itd lanscape permitDistrict 3 Right -of -Way Encroachment Permit Cover & Inspection Form
BLOOD, LLC
ATTN: DAViia BLOOD
629 E.LAKE CREEK ST.
MERIDIAN
ID 83642
PERMIT#
3-18-025
RouTE
SH 69
MILE POINTS
8.53
EXPIRATION
7/20/2018
lTD FOREMAN CONTACT:
Travis Dodd - Cell: 208-830-3607 / Office: 208-332-7162 travis.dodd@itd.idaho.gov
Work Description: Landscape r/w
** For safety concerns during the August 2017 Eclipse; No work shall be done on ITD right-of-way between the dates of Friday
August 18`h through Tuesday August 2Z" at midnight **
Important: Before you start
• Read and understand the entire contents of this permit packet, contact the Idaho Transportation Department (ITD) with
any questions prior to starting work.
• This permit serves as a permit to construct. Failure to complete work as permitted and receive final inspection sign -off
before the expiration date listed shall render permit void.
• Supply a copy of this permit to your contractor(s) including your traffic control contractor. Contractors may be required to
obtain separate permit by 1TD.
• Submit Certification and Materials documentation 14 days in advance (see Certification and Materials in provisions)
• All documentation submitted to ITD shall have the permit number clearly listed on the top of the page; email
correspondence shall reference the permit number in the subject line.
• Receive authorization to begin work by the ITD Foreman listed above. Email start date request a minimum 5 business days
in advance. Do not start without authorization. If needed, request to meet on -site to review the project and permit
requirements.
Prior to completion:
+ Prepare all required documentation, including As -Built submittals (see As -Built Requirement in provisions)
• Send a notification email to the ITD Foreman that work is complete and schedule to meet on -site for inspection, all
documentation must be available for inspection and acceptance, list permit number on each sheet.
Final Inspection (for ITD use only)
❑Yes ❑No Did permittee request and receive authorization to start work prior to working within ETD R/W?
❑Yes ❑No Did ITD receive notification that work is complete and request a meeting for inspection
❑Yes ❑No ITD accepts all required documentation
❑Yes ❑No Was excessive remediation required during any aspect of permitted work? if so, please
document any time and equipment charged outside the normal inspection shift. Document:
date, beginning and end time, dispatched or not and by whom, reason or situation, corrective
action, with whom you spoke.
Additional Notes: (use separate sheet if needed) �0
Do not sign until all documentation has been received!
Is ITD's representative, I accept that the work completed satisfies the permit.
ITD Authorized Representative Signature Date
x
Return this form with all required permit documentation to: ITD District 3 Traffic
Your Safety . Your Mobility . Your Economic Opportunity
District 3 Right -of -Way Encroachment General Provisions
Permit #3-18-025
ITD Foreman contact:
Travis Dodd - Cell: 208-830-3607 / Office: 208-332-7162 travis.dodd@itd.idaho.gov
Temporary Traffic Control (TTC)
No work within the State right-of-way shall commence until a TTC plan has been submitted and accepted by ITD. TTC must be
erected and maintained to meet: District 3 Operational Procedures 'Traffic Control for Encroachment Permits", M.U.T.C.D and Work
Zone Safety and Mobility program as adopted by the State of Idaho. TTC plan must be on -site and available for inspection during
traffic control erection and all construction activities.
❑Yes District 3 has accepted a TTC plan with the issuance of this permit as attached.
ZNo a plan must be submitted and accepted prior to any work within ITD right-of-way.
Travel Way Restrictions and Special Instruction:
** For safety concerns during the August 2017 Eclipse; No work shall be done on ITD right-of-way between the dates of Frida
August 18`h through Tuesday August 22°d at midnight **
No travel way restrictions are authorized for this permit. Work time to be authorized by area Foreman
Notes or Special Conditions :
Hours may be modified by area Foreman, ITD contract or Authorized representative.
511. Traveler Information
email ITDD3-511ReportNotification@itd.idaho.goy , (cc) the Foreman and itdd3permitsPitdJdaho.gov Include in subject line
ITD permit #, inform of: dates of work, start time, end time, route affected, mile points, direction of travel for lane closure, type of
traffic control, additional comments.
