[City of Bloomington, Illinois] (Old)

Section 1 of 1 in this document

Applicant Information

Site & Project Information

I am filling this out as the...

Does owner reside at work site address?

Owner Phone Number

Owner Email

Check this box if this is part of a larger project

Yes

Project details (including additional permit information, etc...)

Contractor Information

Contractor Name

Phone Number

Do you have / require an alternate contact? - i.e. project manager , crew leader, etc.

Yes

Primary / Alternate Contact Information

Phone Number

Company Name

Job Title

NOT sure which permit you need? CHECK BELOW.

If cutting or removing curb for driveway widening or new or new driveway entrance: Curb Cut Section and Excavation Section required
Any work Public Right of Way, including area between curb and sidewalk: Excavation Section required
Removal/Replacement of sidewalk: Excavation and Traffic Control Sections required.
If obstructing a sidewalk, driveway/parking lane or closing a street: Traffic Control Section Required
If replacing or connecting a new sewer or water service from property to city main that is in the street: Excavation Section and Traffic Control required
Utility Easement - Any Excavation/Boring in Easement may require Traffic Control permit
Other - Any questions/concerns please contact City of Bloomington Engineering Department at 309-434-2980

Please list the type of permit(s) you wish to apply for. Please select all that apply.

TRAFFIC CONTROL (required if sidewalk or parking lane or traffic lane is being obstructed)

EXCAVATION (required if any digging will occur in city right-of-way or areas listed above)

CURB CUT (only required if adding a new driveway or expanding an existing driveway)

Scope/ description of work being done.

REMOVAL OF SIGNS FROM PUBLIC RIGHT OF WAYS - PROHIBITED

It is City policy that City maintenance crews will remove and replace any sign posted on any street or public area under City jurisdiction at no charge. A minimum of two working days' notice is required prior to the desired removal date. Unauthorized removal of any City sign will result in the violators being billed for the replacement cost associated with the reinstallation of the sign and may be charged with a violation of Section 11-311 of the Illinois Vehicle Code. The fine for a conviction of this violation is as follows: "Every person convicted of a violation of this section shall be guilty of a Class A Misdemeanor, punishable by a fine of at least $250.00 in addition to any other penalties that may be imposed." If a sign installation is in the way, or interferes with any of your construction projects, please contact the City of Bloomington Public Works Department at phone 309-434-2220 to have this sign removed and to request replacement following completion of construction. Only City of Bloomington Maintenance Crews are authorized to perform sign work on public right-of-way.

GENERAL PROTECTION AND TRAFFIC CONTROL REGULATIONS

The contractor/permit holder shall protect public property from damage. Any damage to the pavement, sidewalk, curb or any other public property caused by the work shall be properly repaired to the satisfaction of the City by the permit holder or by City maintenance forces at the permit holder's expense. All permits issued include an obligation by the contractor/permit holder to provide for public protection based upon worksite circumstances. Worksite protection not only applies to motorized vehicles, but also pedestrians, bicycles and all users of the right-of-way. Worksite protection must comply with all current Americans with Disabilities Act (ADA) requirements. The requirements, standards, and methods of application for traffic control in all permit areas shall conform to the latest approved revision of the Illinois Manual on Uniform Traffic Control Devices for Streets and Highways, and Illinois Department of Transportation (IDOT) Highway Standards. Only traffic control devices approved for use in these publications will be allowed for use within the City of Bloomington. Any variance from these standards without prior permission from the Engineering Department may result in immediate work stoppage and penalties as described in Chapter 38, Section 63 of the Bloomington City Code. All work areas on two-way public streets may require flaggers as outlined in the Illinois Revised Statutes Chapter 121, Par. 314.2

If a permit is obtained by a Homeowner and a Contractor is hired to do the work, the CONTRACTOR is responsible for DISPOSAL OF BULK MATERIAL per Chapter 21, Section 300.7 of the Bloomington City Code

Traffic Control

All fees are doubled if work started before permit issued

Driving Lane

Yes

Number of Days

Follow correct IDOT Standards for appropriate closure

Parking Lane/Sidewalk

Yes

How long will the project/ obstruction be in place?

Will Traffic Control take place between 5:00 p.m. and 8:30 a.m. (weekday), on a weekend, or on a holiday? (Additional emergency contact information entries will be required later)

Additional Emergency Contact Information

Please provide at least two additional contacts below:

Phone Number

Add a third Contact

Phone Number

Follow correct IDOT Standards for appropriate closure.
Must use lighted barricades at each end when stationary objects are placed in parking lane overnight to alert drivers.

Please describe scope of work, including necessary traffic lane closures, signs, devices (cones, barricades, etc.), and layouts to be used. Reference appropriate Highway Standards or section of MUTCD, and any special control measures proposed, if applicable

Please attach a sketch of the traffic layout

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Excavation

All fees doubled if work started before permit is issued

Area of Land to be Disturbed

Measurement

Water Service Install / Repair - $40 permit fee plus $100 deposit

Yes

Sewer Service Install / Repair - $40 permit fee plus $200 deposit

Yes

Sump Pump Drain Line Install / Repair - $40 permit fee

Yes

Sidewalk Install / Repair - $40 permit fee

Yes

Driveway Install / Repair - $40 permit fee

Yes

Other - Fee may vary based on area of excavation.

Yes

Describe Other

Please add any additional information about the excavation to be considered including thickness of driveway, sidewalk, approach, and materials being used or include in attachment drawing.

Attachment(s)

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Curb Cut

All fees doubled if work started before permit issued

Site on Corner Lot (yes or no)

Yes

Entrance Details

Type of Driveway

Width at Property Line (feet and Inches, generally measured at the private side of the sidewalk)

Width of Curb Cut (feet and inches, as measured at the curb)

Distance of Curb Cut from Nearest Property Line (ft and in)

Distance of Curb Cut from Nearest Intersection (ft and in)

Please attach a sketch of the planned curb cut.

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Acknowledgement

By electronically signing this document, applicant agrees that it's electronic signature is the legal equivalent of its manual signature on documents and agreements with the City of Bloomington. By signing documents through electronic means, applicant intends and consents to be legally bound and that the statements and information provided within the document are factual and true

Signature

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.