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2. 
4. Application for a Permit to Occupy the Public Way for the Purpose of Excavation and/or Obstruction

   Use this form to apply for a permit to excavate or obstruct a public way.

6. Applicant Contact Info:
8. Applicant Name*
10. Street #*
11. Street # Suffix
12. Street Name*
14. Phone #*
15. Email Address*
17. Request Information:
19. Location of Excavation or Obstruction*

    Enter street address or intersection. Please be descriptive. 

21. Estimated Size and Scope of Excavation Area*
23. Reason for Excavation*
25. Proposed Date of Work*
    Proposed Date of Work
27. Contractor Information:

    Contractor who will perform the proposed work

29. Contractor Name*
30. Contractor Address*
32. Contractor Phone #*
34. Terms

    By submitting this application, you agree to the following terms:

    1. All public utilities shall be notified prior to excavating. 
    2. No person (s) shall break-up or dig any street without a written permit from the Superintendent of Public Works. All excavation and backfill shall be compacted so as to guarantee no settling. All soils material used for backfill shall be equal to as removed from the excavation except that there shall be placed at least 12” (inches) of a good grade of road gravel under the hardened surface at the ditch section. On both sides of the ditch section the original hardened surface shall be removed along a sharply cut line which shall be not less than 3’ (feet) from the ditch sidewall. The replaced trench gravel shall be compacted to its original density and brought flush with the adjacent undisturbed sub-surface gravel section. The restored hardened surface shall consist of one inch more than existing of bituminous concrete laid down in the ditch repair in two courses, each course compacted to 100% ultimate density. A final bituminous overlay of 1 1/2” (inches) shall extend from not less than 5’ (feet) each side of the ditch patch section to include the full width of the roadway pavement. To prevent disintegration of a featheredge the overlay shall be notched into the original pavement at the point where the overlay is blended into original pavement The Department reserves the right, depending on the location, to require backfill material other than gravel (i.e. flowable fill) if deemed in the best interest of the City of Westfield. (Section 16-66) 2 
    3. All work shall be done under the direction of the Department of Public Works who shall be notified on completion of said project, for inspection and approval. All road repairs must be completed, to the satisfaction of the Department, within five (5) days from the completion of the project. 
    4. Applicant agrees to take responsibility for any and all claims that may be made against the City of Westfield, or it’s agency, for damages which may be occasioned during the period of excavation work and/or for a period of one (1) year from the time of completion. All repairs requested by the Department of Public Works during the one (1) year guarantee period must be made as soon as possible upon notification and completed within three (3) days with all costs borne by the applicant. 
    5. A surety of $500.00 minimum, may be required in accordance with Sec. 16-70. 
    6. In the event that no excavation is planned, all necessary precautions must be taken to ensure the safety of the pedestrian and motoring public, including the establishment of a “temporary” walkway should the sidewalk be affected. 
    7. Contractor is responsible for any and all traffic control and police protection. (Contact Westfield Police Dept., Traffic Bureau @ 413-562-4597) 

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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field