Permits - Permit# 4-16-09 - 4309 Channel Road - 1/1/2009CITY OF SPRING PARK
4349 WARREN AVENUE
SPRING PARK, MN 55384
(952) 471-9051 FAX (952) 471-9160
Qwest# 92mlzwb
APPLICATION FOR: STREET OPENING
& EXCAVATION, CURB CUTS, APRONS,
INSTALLATION OF UTILITIES OR
UNDERGROUND CONSTRUCTION
SITE LOCATION SUBJECT SITE ADDRESS 4309 Channel Rd
SITE OWNER SITE OWNER'S NAME NA
PHONE (Hm) (Wk)_ (Mobile)
LEGAL LOT BLOCK ADDITION
DESCRIPTION PID# PLAT
CONTRACTOR NAME Qwest Communications BOND#
ADDRESS--2—$00 Wayzata Blvd Rm 300 Minneapolis MN 55405
PHONE(Hm) na (Wk) 61 2-1AI-5569 im.hal i na
DESCRIBE WORK Relocate Pole per right—of—way acquirement by the City for road
TYPE OF SURFACE TO BE DISTURBED: PERMANENT
DEPTH FROM SURFACE
DIMENSION OF EXCAVATION
TEMPORARY GRAVEL SOD X OTHER
ESTIMATED STARTING DATE 5 % 01 / 2009 COMPLETION DATE 9 / 01 / 2009
WILL DETOUR BE REQUIRED? YES_ NOX ; IF YES, DESCRIBE ROUTE
I hereby acknowledge that this information is correct and that I agree to conform to City of Spring Park ordinances and State
law regarding this construction, and further agree to pay the permit fee and if at any time the City of Spring Park shall make
any improvements in any part of the right-of-way which affects the utility, then the owner of the utility agrees to alter, change,
move, vacate or remove said utility to conform with such City improvements at the sole cost of the utility company.
APPROVED BY CITY OF SPRING PARK:
print name
signature
date
APPLICANT:
Rick Jorgensen (Field Engineer)
print name
signature
4/16/2009
date
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Printed by Rick Jorgensen at 12:05_on 16/APR/2009 from the Land_b_ase in Work Package 92M1ZWB _
JOB DESCRIPTION:
DESIGNED SERVICES INFO BOX
PRIORITY L2]5VICINITY MAP
LOCATION: HUDSON 417, 4—A
CITY OF SPRING PARK
_�4ni TI-1, - -
CONFIDENTIAL Disclose and Distribute Solely To Qwest Employees Having a Need to Know.
Qwest.
CST COMPLETE:
INV COMPLETE:
ORDER NUMBER(S): NA
CUST NAME: NA
CUST ADDRS: NA
CUST TEA: NA
CKID: NA
F1: NA
F2: NA
XBOX: NA
DO NOT SCAN
ORDER TYPES:
HICAP ------------ -- ---- ----YES/NO
- DESIGNED SERVICES:
S D N �--- ❑
56KB D
J HELD ORDERS:
❑ROW REQ'D:
DESIGN LOW[] ❑
CITY•
RZ: 13 CZ: 9 TOWN: 117 RANGE: 23 SECT: 19
SPECIAL ROUTING INSTRUCTIONS: YES/NO
POLES Fx]
NEW DEVELOPMENT CENTER ❑ X
OTHER ❑ Z
SPECIAL REMARKS:
DO NOT PLACE UNTIL R-O-W IS ACQUIRED
PERMITS
COUNTY:
❑
STATE:
y
LOOP QUAL:
PREMIS FORM:
Z
CONFORMANCE TEST:
Fx]
I
Cable Pairs
4401SD, 1176-1200
ERFS DATE: 12/AUG/2009
TRENCH OPEN DATE:
NA
APPROVED FRCS:
1C 1X 45C
52C 45M
ASSOCIATED JOBS:
NA
QWEST DESIGN ENG.:
Rick
Jorgensen
JOB:
92M1ZWB
TELEPHONE.:
612-381
—5568
CPD JOBNAME:
92M1 ZWB
PAGER.:
612-622-3328
BVAPP:
NA
QWEST FIELD ENGR.:
Rick
Jorgensen
WC CLLI:
NVRRMNNA
TELEPHONE.:
612-381
—5568
WC NAME:
NAVARRE
CONTRACT ENGR.:
NA
EXCH KEY:
CONTRACT COMP.:
NA
RMT SWTCH EXCH KEY:
ADDRESS ID:
M 1 4126
ISSUE:
COUNTY:
HENNEPIN
ISSUE —DATE:
_
SHEET:
1 OF 2
1 7
PLAC —4E --
�— [DA31 PRE —POSTED
25 + 10 ft (45(--) O
1 Ca, 3 6
ANMW — 50
4401SD, 1176-1200
RC, 26-50
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1 9 50 7.5 E ipa 3G ��O
2- 25 25 E
50 50 R
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19315
PRE —POSTED
REMOVE
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NOTE LINE REW
NEW POLE 0 BE PLA D FROM E
POLE APR0 3' TOW ANf332' S
OUT OF N CUR83,IN AND TO A
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DOLLARS TO GUARD AND PROTECT AS
REQUIRED BURIED CABLE (A15).
CURB IS BEING PLACED ABOVE CABLE
�gr,5i [AI5] PRE —POSTED
160 ft (45C) (1985 )
\ AFTW — 50
4401 SD, 1 1 76-1 200
0 1I P.C,_/6-50
63 15 6ft (/01(52C) pRE—POSTED 10A1 —GUY—DOWN / 1C 4401SD0
DD, 26
1 3 \TP,COC
52M
PRE —POST D
GUY / 1 / 52
1 ^ LAC
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1
4309 52C 1
OVERHEAD GU
4317 1
4325 \ 1 F P,EMO
1
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4 \ \ 1X 1961
REMO
NOTE SPUCIN
PLACE ANMW-
SPLIC�/TERM
SLACK\ FOR P
POLE
0 ON RISER TO AERIAL
PROVIDE ADDITIONAL
1 PLAC
6 C
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CONFIDENTIAL Disclose and Distribute
Solely To Qwest Employees Having
a -Need to Know.
Reason for Reissue,
Scale: 1 " = 54'
Sheet: 002 of 2