Create a Website Account - Manage notification subscriptions, save form progress and more.
3635 4th Avenue
Moline, IL 61265
TYPES OF ACTIVITIES WHICH NORMALLY REQUIRE THE APPLICATION FOR THIS PERMIT WOULD INCLUDE THE PLACEMENT OR REPAIR OF ANY OBJECT, STRUCTURE OR FACILITY WITHIN A PUBLIC DEDICATED RIGHT-OF-WAY OR EASEMENT, CITY OWNED PROPERTY, WHETHER ABOVE GROUND OR UNDERGROUND AND ROAD CLOSURES.
Enter today's date
Utilities (Check all that apply):
Drainage (Check all that apply):
Road Closures will be approved with permission from the City of Moline Construction Manager, Darrel Preston at (309)524-2355, with no less than seven (7) business days’ notice. Upon approval, Moline City Departments, Rock Island County Agencies and property owners must have no less than five (5) business days’ notice to time of closure. The following agencies will be notified by e-mail prior to any road closure and proof of notification included in the permit application.
Contacts Revised: 5/27/2022
Select all that apply
1. The applicant certifies that prior to filling out this application that said applicant has ascertained the location of all existing utilities both aerial and underground and the accurate locations are shown on the plans. Contractor to verify location of all utilities. The applicant further certifies that each utility company, public and private within the rights-of-way have been contacted and a copy of their response has been attached as part of this permit application.
2. The construction and maintenance of such utility shall not interfere with the property and rights of a prior occupant.
3. All work shall be done in keeping with the standards approved by the City Engineer of the City of Moline and under the supervision of said City Engineer or representative.
4. All materials & equipment shall be subject to inspection by said City Engineer or their representative.
5. All construction shall be performed in a manner meeting the approval of the City Engineer of the City of Moline and Safety Standards as prescribed by the Manual on Uniform Traffic Control Devices and IDOT Roadway and Bridge Design Standards. The City of Moline shall be relieved of all responsibility from damages of any nature arising from issuance of this permit.
6. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City’s right, title and interest in the land to be entered upon and used by the Permittee and the Permittee will, at all times, assume all risk of and indemnity, defend and save harmless the City from and against all loss, damage, cost or expense arising in any manner on account of the exercise or attempted exercises by said Permittee of the aforesaid rights & privileges.
7. The City requires photos of proposed location when applying for permit and post photo’s upon closing the permit.
8. All City of Moline property and/or rights-of-way shall be restored to original condition as far as practicable and meeting the approval of the City Engineer or representative, this includes the removal of locating flags and resodding.
9. The Permittee shall maintain BMP’s and erosion control measures throughout the duration of the project. This shall include obtaining a Notice of Intent through the Illinois Department of Environmental Protection for projects over one (1) acre. No dewatering shall be done as part of this permit without an approved dewatering plan. If dewatering is contemplated, a plan shall be submitted with the project plans.
10. All overhead installations shall conform to clearance standards of the Illinois Department of Transportation (IDOT), and all underground crossings installations shall be installed at a minimum depth of thirty-six (36”) under the road base and at least thirty-six (36”) under below ditch invert grade. In areas not under the road the minimum cover shall be of thirty (30)” for electric lines, eighteen to twenty-four (18”–24”) for Communication, Cable or Video Service Line, and thirty (30”) for Gas and Petroleum Products. Variations and exceptions may be made by authority from the City Engineer or representative.
11. The attached sketch or sets of plans covering details of this installation shall be made a part of this permit. A copy of this permit must be on site at all times.
12. It is expressly stipulated that this permit is a license for permissive use only and that placing of facilities upon public property pursuant to this permit shall not operate to create or vest any property rights ibn said holder.
13. Whenever necessary for the construction, repair, improvement, alteration, relocation of any portion of a City facility as determined by the City Engineer, any or all poles, wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be removed from said right-of-way, or reset or relocated thereon as required by the City Engineer and shall be done at the expense of the holder. The minimum notice of the requirement for non-emergency removal is ten (10) days: for emergency removal, the City reserves the right to remove improvements without notice.
14. It is agreed that in the event of relocation of said utility, facilities are scheduled to be done simultaneously with a City improvement project, the Permittee will coordinate with the City before proceeding, shall cooperate with the City’s contractor to arrange the sequence of work so as to not unnecessarily delay the work of the City’s contractor, defend any legal claims of the City’s contractor due to delays caused by the Permittee’s failure to comply with the approved schedule. The Permittee shall not be responsible for delays beyond its control. The Permittee shall furnish a relocation schedule if the work will fall into the time frame the capital project is under construction. The City shall be notified at least three (3) business days and not more than five (5) business days prior to starting construction at 309-524-2355, after the permit is issued.
15. Notify J.U.L.I.E at 811 at least two (2) full business days and not more than five (5) business days prior to starting construction.
16. Area of construction shall be marked in white paint and the locate flags removed during restoration.
17. Proposed work must be started within thirty (30) calendar days from the date of approval. The extension of said time may be extended through written request only.
18. Execute and return three (3) copies of this permit with the Permit Closure Section completed and Record Drawings to the City stating that the job is completed in accordance with the permit and all changes have been noted in the Record Drawings.
19. At no time will this permit exceed one (1) year.
20. This permit may be terminated by the City of Moline when the City has determined the Permittee has violated any provision contained herein and/or fails to promptly correct such violation within five (5) day of notice from the City.
21. Permittee is responsible for providing an emergency contact person and phone number for 24 hours a day/7 day a week. Inability to make contact in the event of an emergency may result in the penalty such as revocation of permit and/or back charge as result of damages.
22. The utility shall remove all excess material and restore all turf and terrain and other property, sidewalks, driveways, and roads within ten (10) days after any portion of the rights-of-way are disturbed, damaged or destroyed due to construction or maintenance by the utility, all to the satisfaction of the City. The time period provided in this Section may be extended by the Director of Engineering for good cause shown.
23. The City requires a Security Fund of $2,500.00 or 10% of the total cost of the project be submitted as security for this permit. Upon satisfactory completion of the work including removal of all signs and restoration of the work area, the bond will be released. Upon request, the City reserves the right to waive the security fund requirement.
24. Moline Code of Ordinances, Sec. 21-1100 – Construction and Heavy Equipment Noise. No operation of heavy equipment at any location within five hundred (500) feet of a residential use, prior to 6:00 a.m. on any day and after 9:00 p.m. on any day; however, this prohibition shall not apply in cases where a repair is immediately required for the protection of life or property.
25. The City requires that the approved permit be kept on site until all work is complete.
26. Contact Darrel Preston, Construction Manager at (309)524-2355 prior to starting construction.
See plans attached.
I, the undersigned, do hereby attest that the construction approved by the subject Permit was installed in Accordance with the permit requirements and in accordance with the City’s Rights-of-Way Use Procedures and that all changes have been noted in the Record Drawings. If this section is not completed, the permittee is still responsible to maintain and/or repair any damages to sidewalks, yards, sod, roadways or any other City infrastructure until signed off by the City Inspector.
Application fee in the amount of $200 and security fund of $2,500, can be made by check to “City of Moline” mailed or dropped off at 3635 4th Ave, Moline, IL 61265 Attention Engineering, or made over the phone by credit card with the Engineering Department at 309.524.2350.
This field is not part of the form submission.
* indicates a required field