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Queen Creek

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Encroachment Permit Application

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TYPE OF WORK

A. Applicant MUST be the contractor actually performing the work. General contractors MAY NOT apply for subcontractors. 

B. The Contractor shall submit two (2) approved paper set copies and one PDF version of the project plans. The PDF may be sent electronically or provided on CD. 
C. Improvements shall be constructed in accordance with approved project plans. 
D. The Contractor shall submit a traffic control plan to Traffic Engineering for approval prior to performing any activity within the right-of-way of a street open to public travel.

E. The Contractor will provide General Liability Insurance on an occurrence basis in the amount of $1,000,000 or more and name the Town of Queen Creek as additional insured. 

F. The Contractor will provide Automobile Liability Insurance for hired autos and non-owned autos with a combined single limit of $1,000,000 or more and name the Town of Queen Creek as additional insured. 
G. All contractors are required to be licensed with the State of Arizona.H. All contractors must have a Town of Queen Creek business license

I. The Contractor shall provide the number of the dust control permit issued by the applicable county. This permit shall comply with PM-10 guidelines and regulations. 

J. All work shall comply with Article 7-9 of the Town Code – Pavement Cut Requirements. Street cuts are generally not approved unless they meet the requirements set forth in Article 7-9 of the Town Code. In the event there is no feasible alternative to cutting a street, a cash bond will be required per Section 7-9-3 of the Town Code. The Town Engineer may also require an overlay per Section 7-9-4 & 7-9-6 of the Town Code. The length and width of the overlay shall be determined by the Town Engineer. 
K. Other requirement

The utility company has read and understands the requirements and conditions of this permit.

I hereby certify that I have read this application and state that the above information is correct and that I am the owner or the duly authorized agent of the owner. I agree to comply with all Federal, Town and State laws relating to construction. I hereby request and authorize representatives of the Town of Queen Creek to enter upon the above-mentioned property for inspection purposes related to the encroachment permit.

Created by AIPSS