HomeMy WebLinkAboutDISCOUNT TIRE AT FOSSIL CREEK - Filed OA-OTHER AGREEMENTS - 2004-08-05Issuing authority application
COLORADO DEPARTMENT OF TRANSPORTATION
acceptance date:
STATE HIGHWAY ACCESS PERMIT APPLICATION
of Transportation or your local government to determine your issuing authority.
Instructions: - contact the Department
to determine what plans and other documents are required to be submitted
- contact the issuing authority
with your application.
this form (some questions may not apply to you and attach all necessary documents and
- complete
it to the issuing authority. Submit an application for each access requested.
submit please print or type
- if you have any questions contact the issuing authority.
1) Property owner (Permillee) 2) Applicant
City of Fort Collins
street address, street address, city
PO Box 580 281 N. Colle e Ave state phone
_
state &zip phone #
CO 80522to
-
_
3)Address of propety to be served by permit (if known)
Fossil Creek Parkway
4) Legal description of property: bl ock 'at section t"m9eownship
courtly aubJivlabn
Larimer iscuunt T'r a F
5) What state highway are you requesting access from? 6) What side of the highway ❑ N ❑ S 91 E U W
287 Coll A
feet is the access from the nearest milepost? How many feet is the proposed access from the nearest cross street?
7) flow many proposed
342 0 W Fossil Creek Parkway_
1358 feet(circle: N n E W )from: feet(circle: N S E )from:
8) Check here if you are requesting a
❑ new access ❑ temporary access 91improvement to existing access ❑ change in access use ❑ removal of access
at Fossil frppk Parkway intprcprtjoD
9) What is the approximate dale you Intend to begin construction?
10) Do have knowledge of any State Highway access permits serving this property, or adjacent properties in which you have a property interest.
L1 no ❑ yes, if yes - what are the permit number(s)?: and/or, permit date:
11) Does the property owner own or have any interests in any adjacent property?
L1 no ❑ yes, if yes - please describe:
12)Are there other existing or dedicated public streets, roads, highways or access easements bordering or within the property?
no L1 yes, if yes - list them on your plans and indicate the proposed and existing access points.
13) If you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of each.
business square footage business square footage
Discount Tire - sales and installat
on 8400
Added to existing street traffic
_
14) If you are requesting agricultural field access - how many acres will the access serve?
n/a
15) If you are requesting residential developemenl access, what is the type (single family, apartment, townhouse) and number of units?
type number of units type number of units
n/a
16) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning Is two counts. Indicate if your counts are
a. m IA peak hour volumes or ❑ average daily volumes. See attached fig.6 from traffic study for Discou
# of psse.,nr cars end liyhl Im ks # of mutli unit trucks # of We, vehidea 1 re a o $ s re
15 8/25/02
345 11
# or single unit vehl des in escess or 30 A.
# of farm vehicles (field equipment)
Total count of all vehicles
382
11
0
Ti) Check with the issuing authority to determine which of the following documents are required to complete the review of your application.
(plans should be no larger than 24" x 36")
e) Property map indicating other access, bordering roads and streets.
a) Highway and driveway plan profile. f) Proposed access design
b) Drainage plan showing impact to the highway right-of-way. g) Parcel and ownership maps including easements.
c) Map and letters detailing utility locations before and after h) Signing and striping plans.
development in and along the right-of-way. 1) Traffic control plan.
d) Subdivision, zoning, or development plan. j) Proof of (lability Insurance.
'f an access permit is issued to you it will state the terms and conditions for its use. Any changes in the use of the permitted
not consistent with the terms and conditions listed on the permit may be considered a violation of the permit.
:access
The applicant declares under penalty of perjury in the second degree, and any other applicable state or federal
laws, that all information provided on this form and submitted attachments are to the best of their knowledge true
and complete.
Applicants signature
Date
If the ap ca is not the owner of the property, we require this application also to be signed by the property o ner or their
legally Lit rized representative (or other acceptable written evidence). This signature shall constitute agreement with this
applica to by all owners -of -interest unless stated in writing. If a permit is authorized, the property owner will be listed as
the permittee.
