen L.Krager 03/20/2010
If the applicant is not the own o t e property,we require this application also to be signed by the property owner ortheirlegallyauthorizedreprentative(or other acceptable written evidence).This signature shall constitute agreementwiththisapplicationbyallwners-of-interest unless stated in writing.If a permit is issued,the property owner,in mostcases,will be listed as the permittee.
Property owner signature
Print name Datef,Tc.4 3/rn/ID
1 /If I
Previous editions are obsotete and may not be used Page 2 of 2 COOT Form #137 12/04
‘I
COLORADO DEPARTMENT OF TRANSPORTATION
STATE HIGHWAY ACCESS CODE
NOTICE TO PROCEED
Permittee(s):
Safeway Stores 46,Inc.
Dan Clayton
6900 Yosemite Street
Centennial,CO 80112
Applicant:
Krager &
Kathleen L.Kra
390 Stuart Stre
Denver,CO 80:
The permittee is hereby authorized to proceed with access construction within state highway right-of-way inaccordancewiththeabovereferencedStateHighwayAccessPermitandthisNoticetoProceed.
This Notice to Proceed is valid only if the referenced Access Permit has not expired.Access Permits expireoneyearfromdateofissueifnotunderconstruction,or completed.Access Permits may be extended inaccordancewithSection2.3(11 )(d),of the Access Code.
Adequate advance warning is required at all times during access construction,in conformance with the ManualonUniformTrafficControlDevicesforStreetsandHighways.
All construction shall be completed in an expeditious and safe manner and shall be finished within 45 daysfrominitiation.The permittee or applicant shall notify the Department prior to commencing construction asindicatedontheAccessPermit.
Both the Access Permit and this Notice To Proceed shall be available for review at the construction site.
This Notice to Proceed is conditional.The following items shall be addressed prior to or during construction as
appropriate.
Copyiuhon:
Required:
Region (original)
Applicant
Staff Access Section
Make copies as necessary for:
Local Authority
MTCE Patrol
7-Estes Park
Inspector Lee Ireton
Traffic Engineer
CDOT Permit No.410035
SHISIMP
04-1243
Municipality or County Approval (When the appropriate local authority retains issuing authority)
By Title Date
(X)
This Notice is not valid until signed by a duly authorized representative of the Department
Colorado Department of Transportation
(X)-1
Title Date
6/3/201
Form 1265 8)98,6/99
COLORADO DEPARTMENT OF TRANSPORTATION CDOT Permit No.410035STATEHIGHWAYACCESSPERMITStateHighwayNo/Mp/Side
34A_/_62.716 /_LPermitfeeDateoftransmittalRegion/Section/Patrol Local Jurisdiction$0.00 4/16/2010 4 /01 /7-Estes Park Estes Park
The Permittee(s);Applicant:Ref No.:
Safeway Stores 46,Inc.Krager &Associates,Inc.Dan Clayton Kathleen L.Krager
6900 Yosemite Street 1390 Stuart Street
Centennial,CO 80112 Denver,CO 80204-1243
303-843-7561 303-446-0269
is hereby granted permission to have an access to the state highway at the location noted below.The access shall be constructed,maintained and used inaccordancewiththispermit,including the State Highway Access Code and any attachments,terms,conditions and exhibits.This permit may be revokedbytheissuingauthorityifatanytimethepermittedaccessanditsuseviolateanypartsofthispermit.The issuing authority,the Department and their dulyappointedagentsandemployeesshallbeheldharmlessagainstanyactionforpersonalinjuryorpropertydamagesustainedbyreasonoftheexerciseofthepermit.
Location:The access to be closed is located on State Highway 34,a distance of 3,780 feet east of Mile Post 62 on the north/left side.
Access to Provide Service to:(Land Use Code:)(Size or Count)(Units)
ACCESS CLOSURE
1 EACH
Additional Information:
1.The Notice to Proceed will be issued upon receipt of acceptable construction drawings.
2.The construction drawings will be filed with the Notice to Proceed for Permit #4 10036.
3.The Permittee must conduct a preconstruction conference prior to any work within CDOT right-of-way.The CDOT AccessInspectormustbeinattendanceatthismeeting.
4.The Permittee must provide contractor’s certificate(s)of insurance to the CDOT Access Inspector prior to beginning any workwithintheCDOTright-of-way.
