Company Name: | License Number: | ||
Contact Person: | Phone Number: | ||
Email Address: | Emergency Contact: | ||
Mailing Address: |
Project Location: | |||
Project Description: | |||
Proposed Start Date: | Estimated Completion: | ||
Work Hours: | Days of Week: | ||
Excavation Depth: | Excavation Area (sq ft): |
CALL 811 BEFORE YOU DIG - Utility location must be verified at least 48-72 hours before excavation begins. Failure to comply may result in permit denial and legal liability.
811 Ticket Number: | Date of 811 Call: | ||
Locate Valid Until: | Private Locates Required: | ☐ Yes ☐ No |
811 Utility Location Coordination: Our team provides comprehensive utility location verification services, including coordination with local utility companies, private locate services, and documentation management to ensure full compliance with excavation safety requirements.
Traffic Impact: | ☐ Lane Closure ☐ Sidewalk Closure ☐ Full Road Closure ☐ No Impact |
Traffic Control Company: | |
Flaggers Required: | ☐ Yes ☐ No Number of Flaggers: _____ |
Traffic Control Planning: We provide complete traffic control planning services including permit coordination, signage specifications, flagger certification, and coordination with local transportation authorities for seamless project execution.
Competent Person: | OSHA 30 Certified: | ☐ Yes ☐ No | |
Shoring Required: | ☐ Yes ☐ No | Shoring Type: | ☐ Trench Box ☐ Slope ☐ Benching ☐ Other |
Safety Consultation: Our certified safety professionals provide on-site consultation for excavation operations, shoring system design, and OSHA compliance verification to ensure maximum worker protection and regulatory adherence.
Stormwater Permit Required: | ☐ Yes ☐ No | SWPPP Available: | ☐ Yes ☐ No ☐ N/A |
Wetlands Present: | ☐ Yes ☐ No | Contaminated Soil Possible: | ☐ Yes ☐ No |
Environmental Compliance: We provide comprehensive environmental compliance assistance including permit acquisition, monitoring services, and restoration oversight to ensure full environmental protection and regulatory compliance.
Surface Type: | ☐ Asphalt ☐ Concrete ☐ Gravel ☐ Grass ☐ Other: _______ | ||
Restoration Timeline: | Warranty Period: |
Restoration Monitoring: Our quality assurance team provides comprehensive restoration monitoring services, including progress tracking, compliance verification, and warranty management to ensure complete site restoration to original conditions.
General Liability: | $ __________ Policy #: __________ |
Workers' Compensation: | $ __________ Policy #: __________ |
Performance Bond: | ☐ Required ☐ Not Required Amount: $ __________ |
Base Permit Fee: | $ __________ |
Traffic Control Fee: | $ __________ |
Inspection Fees: | $ __________ |
Total Fees: | $ __________ |
I hereby certify that all information provided in this application is true and accurate. I understand that any false information may result in permit denial or revocation. I agree to comply with all applicable laws, regulations, and permit conditions.
Applicant Signature
Date: ___________
City Inspector
Date: ___________
Permit Official
Date: ___________
ALLIANCE FOR CONTRACTORS - Excavation Permit Application
For assistance with permit applications and compliance services, contact Alliance Integration Services