Property owner signature _
Date
AOT form #737 9196
Previobs dditions may be used until supplies are
State Highway Access Permit Page 1
Attachment to Permit No. 404065 - Additional Terms and Conditions
If there are any questions regarding this permit, please contact Tess Jones at (970) 350-2163.
2. The Permittee shall refer to all additional standard requirements included with this permit and any enclosed
additional terms, conditions, exhibits, and noted attachments.
Incorporated as part of this permit are the following:
Application for Access Permit (CDOT Form No. 137)
Permit (CDOT Form No. 101) and its two page attachment
Exhibits:
"A" - Construction Plan Set (13 sheets)
"B" - Hydraulic Clearance
4. This permit is issued in accordance with the State Highway Access Code (2 CCR 601-1), and is based upon
the information submitted by the Permittee. This permit is only for the use and purpose stated in the
Application and Permit. Any changes in traffic volumes or type, drainage, or other operation aspects may
render this permit void, requiring a new permit to the be applied for based upon exisiting and anticipated
future conditions.
5. Access construction methods and materials shall conform to the Colorado Department of Transportation
Standard Specifications for Road and Bridge Construction (current edition).
6. If necessary, minor changes, corrections and/or additions to this permit may be ordered by the Department
inspector, other Department representative or local authority to meet unanticipated site conditions. Changes
may not be in violation of the State Highway Access Code. All major changes to the plans must be approved
in writing by the Department prior to commencement of any work on or within the State Highway
right-of-way.
7. This permit is subject to revocation due to: 1) Noncompliance with the provisions of this permit; 2)
Abandonment; 3) Supersedure by new permit covering the same installation; or 4) Conflict with necessary
planned highway construction and/or improvements. The Permittee shall promptly terminate occupancy upon
notice of cancellation of the permit from the Department, unless a new permit is applied for and granted.
8. Reconstruction and improvements to the access may be required when the Permittee has failed to meet the
required design and/or material specifications. If any construction element fails within two years due to
improper construction or material specifications, the Permittee is responsible for all such reparis.
9. The Department retains the right to perform any necessary maintenance work in this area.
10. Backing maneuvers within and into the State Highway right-of-way are strictly prohibited. All vehicles shall
enter and exist the highway right-of-way in forward movement. Backing into the right-of-way shall be
considered a violation of the terms and conditions of this access permit and may result in revocation of the
permit by the Department and/or the issuing authority.
11. The Permittee is responsible for obtaining any necessary additional federal, state, and/or City/County permits
or clearances required for construction of the access. Approval of this access permit does not constitute
verification of this action by the Permittee.
12. All costs associated with the installation of this access are the responsibility of the Permittee. This includes
design, construction, signing and striping, utility relocation, testing of materials, and inspections.
13. No work will be allowed at night, or on Saturdays, Sundays, and legal holidays without prior authorization
from the Department. 'The Department may also restrict work within the State Highway right-of-way during
State Highway Access Permit Page 2
Attachment to Permit No. 2104065 - Additional Terms and Conditions
adverse weather conditions.
14. Traffic detours or lane closures will not be allowed, unless pre -approved by the Department.
15. Two-way traffic shal I be maintained throughout the work area at all times unless specific written authorization
is obtained from the Department.
16. No construction vehicles shall be parked, or construction materials/equipment stored, on the State Highway
right-of-way overnight.
17. No work shall be performed near a Department traffic control signal without coordination with Charles Weber
at (970) 350-2137.
18. Landscaping and site construction shall not obstruct sight distance at any State Highway access point.
Landscaping within the State Highway right-of-way requies the Permittee to obtain a CDOT Landscaping
Permit from the Maintenance Section. The access permit does not authorize that activity, although a proposed
landscaping plan shal I be included in the access permitting document. Irrigation of features within the
right-of-way may require the Permittee to install a subsurface drain in accordance with CDOT Standard
M-605-1 or other approved system. The Permittee shall contact Don Miller at the loveland Maintenance
Office, (970) 667-4650, to obtain the Landscaping Permit.
