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Read this packet completely and return the attached forms to the Colonial Beach Department of Planning and Community Development at the address listed above. This packet and its attached fonns are required for any Right-of-Way excavations including: new or improved entrance onto any Town street, paving over any existing gravel driveway, and utility installations
Sketch / Drawing Notes
Application is hereby made for the permit as shown on the accompanying plan or sketch and as described below. Said activity(s) will be done under and in accordance with the rules and regulations of the Commonwealth Transportation Board of Virginia, in so far as said rules are applicable thereto and any agreement between the parties herein before referred to. Where applicable agreements may be attached and made a part of the permit assembly including any cost responsibilities covering work under permit. Applicant agrees to maintain work in a manner as approved upon its completion. Applicant also hereby agrees and is bound and held responsible to the owner for any and all damages to any other installations already in place as a result of work covered by resulting permit. Applicants to whom permits are issued shall at all times indemnify and save harmless the Commonwealth Transportation Board members of the Board, the Commonwealth and all Commonwealth and Town of Colonial Beach employees, agents, and offices, from responsibility, damage, or liability arising from the exercise of the privileges granted in such permit to the extent allowed by law. In consideration of the issuance of a permit the applicant agrees to waive for itself, successors in interest or assigns any entitlements it may otherwise have or have hereafter under the Uniform Relocation and Assistant Act of 1972 as amended in event the Department or its successor, chooses to exercise its acknowledged right to demand or cause the removal of any or all fixtures, personality of whatever kind or description that may hereafter be located, should this application be approved.
Applicant has provided one of of the following requirements in accordance as defined in Code of Virginia, section 2.2-1151.1.
as per attached plans.
If applicable, I agree to pay the full salary and expenses of a town-assigned inspector in conjunction with this project, covered by account receivable number.
All applicable items on this form must be completed before your request can be considered. Recheck information furnished to avoid delay. Prepayment Required - make Remittance payable to Treasurer, Town of Colonial Beach.
In accordance with the Virginia Department of Transportation (VDOT) Road and Bridge Specification, Special Provision 105.14, beginning July 1", 2009, all activities performed under the auspices of a CBPWSD Land Use Permit involving the installation, maintenance and removal of work zone traffic control devices must have at least one (1) person on-site who, at a minimum, is verified by VDOT in Basic Work Zone Traffic Control. A person verified by VDOT in Intermediate Work Zone Traffic Control must be on-site to provide supervision during work zone adjustments or changes to traffic control due to field conditions. These persons must have their verification card with them while on the project site.
I state that I will have at least one person that is verified by VDOT in Basic Work Zone Traffic Control who will be responsible for the placement, maintenance and removal of work zone traffic control devices within the project limits in compliance with the permit requirements and conditions, the approved plans, specifications, the Virginia Work Area Protection Manual and the Manual of Uniform Traffic Control Devices. A person verified by VDOT in Intermediate Work Zone Traffic Control will be on-site to provide supervision during work zone adjustments or changes to traffic control due to field conditions. These persons will provide evidence of these verifications upon request from VDOT personnel.
I, the undersigned, hereby acknowledge that I am fully cognizant of all of the following requirements associated with the issuance of a VDOT/CBPWSD Land Use Permit:
The following three options are available to receive Work Zone Traffic Control (WZTC) training based on an individual's job duties and responsibilities as required by the FHWA Final Rule on Work Zone Safety and Mobility, the Virginia Department of Transportation and CBPWSD:
Option 1 - Have someone become a qualified instructor in your company, who can then instruct others for you using training material from VDOT. The following qualifications are needed for teaching the VDOT Basic, Intermediate, or Advanced WZTC training courses:
To become an approved instructor, an application (PDF) must be completed listing the above qualifications and sent to the chairman of VDOT's WZST committee:
Once a person has become an approved instructor, training material can be obtained from VDOT using the order form (PDF) (the order form requires an approved instructor number):
Option 2 - Obtain the services of an approved instructor from VDOT's Approved WZTC Instructor List to teach the course or courses you need for your employees. See a list of Approve Providers of training (PDF).
Option 3 - Send personnel to classes conducted by approved sources such as ATSSA or the Virginia Local Technical Assistance Program (LTAP). See Courses in Virginia by ATSSA. See Courses by LTAP (PDF). See Basic WZTC courses by the Virginia Rural Water Association (Look under Training Schedule). See training by the Virginia Transportation Construction Alliance (VTCA).
For additional information about Virginia's Work Zone Traffic Control training program, please visit VDOT.
The director's designee shall determine the applicable permit fee and surety for emergency repair permits.
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