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MR 'S05 <br />App No <br />State of Ohio <br />Departmenbf Transportation <br />Perrnit Application <br />SeeReverse side for additional requfrernents <br />[l ] This form must becompletedby the property owner or agentsworking for a utilify <br />compan?If applicableJ, Appllcation by contractor is unacceptable, <br />Name CITY OF NORTH OLMSTED <br />Addl'ess 5200 DOVER CENTER ROAD City NORTH OLMSTED <br />State OHIO <br />Zip 44070 Phone ( aao )777-800o Other (Fax, fr°?erH) 440-777-5889 <br />[2] Type of Permit requested; x Commercial (See other side) Residentlal _Fleld _Utillty x Drainage <br />Beautification (See other side) _Spraying, trimming, tree removat Other <br />[3] Bdefiy describework to bepertormed, (Altach plans andseelnstructions,) <br />CONSTRUCTION OF NEW NQRTH OLMSTED tRANSIT CENTER INCLUDING NEW ACCESS ROAD FROM STATE ROUTE 252. <br />STATE ROUTE 252 MEDIAN & TRAFFIC SIGNALS TO BE MODIFIED TOACCOMMODATE NEW ROAD. <br />[4] Locatfon where work is to bepertormed, Glve sufficient detall to locatethe stte accurately,such asthe distancein miles or feetfrom <br />a mlle post or from somegeographfcaleature such as an intersectfng highway, <br />In CUYAHOGA County (along,Bertess) State Route 252 mfles or 846 feet <br />Notth _East West South X of 1-480 CENTERLINE on the North East X West South side of the rpad. <br />Work to commencen JuLY 1, 2002 and will require days to complete <br />[5] Doesthe properly owner own or haveany interests in any adjacentproperiy? Yes x No <br />If yes, pleasedescribe, <br />[6] Pdor to any excavationin the highway nght-of-way, the Ohio Utilities Protection Service (OUPS) must becontactedh accordance <br />'with ORC Sectlon 3781,25to 3781,32, OUPS canbereachedat 1-800-362-2764, <br />[7] Dpencutting oi pavementhali not bepermitFed unless no reasonabiealtetnate method(s available, Written approval of the Ohio <br />Departmentof Transportaiion Disirict Office must beobtained. <br />[8] Ail work requiring menor vehicleswithfn ODOT right of way shall complywlth ail appilcablerequirements of the Ohio Manual of <br />Traffic Control Devicesand Item 614 (Maintaining Traffic) of the Construction andMaterial Specifications, latest editions. Fallure to <br />complywith theserequlrements wiil becausefor immediaterevocation or suspension of the permit until the proper traffic control <br />deviceshavebeerprovided. <br />[9] I havereceiveda copyof the policies and regulations pertaining to the permit for which I haveapplied, If a permit is subsequently <br />Issued to meby the Ohlo Department of Transporfatlon, I understand that the permit will state the terms and conditions for its use, and I <br />agreeto complywith all conditions andregulatfons stipulated on or attachedo the permit, I also understand andagreethat fqilure to <br />compiyfully with all condltions and regulations of the permit or any changen the use of the permit inconslstent with its terrns and <br />conditlons wlll beconsidereda violation and causefor suspension, revocation, or annulmentof the perm(t thereby rendering the permit <br />illegal and subjectto appropriate Departrnent actlon, up to an fnciuding removal of the installation at the permiitee's expense, <br />SIGN HERE 0 <br />Signa#ure f Property Owner or Agent fo Owner <br />Date&7p L- <br />Day time Phone SyO -2/ S/O <br />Rev 10/ 17/00 <br />(See Other SIde) <br />Office use only <br />Date Received <br />By <br />Date Accepted <br />Offlce Use Oniy <br />couniy/ <br />Jurisdiction <br />Rte LogPt <br />AccCat <br />