19. Routine, periodic maintenance and emergency repairs may be performed within the State Highway
right-of-way, under the general terms and conditions of the permit. Any significant repairs such as culvert
replacement, resurfacing, or changes in design or specifications, will require written authorization from the
Department. The Department shall be given proper advance notice whenever maintenance work will affect the
movement or safety of traffic on the State Highway. In an emergency, the Department Region Office and the
State Patrol shall immediately be notified of possible hazards.
20. All work is to conform to the plans referenced by this permit on file with the Department or as modified by
this permit. (If discrepancies arise, this permit shall take precedence over the plans.) The Department plan
review is only for the general conformance with the Department's design and code requirements. The
Department is not responsible for the accuracy and adequacy of the design, dimensions, elevations, and any
other elements which shall be confirmed and correlated at the work site. The Department through the
approval of this document, assumes no responsibility for the completeness and/or accuracy of the plans.
21. The State requires a Certificate of Insurance prior to commencing any work on the State Highway
right-of-way. Policies shall name the State of Colorado as additional insured party. All vendors, contractors,
and utility companies shall procure, at their own expense, and maintain for the duration of the work period, the
following minimum insurance coverages:
A. Standard workman's compensation and employer's liability, including occupational disease, covering all
employees engaged in performance of the work at the site, in the amount required by State Statutes.
B. Comprehensive general liability in the amount of $600,000 combined single limit bodily injury and
property damage, each occurrence and $2,000,000 annual aggregate.
C. Automobile liability in the amount of $600,000 combined single limit bodily injury and property damage,
for each accident.
Certificates of insurance showing compliance with these provisions shall be attached to and made a part of this
permit and be available on the site during construction.
State Highway Access Permit Page 3
Attachment to Permit No. 404065 - Additional Terms and Conditions
22. All materials, equipment, installation, construction, and design, including the auxiliary lane(s) and intersection
improvement(s) within the State Highway shall be in accordance with the following Department standard
references as applicable:
A. State Highway Access Code, 2 CCR 601-1
B. Roadway Design Manual
C. Materials Manual
D. Construction Manual
E. Standard Specifications for Road and Bridge Construction, latest edition
F. Standard Plans (M&S Standards)
G. Manual on Uniform Traffic Control Devices (M.U.T.C.D.) for Streets and Highways and the Colorado
Supplement thereto
H. A policy on Geometric Design of Highways and Streets, American Association of State Highway and
Transportation Officials (AASHTO), latest edition
I. AASHTO Roadside Design Guide
J. Institute of Transportation Engineer's Trip Gneration Manual, 6th edition
Some of the reference: materials listed above (A thru F) may be purchased from:
Colorado Department of Transportation
Bid Plans Room
4201 East Arkansas Avenue
Denver, CO 80222-3400
(303) 757-93 13
The State Highway Access Code may be purchased from:
The Public Records Corporation
1666 Lafayette Street
PO Box 18186
Denver, CO 80218
(303)832-8262
The website is:
www.dot.state.co.us/business/accessmgt/
23. Survey markers or monuments must be preserved in their original positions. Notify the Department at (970)
350-2173 immediately upon damage to or discovery of any such markers or monuments at the work site. Any
survey markers or monuments disturbed during the permitted work shall be repaired and/or replaced
immediately at the expense of the Permittee.
24. Should any excavation encounter plant or animal fossils, the remains of historic or prehistoric structures,
artifacts, (pottery, stone tools, arrowheads, etc.), the work shall be stopped and the Permittee shall notify the
Department inspector.
25. The Permittee or the contractor shall notify Linda McWilliams at (970) 350-2147, at least two working days
prior to beginning any access improvements or construction of any kind within the State Highway
right-of-way. Failure to comply with this requirement may result in revocation of this permit.
State Highway Access Permit Page 4
Attachment to Permit No. 404065 - Additional Terms and Conditions
26. The Department inspector may suspend any work due to: I)Noncompliance with the provisions of this
permit; 2) Adverse weather or traffic conditions; 3) Concurrent highway construction or maintenance in
conflict with permit work; 4) Any condition deemed unsafe for workers or the general public. The work may
be resumed upon notice from the Department inspector.