MUNICIPALITY OR COUNTY APPROVAL
Required only when the appropriate local authority retains issuing authority.
Signature Print Name Title Date
Upon the signing of this permit the permittee agrees to the terms and conditions and referenced attachments containedherein.All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days fromInitiation.The permitted access shall be completed in accordance with the terms and conditions of the permit prior tobeingused.
The permittee shall notify Lee Ireton with the Colorado Department of Transportation inGreeley,Colorado at (970)350-2147,at least 48 hours prior to commencing construction within theStateHighwayright-of-way.
The person signing as the permittee must be the owner or legal representative of the property served by the permitted access and have full authority toacceptthepermitanditstermsandconditions.
Permittee Signature Print Name DateS-fCJ T D€
This permit is not valid until signed by a duly authorized representative of the Department.COLORADO DEPARTMENT OF TRANSPORTATION
Prt Name Title ,Date (of issue)
GL b(or ‘e—U(--rm’çY (//lo
Required:Make copies as necessary for:Previous editi n are obsolete and ay not be used1Region3StaffAccessSectionLocalAuthorityageIof3COOTForm#101 51072Applicant4.Central Files MTCE Patrol
Inspector
Traffic Engineer
State I-Iighway Access Permit
1AttachmenttoPermitNo.410035-Additional Terms and Conditions
1.If there are any questions regarding this permit,please contact Gloria Hice-Idler at (970)350-2148.
2.The Permittee shall refer to all additional standard requirements included with this permit and anyenclosedadditionalterms,conditions,exhibits,and noted attachments.
3.Incorporated as part of this permit are the following:
Application for Access Permit (CDOT Form No.137)
Permit (CDOT Form No.101)and its two page attachment
Exhibits:
“A”-Construction Plans (to be filed with the Notice to Proceed for Permit #4 10036“B”-Vicinity Map
4.This permit is issued in accordance with the State Highway Access Code (2 CCR 601-1),and is basedupontheinformationsubmittedbythePermittee.This permit is only for the use and purpose stated in theApplicationandPermit.Any changes in traffic volumes or type,drainage,or other operation aspects mayrenderthispermitvoid,requiring a new permit to the be applied for based upon existing and anticipatedfutureconditions.
5.Access construction methods and materials shall conform to the Colorado Department of TransportationStandardSpecificationsforRoadandBridgeConstruction(current edition).
6.If necessary,minor changes,corrections and/or additions to this permit may be ordered by theDepartmentinspector,other Department representative or local authority to meet unanticipated siteconditions.Changes may not be in violation of the State Highway Access Code.All major changes to theplansmustbeapprovedinwritingbytheDepartmentpriortocommencementofanyworkonorwithintheStateHighwayright-of-way.
All workers within the State Highway right of way shall comply with their employer’s safety and healthpolicies/procedures,and all applicable U.S.Occupational Safety and Health Administration (OS[-IA)regulations —including,but not limited to the applicable sections of 29 CFR Part 1910 -OccupationalSafetyandFlealthStandardsand29CFRPart1926-Safety and Health Regulations for Construction.
At a minimum,all workers in the State Highway right of way,except when in their vehicles,shall wear thefollowingpersonalprotectiveequipment:
•Head protection that complies with the ANSI Z89.l-l997 standard;
•At all construction sites or whenever there is danger of injury to feet,protective footwear thatcomplieswiththeANSIZ4l-l999 standard will be worn;
•High visibility apparel as specified in the Traffic Control provisions of this permit (at a minimum,ANSI/ISEA 107-1999,Class 2).
Where any of the above-referenced ANSI standards have been revised,the most recent version of thestandardshallapply.
7.This permit is subject to revocation due to:1)Noncompliance with the provisions of this permit;2)Abandonment;3)Supersedure by new permit covering the same installation;or 4)Conflict with necessaryplannedhighwayconstructionand/or improvements.The Permittee shall promptly terminate occupancy
State Highway Access Permit
2AttachmenttoPermitNo.410035 -Additional Terms and Conditions
upon notice of cancellation of the permit from the Department,unless a new permit is applied for andgranted.
8.Reconstruction and improvements to the access closure may be required when the Permittee has failed tomeettherequireddesignand/or material specifications.If any construction element fails within two yearsduetoimproperconstructionormaterialspecifications,the Permittee is responsible for all such repairs.