Safety & Work Zone Practices
All operations shall comply with the Work Zone Safety and Mobility program as adopted by the State of Idaho, (OSHA) regulations as
enacted by The United States Department of Labor Occupational Safety and Health Administration, and ITD Policy (23 CFR § 634 —
Worker Visibility)
All workers within the highway right-of-way who may be exposed either to traffic (vehicles using the highway for purposes of travel)
or to construction equipment within the work area shall wear high -visibility reflectorized safety apparel that is intended to provide
conspicuity during both daytime and nighttime usage, and meets the Performance Class 2 or 3 requirements of the ANS111SEA 107-
2004 publication.
As -Built drawings
Subject to all ITD encroachment permits - shall apply when work consists of the exposure, installation, or modification of pipe,
conduit, cable, or other utility conveyance. Overhead utilities will he excluded from this requirement; except for new pole or
structure placement. As -built submittals must satisfy the following requirements: the precise location, referenced from the highway
centerline or edge of right-of-way, where any utility is placed, or encountered during placement. Document: the type, quantity, size;
referenced from the highway centerline or the edge of right-of-way, dimension horizontal, vertical and/or depth.
Submittals may be accepted from: (GIS) geo-referenced spatial data bore logs, drawn/sketched, or prepared as -constructed stamped
by a licensed engineer. Drawn/sketched sheets should be as "plan and profile" format. Other methods may be accepted with ITD
prior authorization.
Compaction effort and method must be documented for work outside the roadway prism. (see: Excavation and Paving for
compaction requirements)
Expeditious
Prior to beginning construction, sufficient labor, material and equipment shall be at the job site to expediently complete the project.
Addendums
Any addendum "change order, alteration or modification" to this permit or any of its terms or conditions, must be authorized and
signed by an ITD authorized representative. Addendum shall be on -site and available for inspection (with original permit) during
construction activities. Addendum will be filed on record along with permit at ITD District 3 Traffic Department.
Rev. 12-2016
Your Safety . Your Mobility . Your Economic Opportunity
Damages
The Permittee shall be responsible for damages caused during permit activity and must be reported to the area Foreman
immediately. Repairs shall be made by the permittee as directed by the ITD authorized representative at no cost to the Department_
If the permittee falls to make the necessary repairs, the Department will make the repairs and bill the permittee. No new permits
shall be issued to the permittee until such claims have been settled.
Monuments
Idaho Statute 54-1234 If any person shall willfully deface, injure or remove any signal, monument, building or other object set as a
permanent boundary survey marker by a registered, professional land surveyor, he shall forfeit a sum not exceeding five hundred
dollars ($500) for each offense, and shall be liable for damages sustained by the affected parties in consequence of such defacing,
injury or removal, to be recovered in a civil action in any court of competent jurisdiction.
Idaho Statute 18-7021 Every person, not the owner thereof, who willfully mars, disfigures breaks or otherwise injures, or molests,
removes or destroys, any work of art, monument, landmark, historic structure, shade tree, shrub, ornamental plant, or useful or
ornamental improvement, is guilty of a misdemeanor.
Landscaping
The permit holder shall return to original condition and re -seed all areas disturbed. Repair of landscaping shall be the responsibility
of the permittee. The State will not be responsible for or participate in any repair or maintenance costs. Berms and/or fences will
not be permitted. Only flowers, grasses and shrubs with a mature height not to exceed three (3) feet or trimmed with no sight
obstructions between three (3) feet to five (5) feet in areas with a posted speed limit of 35 M.P.H or less, and three (3) feet to seven
(7) feet in areas with a posted speed limit above 35 M.P.H. will be allowed within the sight triangle at corners and the safety clear
zone of the State Highway. Landscaping shall be short enough or trimmed so it doesn't interfere with State Highway signs. No rocks
over four (4) inches maximum size will be allowed within the State Highway right of way. Sprinkler heads shall be no closer than five
(5) feet from the pavement edge and shall be adjusted so as not to cause water to cover any part of the highway surface.
Landscaping shall be placed so as not to disturb the normal drainage patterns within the State Highway Right of Way.
1DAPA Rule 39.03.42, # 13. Drainage, B, Landscaping irrigation systems shall not disturb, obstruct, or add to the normal drainage
patterns of the State highway right-of-way. No new ditches shall be constructed without prior approval. Landscaping, farming, and
irrigation systems shall not interfere with utility installations, removals, or operations_
This section intentionally left blank
Rev. 12-2016
SPECIAL PROVISION 6
LANDSCAPING
Berms and/or fences will not be permitted within the State Highway Right of Way.