27. Upon completion of the work, a letter certifying that all project materials, construction, inspection and
workmanship was in accordance with the plans and applicable Department Standard Specifications for Road
and Bridge Construction shall be submitted to the Region Access Manager. The certification letter must be
signed and stamped (sealed) by a Colorado registered professional engineer.
28. Speed change lane(s) shall be provided in accordance with Exhibit "A" and Section 4 of the State Highway
Access Code, 2 CCR 601.I .
29. The access shall be reconstructed as shown in Exhibit "A".
30. Construction traffic control devices, when not in use, shall be removed or turned away from traffic.
31. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from
initiation of construction within State Highway right-of-way.
32. All required access improvements shall be installed prior to the herein authorized use of this access.
33. The access shall be surfaced immediately upon completion of earthwork construction and prior to use.
34. No paved surface shall be cut unless specified in this permit. Asphalt removal shall be saw cut to assure a
straight edge for patching.
35. The top layer of plant mix bituminous pavement shall not be placed between October I and April 1, unless
otherwise approved by the Department.
36. Any layer of bituminous pavement that is to have a succeeding layer placed thereon shall be completed full
width, before succeeding layers are placed.
37. If frost, water or moisture is present in the subgrade, no surfacing materials shall be placed until all frost,
water or moisture is gone or removed.
38. The access shall be reconstructed and maintained in a manner that will not cause water to enter onto the
roadway, and will not interfere with the existing drainage system within the State Highway right-of-way.
Drainage to the State Highway right-of-way shall not exceed historical rate of flow.
39. All existing drainage structures shall be extended, modified, or upgraded as necessary, to accommodate all
new construction and safety standards, in accordance to the Department's standard specifications.
40. The Pernittee shall request final inspection by
within 10 days following
completion of access construction, and prior to authorized use. The Permittee or their representative shall be
present.
41. A fully executed complete copy of this permit must be on the job site with the contractor at all times during
construction. Failure to comply with this or any other construction requirement may result in the immediate
suspension of work by order of the Department inspector or the issuing authority.
42. The design and construction of access and/or development of this property shall not negatively impact
adjacent nearby properties. Correction of the problem and cost resulting from damages shall be bome by the
Permittee.
COLORADO DEPARTMENT OF TRANSPORTATION
Issua
aoateapplicatio
te:
STATE HIGHWAY ACCESS PERMIT APPLICATION
ccep n
accep
Instructions: - contact the Department of Transportation or your local government to determl e yourONs1 .1 authority.
- contact the issuing authority to determine what plans and other documents are required to be submitted
with your application.
- complete this form (some questions may not apply to you) and attach all necessary documents and
submit it to the issuing authority. Submit an application for each access requested.
- if you have any questions contact the issuing authority. Please print or type
1) Properly owner (Pennittee)
2) Applicant
City of Fort Collins
Assoc -
_ --- —
street address, city
street address, city
PO Box 580 (231 N. College Ave)
-
state & zip phone #
state & zip phone #
CO 80522 -
-
3)Address of propely to be served by pemoit (if known)
Fossil Creek Parkway_
4) Legal description of properly:
county subdivision block bt sectrm township range
Larimer__IDiscount Tire at Fossil Creek 5 N
5) WhatWhat state highway are you requesting access from? 6) What side of the highway ❑ N ❑ S $I E ❑ W
Z87�Co
-eg�_AVenu —
7) II -low many feet is the proposed access from the nearest milepost? How many feet is the proposed access from the nearest cross street?
1358 feet circle: N E W from342 D feet(circle: N S E W )from: Fossil .Creek Parkway
6) Check here if you are requesting a
U new access ❑ temporary access ® improvement to existing access ❑ change in access use ❑ removal of access
at Fnceil fr
g) What is the approximate date you intend to begin construction?
10)) Do you have knowledge of any State Highway access permits serving this property, or adjacent properties in which you have a property interest.
L3 no U yes, if yes -what are the permit number(s)?: and/or, permit date:
11) Does the property owner own or have any interests in any adjacent property?