9.The Department retains the right to perform any necessary maintenance work in this area.
10.Backing maneuvers within and into the State Highway right-of-way are strictly prohibited.All vehiclesshallenterandexitthehighwayright-of-way in forward movement.Backing into the right-of-way shall beconsideredaviolationofthetermsandconditionsofthisaccesspermitandmayresultinrevocationofthepermitbytheDepartmentand/or the issuing authority.
11.All existing accesses to the property shall be removed immediately.Removal shall include,but notlimitedto,the return of the highway right-of-way side slopes,ditches,and fences to match existing adjacentconditions,INCLUDING REMOVAL OF ASPHALT APRONS.Any asphalt removed from the highwayshallresultinasmoothfinishededge.
12.The Permittee is responsible for obtaining any necessary additional federal,state,and/or City/Countypermitsorclearancesrequiredforconstructionoftheaccess.Approval of this access permit does notconstituteverificationofthisactionbythePermittee.
13.All costs associated with the closure of this access are the responsibility of the Permittee.This includesdesign,construction,signing and striping,utility relocation,testing of materials,and inspections.
14.No work will be allowed at night,or on Saturdays,Sundays,and legal holidays without priorauthorizationfromtheDepartment.The Department may also restrict work within the State Highwayright-of-way during adverse weather conditions.
15.Traffic detours or lane closures will not be allowed,unless pre-approved by the Department.
16.Two-way traffic shall be maintained throughout the work area at all times unless specific writtenauthorizationisobtainedfromtheDepartment
17.No construction vehicles shall be parked,or construction materials/equipment stored,on the StateHighwayright-of-way overnight.
18.No work shall be performed near a Department electronic traffic control device without coordinationwithCobieGarbisoat(970)350-2137.
19.Landscaping and site construction shall not obstruct sight distance at any State Highway access point.Landscaping within the State Highway right-of-way requires the Permittee to obtain a CDOT LandscapingPermitfromtheTraffic/Access Section.The access permit does not authorize that activity,Irrigation offeatureswithintheright-of-way may require the Permittee to install a subsurface drain in accordance withCDOTStandardM-605-I or other approved system.The Permittee shall contact Gloria lice-Idler at theGreeleyTrafficOffice,(970)350-2147,to obtain the Landscaping Permit.
State Highway Access Permit
3AttachmenttoPermitNo.410035 -Additional Terms and Conditions
20.Routine,periodic maintenance and emergency repairs may be performed within the State Highwayright-of-way,under the general terms and conditions of the permit.Any significant repairs such as culvertreplacement,resurfacing,or changes in design or specifications,will require written authorization from theDepartment.The Department shall be given proper advance notice whenever maintenance work will affectthemovementorsafetyoftrafficontheStateHighway.In an emergency,the Department Region OfficeandtheStatePatrolshallimmediatelybenotifiedofpossiblehazards.
21.All work is to conform to the plans referenced by this permit on file with the Department or as modifiedbythispermit.(If discrepancies arise,this permit shall take precedence over the plans.)The DepartmentplanreviewisonlyforthegeneralconformancewiththeDepartment’s design and code requirements.TheDepartmentisnotresponsiblefortheaccuracyandadequacyofthedesign,dimensions,elevations,and anyotherelementswhichshallbeconfirmedandcorrelatedattheworksite.The Department through theapprovalofthisdocument,assumes no responsibility for the completeness and/or accuracy of the plans.
22.The State requires a Certificate of Insurance prior to commencing any work on the State Highway right-of-way.Policies shall name the State of Colorado as additional insured party.All vendors,contractors,and utility companies shall procure,at their own expense,and maintain for the duration of the work period,the following minimum insurance coverages:
A.Standard workman’s compensation and employer’s liability,including occupational disease,covering allemployeesengagedinperformanceoftheworkatthesite,in the amount required by State Statutes.B.Comprehensive general liability in the amount of $1,000,000 combined single limit bodily injury andpropertydamage,each occurrence and $2,000,000 annual aggregate.
C.Automobile liability in the amount of $1,000,000 combined single limit bodily injury and propertydamage,for each accident.
Certificates of insurance showing compliance with these provisions shall be attached to and made a part ofthispermitandbeavailableonthesiteduringconstruction.
