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CITY AND COUNTY OF BROOMFIELD Engineering Division [PHONE REDACTED] One DesCombes Drive, Broomfield, CO 80020 E-MAIL: [EMAIL REDACTED] OVER-EXCAVATION PERMIT Fax: [PHONE REDACTED] Date: Permit Number: Owner Name: Owner Business Name: Owner Address: Owner Phone Number: Cell Phone: E-mail: Contractor Name: Contractor Business Name: Contractor Address: Contractor Phone Number: Cell Phone: E-mail: Contractor License Site Address: Estimated Volume of Excavation/fill: CY Disturbed Area: Ac. Work Begin: Work End: (Permit must be on site before work can start) FEES Over- Ex Permit Fee: $ Over-Ex Plan Review Fee: $ Total Fee: $ Date Paid: All WORK SHALL COMPLY WITH CURRENT BROOMFIELD STANDARDS AND SPECIFICATIONS When required: A grading/over-excavation permit shall be required as specified in Appendix J of the International Building Code Requirements: Each grading/over-excavation permit application shall be accompanied by the following information, as required in Appendix J of the International Building Code. 1. Two sets of plans showing: vicinity map, property limits, accurate contours, detailed plans of all surface and subsurface drainage devices, finish contours, erosion control plans and details. 2. Drainage Report 3. Final Geotechnical Report including earthen cut/fill analysis and construction procedure, and over-excavation recommendations and construction procedure. 4. Wildlife and environmental assessment report. See Permit Condition 11 below if wildlife or environmental issues have been identified. 5. Copy of Construction Stormwater Permit from the Colorado Department of Public Health and Environment (if required). 6. Copy of all other applicable Federal and State Permits. 7. Certification in accordance with Ordinance No. 1698: Oil and Gas Wells Production Site Abandonment. PERMIT CONDITIONS 1. Plan review and grading permit will be valid for a maximum of one year. 2. If grading is in excess of 5,000 CY, consult additional requirements in Appendix J of the International Building Code. 3. No construction debris will be allowed in the fill. All existing debris on site will be stockpiled separately for removal. 4. Erosion control measures must be installed and maintained as shown on the approved erosion control plans. 5. The Contractor shall provide fugitive dust control arising from operations. The Contractor shall dustproof the work area by sprinkling with water or a water/calcium chloride mixture where necessary. 6. No dirt or mud will be left on the streets at the end of each operating day. No equipment will be allowed to be loaded or parked on any paved roadway. 7. Construction traffic will conform with routes as stated in Broomfield Ordinance No. 1159. 8. Owner/Contractor shall conform to requirements of the construction Stormwater Permit. 9. Owner/Contractor shall comply with all Broomfield, State, and Federal environmental laws including Broomfield’s Prairie Dog Policy. All wetlands shall be protected by construction fencing during grading. 10. Owner/Contractor requesting permit shall verify by submitting the permit that they have visited the site and there is no wildlife existing on site. A field visit with Broomfield following the Preconstruction Meeting is required. 11. If environmental or wildlife issues were identified for the site with issues to be resolved before construction, the Owner/Developer shall provide a letter from the Environmental Consultant that the issues have been resolved not more than 20 days prior to the anticipated start date of construction. 12. Other: Inspector Assigned: City Engineer: Date: Owner/Contractor Signature: Date: Revised 11/18/16 SIGN ---PAGE BREAK--- TABLE A-33-A---GRADING PLAN REViEW FEES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50cubic yards (38.2 in3) Or less . No fee 51 to 100 cubic yards (44) in3 to 76.5 m3) . $2330 101 to 1,000 cubic yards (77.2 in3 to 764.6 m3) 37.00 1,001 to 10,000 cubic yards (765.3 m3 to 7645.5 in3) 49.25 10,001 to 100,000 cubic yards (7646 .3 m3 to 76455 m3)-$49.25 for the first 10,000cubic yards (76453 m3), plus $24.50 for each additional 10,000 yards (76453 m3) or fraction thereof. 100,001 to 200,000 cubic yards (76 456 in3 to 152 911 m3)-$269 .75 for the first 100,000 cubic yards (76 455 m3), phas $13.25 for each additional 10,000 cubic yards (76453 in3) or fraction thereof. 200,001 cubic yards (152 912 m1) or more-$402 .25 for the first 200,000 cubic yards (152911 m3), plus $7.25 for each additional 10,000 cubic yards(7645 .5 m3) or fraction thereof. Other Fees: Additional plan review required by changes, additions or revisions to approved plans $5030 per hour* (minimum charge-one-half hour) 50r the total hourly cost to the jurisdiction, whichever is the greatest . This cost shall Indude supervision, overhead, equip- ment, hourly wages and fringe benefits of the employees involved. TABLE A-33-B-GRADING PERUfT FEES1 S0cubicyards(38.2m3)orless $2330 Sltol0ocubicyards(40in3to76$m3) 37 .00 101 to 1,000 cubic yards (77.2 m3 to 764.6 m3)-$37.00 for the first 100 cubic yards (763 m3) plus $1730 for each addition- al 100 cubic yards (76.5 in3) or fraction thereof. 1,001 to 10,000 cubic yards (765 .3 rn3 to 76453 m3)-$19430 for the first 1,000 cubic yards (764 .6 in3), plus $1430 for each additional 1,000 cubic yards (764.6 m3) or fraction thereof. 10,001 to 100,000 cubic yards (7646 .3 in3 to 76455 m3)-$325 .00 for the first 10,000 cubic yards (76453 in3), plus $66.00 for each addItional 10,000 cubic yards (7645.5 or fraction thereof. 100,001 cubic yards (76 456 in3) or more-4919.00 for the first 100,000 cubic yards (76 455 in3), plus $3630 for each addi- tional 10,000 cubic yards (7645.5 or fraction thereof. Other Inspections and Fees: 1. Inspections outside of normal business hours $50.50 per hour2 (minimum charge-two bows) 2. Reinspectlon fres assessed under provisions of Section 108.8 $50.50 per ho& 3. tnsnections for which no fee is specifically indicated $50.50 per hour2 (minimum charge-one-half how) 1The fee for a grading permit authorizing additional work to that under a valid permit shall be the difference between the fee paid for the original permit and the fee shown for the entire project. 20r the total hourly cost to the jurisdiction, whichever is the greatest. This cost shall include supervision, overhead, equipment, hourly wages and fringe benefits of the employees involved .