Lx no ❑ yes, if yes - please describe:
12) Are there other existing or dedicated public streets, roads, highways or access easements bordering orwilhin the property?
U no L_* yes, if yes - list them on your plans and indicate the proposed and existing access points.
13) If you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of each.
business square footage business square footage
Discount Tire - sales a,nd,installat
on 8400
Added to existing street traffic
14) If you are requestingagriculturalfield access - how many acres will the access serve?
n/a
15) If you are requesting residential developement access, what is the type (single family, apartment, townhouse) and numberof units?
type number of units type number of units
—- — —
n/a
16) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then retuming is two counts. Indicate if your counts are
a.mJApeak hour volumes of ❑ average daily volumes. See attached fig.6 from traffic study for Discou
# of passenger cars and light trucks
# of multi unit trucks
# of other vehicles ire a 05 5 re
345
11
15 8/25/02
-jet sinyin unit vehicles In excess or 30 fl.
# of fans vehicles (held equipment)
Total count of all vehicles
11
0
382
17) Check with the issuing authority to determine which of the following documents are required to complete the review of your application.
(plans should be no larger than 24" x 36")
e) Property map indicating other access, bordering roads and streets.
a) Highway and driveway plan profile. f) Proposed access design
b) Drainage plan showing impactto the highway right-of-way. g) Parcel and ownership maps including easements.
c) Map and letters detailing utility locations before and after h) Signing and striping plans.
development in and along the right-of-way. i) Traffic control plan.
d) Subdivision, zoning, ordevelopment plan. j) Proof of liability insurance.
If an access permit is issued to you it will state the terms and conditions for its use. Any changes in the use of the permitted
access not consistent with the terms and conditions listed on the permit may be considered a violation of the permit.
The applicant declares under penalty of perjury in the second degree, and any other applicable state or federal
laws, that all information provided on this form and submitted attachments are to the best of their knowledge true
and complete.
Applicants signature /� -
Date
If the ap ca is not the owner of the property, we require this application also to be signed by the property o ner or their
legally ut rized representative (or other acceptable written evidence). This signature shall constitute agreement with this
applica Ion by all owners -of -interest unless stated in writing. If a permit is authorized, the property owner will be listed as
the permittee.
Properlyownersigna re
dz ` �j`,•
Date
ZD
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ACCESS PERMIT # 404065
HYDRAULIC CLEARANCE
r
Tess
From: Jones, Tess
Sent: Monday, March 22, 2004 6:58 AM
To: AIHaj, Samer;'kamoore@ci.fort-collins.co.us'
Cc: Jones, Tess.
Subject: minor development issue
Samer - I am forwarding to you a drainage report for the Discount Tire site at the SE corner of Fossil Crk and 287, south of
Harmony Rd. The property falls away from the highway, and the plan indicates that the flows will be away from our
system.
Could you please take a look at that plan and give me a clearance? They will be widening the road to provide a right decel
lane, and that will include an inlet to connect to the existing storm sewer. You may need to see more plans than the single
grading and drainage plan included in the report. The City is working with the development to get an access permit going.
The report was prepared by Stewart and Associates. I assume that you will work directly with them to resolve any
concerns, but please let me know if you need anything more from me.
(I only have one copy of their report, and am forwarding that to you this morning.)
thanks - please let me know if you have
Tess
r
AFCEIVED MAR 2 2 2004
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Issuing authority application
COLORADO DEPARTMENT OF TRANSPORTATION
acceptance date:
STATE HIGHWAY ACCESS PERMIT APPLICATION
of Transportation or your local government to determine your issuing authority.
Instructions: - contact the Department
- contact the issuing authority to determine what plans and other documents are required to be submitted
with your application.
- complete this form (some questions may not apply to you and attach all necessary documents and
submit it to the issuing authority. Submit an application for each access requested. please print or type
- if you have any questions contact the issuing authority.