Only flowers, grasses and shrubs with a mature height not to exceed three (3) feet or trimmed with no
sight obstructions between three (3) feet to five (5) feet in areas with a posted speed limit of 35 M.P.H or
less, and three (3) feet to seven (7) feet in areas with a posted speed limit above 35 M.P.H. will be
allowed within the sight triangle at corners and the safety clear zone of the State Highway.
Landscaping shall be short enough or trimmed so it doesn't interfere with State Highway signs.
No rocks over four (4) inches maximum size will be allowed within the State Highway right of way.
Sprinkler heads shall he no closer than five (5) feet from the pavement edge and shall be adjusted so as
not to cause water to cover any part of the highway surface.
Landscaping shall be placed so as not to disturb the normal drainage patterns within the State Highway
Right of Way. IDAPA Rule 39.03.42, ff 13. Drainage, B
Landscaping irrigation systems shall not disturb, obstruct, or add to the normal drainage patterns of the
State highway right-of-way. No new ditches shall be constructed without prior approval.
Landscaping, farming, and irrigation systems shall not interfere with utility
installations, removals, or operations.
The permit holder shall return to original condition and re -seed all areas disturbed, by their construction
within the State Highway Right of Way, to the satisfaction of the District Engineer.
Repair of landscaping shall be the responsibility of the perrnittee. The State will not be responsible for or
participate in any repair or maintenance costs.
Revised 0812013 Page I of I
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SPECIAL PROVISION 16
INSURANCE
At its sole expense, the PERMITEE shall secure and maintain in effect a policy of general liability insurance
issued by an insurer licensed to conduct business in the State of Idaho. The insurance policy shall provide
liability coverage for any and all claims of bodily injury, property damage, and personal injury arising from
the PERMITEE'S use of the Premises which is the subject of this Permit. The insurance policy required by
this section shall provide coverage of not less $500,000.00 combined single limit of liability per occurrence.
The PERMITEE shall provide additional endorsements and/or increase the policy limits at its sole cost, when
and if the limits of liability contained in the Idaho Tort Claims Act are increased.
The coverage required by this section shall be provided by the most current Commercial General Liability
Policy Form ISO (Insurance Services Offices, Inc.) and shall be endorsed to include pollution liability
coverage.
The State of Idaho shall be the second named insured (not an additional insured) of the commercial general
liability policy required by this section, and shall be written as new business, (upon policy inception). The
policy shall be endorsed with a provision relieving the STATE of any responsibility for the payment of any
policy premium. The endorsement shall require the insurer to provide the Idaho Transportation
Department, District Three Maintenance Engineer in Boise, with no less than THIRTY (30) days written
notice before any cancellation of the coverage required by this section.
No changes whatsoever shall be initiated as to the coverage without prior written approval by the STATE
and written authorization by the STATE to make any requested changes.
Any self -insured retained limit of liability is subject to the STATE'S approval. Coverage, if obtained by the
PERMITEE in compliance with this section, shall not be deemed as having relieved the PERMITEE of any
liability.
The PERMITEE shall provide the STATE with a certificate of insurance reflecting the insurance coverage
required by this section within TEN (10) business days of the execution of this Permit. Such certificates
shall also be provided upon renewal of said policies and changes in carriers.
Wherever in this Special Provision written notices are to be given or made, they will be served, personally
delivered or sent by certified or overnight mail addressed to the parties at the address listed below unless a
different address has been designated in writing and delivered to the other party. The PERMITEE agrees to
accept service of process at said address,
STATE: IDAHO TRANSPORTATION DEPARTMENT
Attn.: District Maintenance Engineer
8150 Chinden Boulevard
P.D. Box 8028
Boise, ID 83707-2028
PERMITTEE:
Revised 0812013 Page 1 of I
Right -Of -Way Encroachment Application and Permit ITD2111 (Rev.11-13)
Other Encroachments itd.idaho.gov
Idaho Transportation Department
ITD Permit Application Number Z18-00
Route S 14 b G Milepost J8, ,5_3
Annlicant Information - Print or Tune
Applicant(s) Name (Printed)
Mailing Address or P.O. Box
City
State
Zip Code
Blood Ilc
629 E Lake Creek St
Meridian
Id
83642
E-Mail Address (If available)
Daytime Phone Number
Alternate Phone Number
davjd@speedyquick.net
208-272-0813
Property Owner's Name (Printed)
Property Address and TAX ID Number
City (If in city limits)
County
Blood Ilc
2560 S Meridian Rd
Meridian
Request Detail (i.o.., landscaping, benches, bus turnout, etc.)
