Excavation Permit - New Hampshire Department Of Transportation
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5PERMIT NO:
THE STATE OF NEW HAMPSHIRE
TOWN/CITY:
DEPARTMENT OF TRANSPORTATION
ROAD/ROUTE:
EXCAVATION PERMIT
DATE:
DISTRICT 1
1
District 1, 641 Main St, Lancaster, NH 03584
District 4, 19 Base Hill Road, Swanzey, NH 03446
District 2, 8 Eastman Hill Road, Enfield, NH 03748
District 5, 16 East Point Drive, Bedford, NH 03110
District 3, 2 Sawmill Road, Gilford, NH 03249
District 6, PO Box 740, Durham, NH 03824
I. Pursuant to Chapter 236:9-11 and/or 231:184-186, New Hampshire Revised Statues Annotated, 2007, and
amendments thereto, permission is requested to disturb the pavement, shoulders and slopes within the right-of way
1)
on the
side of Route
or
Road
2)
in the town of
3)
for the purpose of
4)
located (give distance to nearest crossroad and/or other local landmark and include sketch or plan)
5)
during the period of dates between
and
LOCATION/DESCRIPTION:
As shown on the attached plans, sketches, letters, and notes which shall be made a part of this permit.
Construction shall be performed as shown on the attached plans, topographical, and description of work. Any variation
shall require prior approval from the District Engineer.
This permit concerns only the type and manner of work to be performed in the New Hampshire Department of
Transportation (NHDOT) ROW. NHDOT cannot and does not hereby grant permission to enter upon or utilize any
privately owned land.
I/We
, Contractor, and I/We
, Owner, agree to conform to the
NHDOT Standard Specifications for Road and Bridge Construction (Standard Specifications), as revised, the following
provisions, instructions and regulations in processing the work under this request, and to any additional instructions
issued by the District Engineer or designee during the process of the work.
STATE LAW REQUIRES THAT “DIG SAFE” BE NOTIFIED 72 HOURS IN ADVANCE OF EXCAVATION.
CONTACT DIG SAFE BY TELEPHONE: 1-888-344-7233.
THE DISTRICT OFFICE MUST BE NOTIFIED AT LEAST FORTY EIGHT
(48) HOURS BEFORE PERFORMING ANY WORK.
A COPY OF THIS PERMIT SHALL BE PRESENT AT THE WORK SITE AT ALL TIMES.
Photographs or videos in sufficient detail to show the existing condition of the area to be disturbed within the ROW
1.
shall be furnished to the District Engineer prior to the start of work. Photographs of all State underground
structures shall be taken just prior to backfill and furnished to the District Engineer.
2.
No work in the highway ROW shall be permitted during the following conditions:
a.
Inclement weather.
b.
The hours of darkness*.
c.
Saturdays, Sundays or Holidays. **
th
th
d.
During the period from November 15
to April 15
. **
* Work after dark may be permitted at the discretion of the District Engineer if adequate lighting is in place and is
sufficient to protect the traveling public and workers.
** Work during these periods may be permitted at the discretion of the District Engineer.
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