2)Applicant
1)Property owner (Permittee)
Stewart &-As-nr
City of Fort Collins street address, city Jack Blake
street address, city
PO Box 580 281 N. Colle e Ave phone
state &zip
stale 8 zip phone it
CO 80522 -
3) Address of propety to be served by permit (if known)
Fossil Creek Parkway
4) Legal description of property: section mwnsnlp range
block lot
county subdlNebn
iscount rr a F
_Larilner
5) What state highway are you requesting access from? 6) What side of the highway ❑ N ❑ S ® E ❑ W
287 Culleae A
7) How many feet is the proposed access from the nearest milepost? How many feet is the proposed access from the nearest cross street?
1358 342 0 feet(circle: N S E W )from: Fossil Creek Parkway
feet N E W )from:
8) Check here if you are requesting a
U new access ❑ temporary access ® improvement to existing access ❑ change in access use ❑ removal of access
at. Fossil Crpek Parkway intier-pctifin
g) What is the approximate date you Intend to begin construction?
04
10) Do you knowledge of any State Highway access permits serving this property, or adjacent properties in which you have a property Interest.
Ln no U yes, if yes - what are the permit number(s)?: and/or, permit date:
it) Does the property owner own or have any interests in any adjacent property?
Lf no ❑ yes, if yes - please describe:
72) Are there other existing or dedicated public streets, roads, highways or access easements bordering orwithin the property?
U L f if - list them on your plans and indicate the proposed and existing access points.
no yes, yes
13) If you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of each.
business square footage business square footage
Discount Tire - sales and installat
oil 8400
Added to existing street traffic
14) If you are requesting agricultural field access - how many acres will the access serve?
n/a
15) If you are requesting residential developement access, what is the type (single family, apartment, townhouse) and number of units?
type number of units type number of units
n/a
16) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning is two counts. Indicate if your counts are
a.lnf-tpeak hour volumes or ❑ average daily volumes. See attached fig.6 from traffic study for Discou
pal passenger ors and light trucks
fl or multi unit Inxks
p of other vehides ire a ossi Crier
15 8/25/02
345
11
p of singly unit vehicles M excess o130 9.
M of tans vehldes (field equipment)
Total count of all vehicles
382
11
0
17) Check with the issuing authority to determine which of the following documents are required to complete the review of your application.
(plans should be no larger than 24" x 36")
e) Property map Indicating other access, bordering roads and streets.
a) Highway and driveway plan profile. f) Proposed access design
b) Drainage plan showing impact to the highway right-of-way. g) Parcel and ownership maps including easements.
c) Map and letters detailing utility locations before and after h) Signing and striping plans.
development in and along the right-of-way. i) Traffic control plan.
d) Subdivision, zoning, or development plan. j) Proof of liability insurance.
If an access permit is issued to you it will state the terms and conditions for its use. Any changes in the use of the permitted
access not consistent with the terms and conditions listed on the permit may be considered a violation of the permit.
The applicant declares under penalty of perjury in the second degree, and any other applicable state or federal
laws, that all information provided on this form and submitted attachments are to the best of their knowledge true
and complete.
Applicants signature IDate
is not the owner of the property, we require this application also to be signed by the property o ner or their
If the a0ion
legallyrized representative (or other acceptable written evidence). This signature shall constitute agreement with this
applicay all owners -of -interest unless stated in writing. If a permit is authorized, the property owner will be listed as
the permittee.
Property owner signature
ll%L.Y�%(
Date
.nftT Fnrm R13] 9196
Prevlobs editions may be useb unit suppues are
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City of Port Collins
Transportation Services
lIngineering Department
Revocable Permit for Encroachment Permit Number
in the Right -of -Way ApProvvl Date
(minimum of 5 days required for approval)
Applicant Name: i/' ���( L% 7//C �� Phone: Zl<<'li(-
lam'
Company)
%J'� / l t /7C /";7
Address: j z4'� �, ; /di°��; City, State, Zip:
Sub -Contractor:
Phone
Address: z � 'i17 City, State, Zip:
/5/_y
Dates of Encroachment: From:
T
Location of Encroachment: J�C l//JC i �e r, �ti� ire r >iZcUJ�
Type: O Alley O Sidewalk O Street O Outdoor eating ,(Other
i
Purpose of Encroachment' : �� �'c�t'l ��� m
-Applicants for an encroachment permit that will occupy any parking spaces in the downtown area, must
notify the City of Fort Collins Transportation Department, at 235 Matthews Street, (970) 221-6608.
