Street Opening Permit
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1STREET OPENING PERMIT
APPLICANT INFORMATION
Name of Applicant: ________________________________________________________________________________________
Contact Person: _____________________________________________________________ Phone: (
) _______________
Address: __________________________________________________________________
Fax:
(
) _______________
City: ________________________________ State:______ Zip Code: _____________ Email: ____________________________
CONTRACTOR INFORMATION
Name: __________________________________________________________________________________________________
Contact Person: _____________________________________________________________ Phone: (
) _______________
Address: __________________________________________________________________
Fax:
(
) _______________
City: ________________________________ State:______ Zip Code: _____________ Email: ____________________________
LOCATION INFORMATION
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Will work take place within a Homestead Right-of-Way?
Yes
No
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Will road surface, curb or sidewalk be disturbed?
Yes
No
If yes, describe what will be disturbed: _____________
________________________________________________________________________________________________________
NAME OF STREET(S) where work will take place (include cross streets): _____________________________________________
________________________________________________________________________________________________________
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Type of pavement:
Concrete
Asphalt
Brick
Tar & Chip (Seal Coat)
Length of excavation in paved area: ____________ Ft.
Width of excavation in paved area: _____________ Ft.
Length of excavated area in unpaved area: ____________ Ft.
Width of excavation in unpaved area: _____________ Ft.
Reason for work: __________________________________________________________________________________________
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Emergency repair?
No
Yes, please explain: ____________________________________________________________
Number of Core Drillings: __________
The applicant must notify Homestead Borough (412-461-1340) a minimum of 24 hours before work is commenced and shall not
backfill any trenches before the work has been inspected and approved by Homestead Borough. The applicant also agrees to protect
the opening by suitable barricade and lights, in accordance with said Ordinance, and to be liable for any damage of whatever kind
that may be caused by reason of said opening, as also the whole expense or restoring, in accordance with the terms of said
Ordinance, said (street/road) to as good condition as possible. The entire work must be done in accordance with the Ordinances of
Homestead Borough.
Applicant name (print): __________________________________________
Date of application: ____________________
Applicant signature: ____________________________________________
(FOR BOROUGH USE ONLY)
$
PERMIT FEE
Street opening fee- $1,000.00 plus $3.00 for each additional lineal foot
greater than 25 feet.
$
____________BOND (if cash or check)
Core drilling fee- $5.00 each
$
____________ SCANNING FEE
Scanning fee- $2.00 per page or drawing
$
____________DOCUMENT STORAGE
Document storage- $1.50 per page or drawing
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$
____________TOTAL FEE
Has $5,000.00 performance guarantee (bond) been provided?
Yes
No
Amount: $ _______________________
Type: ___________________________________________________________
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Has site plan and profile been provided?
Yes
No
Permit approved: __________________________________________________
Date: ______________
Borough Engineer
Permit Issued by: __________________________________________________
Date: ______________
Building Code Official/Zoning Officer
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