23.Survey markers or monuments must be preserved in their original positions.Notify the Department at(970)350-2173 immediately upon damage to or discovery of any such markers or monuments at the worksite.Any survey markers or monuments disturbed during the permitted work shall be repaired and/orreplacedimmediatelyattheexpenseofthePermittee.
24.Should any excavation encounter plant or animal fossils,the remains of historic or prehistoricstructures,artifacts,(pottery,stone tools,arrowheads,etc.),the work shall be stopped and the PennitteeshallnotifytheDepartmentinspector.
25.The Permittee or the contractor shall notify Lee Ireton at (970)350-2147 or (970)590-7155 at leasttwoworkingdayspriortobeginninganyaccessimprovementsorconstructionofanykindwithintheStateHighwayright-of-way.Failure to comply with this requirement may result in revocation of this permit.
26.The Department inspector may suspend any work due to:1)Noncompliance with the provisions of thispermit;2)Adverse weather or traffic conditions;3)Concurrent highway construction or maintenance inconflictwithpermitwork;4)Any condition deemed unsafe for workers or the general public.The workmayberesumeduponnoticefromtheDepartmentinspector.
State Highway Access Permit
4AttachmenttoPermitNo.410035-Additional Terms and Conditions
27.Construction traffic devices,when not in use,shall be removed or turned away from traffic.
28.No paved surface shall be cut unless specified in this permit.Asphalt removal shall be saw cut toassureastraightedgeforpatching.
29.The removed access shall be constructed and maintained in a manner that will not cause water to enterontotheroadway,and will not interfere with the existing drainage system within the State Highway right-of-way.Drainage to the State Highway right-of-way shall not exceed historical rate of flow.
30.All existing drainage structures shall be extended,modified,or upgraded as necessary,to accommodateallnewconstructionandsafetystandards,in accordance to the Department’s standard specifications.
31.The Permittee shall request final inspection by Lee Ireton at (970)350-2147,within 10 days followingcompletionofaccessconstruction,and prior to authorized use.The Permittee or their representative shallbepresent.
32.A fully executed complete copy of this permit must be on the job site with the contractor at all timesduringconstruction.Failure to comply with this or any other construction requirement may result in theimmediatesuspensionofworkbyorderoftheDepartmentinspectorortheissuingauthority.
33.The design and closure of the access and/or development of this property shall not negatively impactadjacentnearbyproperties.Correction of the problem and cost resulting from damages shall be borne bythePermittee.
34.It is the responsibility of the Permittee to determine which environmental clearances and/or regulationsapplytotheproject,and to obtain any clearances that are required directly for the appropriate agency priortocommencingwork.Please refer to or request a copy of the “CDOT Environmental ClearanceInformationSummary”(ECIS)for details.The ECIS may be obtained CDOT Permitting Offices or may beaccessedviatheCDOTPlanning/Construction-Environmental Guidance webpage athttp://www.dot.state.co.us/environmental/Forms/asp.FAILURE TO COMPLY WITH REGULATORYREQUIREMENTSMAYRESULTINSUSPENSIONORREVOCATIONOFYOURCDOTPERMIT,OR ENFORCEMENT ACTIONS BY OTHER AGENCIES.
ALL discharges are subject to the provisions of the Colorado Water Quality Act and the ColoradoDischargePermitRegulations.Prohibited discharges include substance such as:wash water,paint,automotive fluids,solvents,oils or soaps.
Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental(CDPHE)Water Quality Control Division (WQCD)as significant sources of pollutants to the waters of theState,the following discharges to storm water systems are allowed without a Colorado Discharge PermitSystemPermit:landscape irrigation,diverted stream flows,uncontaminated ground water infiltration toseparatestormsewers,discharges from potable water sources,foundation drains,air conditioncondensation,irrigation water,springs,footing drains,waterline flushing,flows from riparian habitats andwetlands,and flow from fire fighting activities.
State Highway Access Permit 5
Attachment to Permit No.410035 -Additional Terms and Conditions
ANY OTHER DISCHARGES,including storm water discharges from industrial facility or construction
sites,may require Colorado Discharge Permit System permits from CDPHE before work begins.For
additional information and forms,go to the CDPHE website at:
http://cdphe.state.co.us/wq/PermitsUnit/wqu.
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Not to Scale
1.
Krager and Associates
Safeway Fueling Store #920
Estes Park,Colorado
L!4):
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Figure 1
SITE LOCATION
May 2009 905 fig -5 LOC