Applicant agrees to submit with this permit application a sketch, drawing, or plan that illustrates
the location of the proposed encroachment, obstruction, or other structure in the public right-of-
way.
This permit is non -transferable, is personal to the Applicant and is non -assignable. Applicant agrees that
any transfer of ownership of the business holding the permit will terminate this permit and require a new
application to be filed by the new owner.
Applicant has read this permit and agrees to abide by the current City of Fort Collins Standard
Specifications and to any such special conditions, restrictions, and regulations that may be imposed by
the City Engineer.
Applicant's Signat- Date:
Engineering Approval: O,i1i► V I c 1a�w^ Date: (0117 D
Application Fee: $ Inspection Fee: $ Total Due: $
Conditions:
t North Collr1;c AVC'l1UP • PO. Roa 580 • Fort Collins, CO 80522-0580 • (970) 221-6605 • FAX (970) ^_2i-6378
www.ci.to] t-0011111e_aO.us
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Permit No.
STATE HIGHWAY ACCESS PERMIT
ismittal Region/Section/Patrol
08/03/2004 04/01/04
State Highway No/Mp/Side
287C/341.540/R
Local Jurisdiction
Fort Collins
The Permittee(s), Applicant; Ref No. 2004
Katie Moore Jack Blake
City of Fort Collins Stewart & Associates
281 N. College Avenue 103 S. Meldrum Street
PO Box 580 Fort Collins, CO 80521
Fort Collins, CO 80522 970-482-9331
970-221-6605
is hereby granted permission to have an access to the state highway at the location noted below. The access shall be constructed, maintained and used in
accordance with this permit, including the State Highway Access Code and any attachments, terms, conditions and exhibits. This permit may be revoked
by the issuing authority if at any time the permitted access and its use violate any parts of this permit. The issuing authority, the Department and their duly
appointed agents and employees shall be held harmless against any action for personal injury or property damage sustained by reason of the exercise of
the permit.
Location:
The access is to be located on State Highway 287, a distance of 2,851 feet north from Mile Post 341 on the eastiright side.
"FOSSIL CREEK PARKWAY"
Access to Provide Service to:
City Street - FOSSIL CREEK PARWAY....................................................... 1 Each 100.00 %
New use at existing street — "Fossil Creek Parkway"
New use is tire store = 8,400 sq ft
Other terms and conditions:
• See Attached Pages 2 and 3 and Other Enclosures for Additional Terms and Conditions.
• Improvements to the existing street intersection are required at the southeast corner of the intersection.
• The contractor must obtain clearance of the asphalt paving design mix and pavement section prior to any roadway
work along SH 287.
• The Notice to Proceed will be issued upon CDOT's receipt of the contractor's certificate(s) of insurance.
MUNICIPALITY OR COUNTY APPROVAL
Required only when the appropriate local authority retains issuing authority.
W I---
Date
Iols-l�1�-
Title
G1\1
Upon the signi g of this permit the permittee agrees to the terms and conditions and referenced attachments contained
herein. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from
Initiation. The permitted access shall be completed in accordance with the terms and conditions of the permit prior to
being used.
The permittee shall notify Linda McWilliams with the Colorado Department of Transportation in Greeley at 970-350-
2147 at least 48 hours prior to commencing construction within the State Highway right-of-way.
The person signing as the permittee must be the owner or legal representative of the property served by the permitted access and have full authority to
accept the permit and its terms and co ditions.
Permittee Date
This permit is not valid until signed by a duly authorized representative of the Department.
COLORADO DEPARTMENT OF TRANSPORTATION
By
(x) •p�(, o
I d,
Date (of issue)
Z,
Title
Access Manager
—
) C
copy
/Dis ibution: Required: Make copies as necessary for: Previous editions are obsolete and may not be used
1 Region Local Authority Inspector CDOT Form #101 af98
2.Applicant MTCE Patrol Traffic Engineer
3.Slaff Access Section
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