ROW Permit

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I Want To . . .

Right-of-Way Work Permit

* Indicates required field

Applicant Name *

First

Last

Phone Number *

Company Name *

Email *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Location of Work *

Description of Work *

This proposed work is being performed at the request of the City of Perry *

Yes No

Will the proposed work result in a permanent use of city property or right-of-way? *

Yes No

Will the proposed work impact adjacent roadways? *

Yes No

If so, please explain the impact and what steps will be taken to ensure safety and prevent traffic concerns. *

Will the proposed work included removal and/or replacement of any portion of the roadway? *

Yes No

If so, please provide an estimated timeline for the street repair *

Will the proposed work include removal and or replacement of any portion of a sidewalk? *

Yes No

If so, please provide an estimated timeline for pouring back the disturbed sidewalk *

Please note,
The cost for a street cut is $25.00 per square foot
The cost for a curb cut is $20.00 per linear foot with a minimum $300.00 fee per curb cut

Please list any subcontractors below: *

Please attach a copy of your current liability insurance. The City MUST be listed as additional insured to be able to work on City property or rights-of-way *

Max file size: 20MB

Please attach a map/drawing of the proposed work area. Maps/drawings must be scaled and list the type and location of other utilities in the work area. *

Max file size: 20MB

By providing my E-Signature below, I hereby Acknowledge that I have read this application, state that its contents are correct and agree to comply with all relevant ordinances of the City and State Laws. I also agree to pay all required fees prior to the commencement of work and to give at least 24 hours notice for the need of an inspection. *

Submit

City of Perry, Iowa- 'Make Yourself At Home!' | 1102 Willis Avenue P.O. Box 545, Perry, IA 50220 | (515) 465-2481