We would like to landscape the Itd right of way between our property and the pavement.
Attached is the lanscape plan.
For ITD Use
Project Number From ITD Highway Plan Date Application Received Date Application Determined Complete In City Limits
�S - 379 Cz 711,— zo/7 ] Yes ❑ No
Route Segment CIL Milepost CIL Highway Station
H (� DG Z f S^d . S 3 4 Right ❑ Left r.7S-- E� Right ❑ Left
Site Distance Reason if Restricted to Right Or Left
Right Left
ITD Distrir_t Review
Section
Reviewer
Date
Recommendation
A rove Den
Section
Reviewer
Date
Recommendation
_...._.._._..
A rove Den
Design
❑ 3
❑
Property Mgmt
❑
❑
Maintenance
❑
❑
Traffic
❑
❑
Planner
❑
❑
Dist. Engineer
❑
❑
List any conditions of approval
List reason(s) for denial recommendation
❑ttar_hmPntc
❑ Special Provisions/Conditions of Approval
❑ Construction Drawings
❑ Traffic Control Plan
❑ Dept. Roadway Plansheets
❑ Standard Drawings
❑ Letters of Recommendation/Denial
Upon signature of both parties, subject to all terms, conditions, and provisions of this permit or attachments,
permission is hereby granted to begin work within the State Highway Right of Way.
Property Owner/Authorized Representative's Signature
Date
Phone Number
X Z7)av-z�ke4
7/15/2017
2082720813
Idaho Transportation Department Authorized Representative's Signature
Title
Date
X
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Page 1 of 2
General Requirements
ITD Permit Application Number
1. The original permit or a copy must be kept an the job site whenever work is taking place.
2. No work shall commence until the permittee is given notice to proceed by an authorized representative of ITD_ The
permittee shall notify ITD five (5) working days prior to commencing the permitted work if work does not commence
immediately upon notice by ITD.
3. During the progress of all work, traffic control devices shall be erected and maintained as necessary or as directed. All
traffic control devices shall conform to the most current edition of the Manual on Uniform Traffic Control Devices for
Streets and Highways, as adopted by the State. Equipment or materials left within the highway right-of-way when work is
not taking place shall be delineated and protected with appropriate approved traffic control devices.
4. All work within the State Highway Right of Way shall comply with the requirements of the ITD Workzone Safety and
Mobility Policy. Copies available from ITD upon request.
5. All work herein permitted shall conform to current government and industry standards, including Americans with
Disabilities Act, and shall be performed and completed to the satisfaction of ITD. The expense of any required
supervision of work performed under this permit shall be borne by the permittee.
6. All utilities shall be installed under culverts.
7. Work done under this permit shall be constructed in a manner that shall not cause water to flow onto the roadway or
shoulder, and shall not interfere with the existing drainage on the State Highway System or any adjacent drainage
system.
8. The permittee shall furnish all material; labor, and equipment for the installation and maintenance of approved
encroachments. This shall include furnishing drainage pipe, curb, gutter, concrete sidewalk, etc., where required.
9. ITD may inspect the materials and workmanship during construction and upon completion to determine that all terms and
conditions of the permit are met. Inspectors are authorized to enforce the conditions of the permit during construction
and to halt any activities within state right-of-way that do not comply with the provisions of the permit, that conflict with
concurrent highway construction or maintenance work, and/or that endanger highway property, natural or cultural
resources protected by law, or the health and safety of workers or the public.
% ITD shall be reimbursed by the permittee for any additional inspection required to insure compliance with the conditions
of this permit. Inspection fees will be based upon inspection time including travel from the ITD facility and charged at
rates commensurate with industry standards.
11. [upon completion of the permitted work, any disturbance of the highway, right of way, and/or traffic control devices shall
be restored to the satisfaction of ITD including the removal of all rubbish and debris and may include seeding, planting
and grading.
12. Any encroachment that is found to be in non-compliance with the terms of the approved permit may be required to be
modified, relocated, or removed at the sole expense of the permittee upon written notification by the District Engineer or
his authorized representative.
13. The permittee shall maintain at its sole expense the encroachment for which this permit is granted.
14. Changes in the use as defined in I. D.A.P.A. 39.03.42, of the permitted access not consistent with the terms and
conditions listed on the permit may be considered a violation of the permit. Any modification, relocation, or removal of an
encroachment or subject granted by this permit shall require a new permit prior to commencement of such work.
15. ITD may revoke, amend, amplify, or terminate this permit or any of the conditions herein enumerated if the permittee fails
to comply with any or all of its provisions, requirements, or regulations as herein set forth or through willful or
unreasonable neglect, fails to heed or comply with notices given, or if the approach, structure, or subject herein granted is
not installed or operated and maintained in conformity herewith.
Final Inspection and Approval
Subject to all terms, conditions, and provisions of this permit or attachments, Final Inspection has been completed
and the permitted work within the State Highway Right of Way is hereby given final approval.
District Engineer or Assigns Signature Date
X
Page 2 of 2
Instructions For Completing ITD 2111, Right -of -Way Encroachment
t Application And Permit - Other Encroachments
Idaho Transportation Department
Note: An incomplete application will delay processing
You may be able to expedite the application process and reduce site designing and engineering costs by requesting a
pre -application conference with the Idaho Transportation Department (ITD). Contact your local ITD District Office and
ask to speak with the Permits Coordinator to schedule a meeting.
District 1
District 2
District 3
District 4
District 5
District 6
600 W. Prairie Ave.
P.O. Box 837
8150 Chinden Blvd.
216 & Date St,
5151 S. 5th Ave.
206 N_ Yellowstone Ave.
Coeur d'Alene, Idaho
Lewiston, Idaho
Boise, Idaho
Shoshone, Idaho
Pocatello, Idaho
Rigby, Idaho
83815-8764
83501-0837
83714-8028
83352-0820
83205-4700
83442-0097
(208) 772-1200
208) 799-4300
(208) 334-8300
(208) 886-7800
(208) 239-3300
(208) 745-7781
Counties served:
Bonewah, Bonner,
Counties served:
Clearwater, Idaho,
Counties served: Ada,
Adams, Boise, Canyon,
Counties served: Blaine,
Camas, Cassia, Custer,
Counties served:
Bannock, Bear Lake,
Counties served:
Bonneville, Butte, Clark,
Boundary,Kootenai,
Latah, Lewis, Nez
Perce
Elmore, Gem, Owyhee,
Payette, Valle
y
Goading, Jerome; Lincoln,
Bingham, Caribou,
Custer, Fremont, Jefferson,
Shoshone
, y,
Washington
Minidoka, Twin Falls
Franklin, Oneida, Power
Lemhi, Madison, Teton
I. The form initially serves as an application_ If approved, the completed and signed form becomes a permit for
the encroachment.
2. Please print (in ink), type, or complete the application in Microsoft Word and print the form.
3. Read and understand these instructions and all of the General Requirements on the form. These requirements
apply to all permits and if you are granted a permit, you must adhere to each of them. Additional permit -specific
provisions may be a part of any approved permit.
4. Complete each item in the shaded box titled "Applicant Information."
5. Include the following with your application:
a. $50 non-refundable application fee.
b. Photographs of the proposed encroachment location, including one looking each direction along the highway
from the proposed location. Digital photographs are acceptable.
c. Include:
A drawing or map that shows the location of your property in relation to other roads and/or landmarks.
A drawing, such as a landscaping plan or detail of a turnout location. Show the requested encroachment
in relation to property lines, the highway, existing buildings, etc. Show dimensions, mark which direction
is north and if possible, draw to scale.
6. After your application is received:
a. ITD will review the application, all access options, local conditions, and local government plans. The application will
then be discussed internally with staff. Your request may be approved, approved with conditions, or denied.
b. If your application is approved or approved with conditions, you will receive your permit from lTD accompanied by any
additional special provisions that must be adhered to.
i. All work under the permit shall be completed within one year from the date that the Department issues the permit
to begin work. You may request, in writing, one, 6 month extension prior to expiration of the permit.
ii. All permitted work shall be completed and available for final inspection within thirty (30) days after construction
begins, unless otherwise stated in the special provisions of the permit.
iii. After construction is completed you must notify the ITD Maintenance Foreman for final inspection of the permitted
work. The contact information for the foreman will be included in your permit package.
iv. Permit will be considered temporary until final approval by the [TD.
V. Failure to complete all work in accordance with the requirements of the permit and receive final approval within
the allotted time will render the permit null and void.
c. If your application is denied, you will be notified by certified mail. The reason(s) for the denial and the process for
appealing the denial will be outlined in the letter you receive.
ITD 2111 Instructions, Rev. 11-13