Florida Department of Transportation
FLORIDA’S TURNPIKE ENTERPRISE
GENERAL USE (ENVIRONMENTAL MITIGATION) PERMIT
Date Received:
County:
TP Reference:
Section:
BMP:
TP/
- SP EMP:
Permit:
/
- 853 State Road:
Applicant:
Address:
Telephone No.:
Fax No.:
Email:
Mobile No.:
Applicant requests permission from the State of Florida, Department of Transportation and Florida’s Turnpike
Enterprise to perform environmental clean-up work at this location.
Date of Spill:
Spill Material:
FHP Citation Number:
Affected Area:__________ sq. ft.
LAT: _ _ . _ _ _ _ _
LONG: _ _ . _ _ _ _ _
Name of Contractor:
Contractor’s Address:
Telephone No:
Fax No:
Contractor’s e-mail
Mobile No:
The Applicant understands and agrees to the following general conditions:
1. The Applicant is responsible for the supervision of the permitted work (see 11 and 12 below):
2. The site is within _____________________________ City Limits.
3. Applicant declares that prior to submitting this application the applicant has ascertained the location of all
existing utilities, both aerial and underground. A letter of notification and plan of improvement was mailed
on:
, to the following utilities/municipalities:
4. This permit is a license for permissive use only the placing of facilities upon public property pursuant to this
permit shall not operate to create or vest any property right in the Applicant.
5. Whenever it is determined by the Department that it is necessary for the construction, repair, improvement,
maintenance, safe and efficient operation, alteration or relocation of all or any portion of such highways, or that it is
necessary for the public transportation facility, any and all of the Applicant’s facilities or operations shall be
immediately removed from said highway, or reset or relocated thereon as required by the Department, all at the
expense of the Applicant.
6. The Applicant’s construction, maintenance, or operations shall not interfere with the property and rights of any
prior Applicant.
7. The privileges set out and permitted herein are permitted only to the extent of the Department’s right, title, and
interest in the property to be used by the Applicant.
8. To the extent allowed by law, the Applicant indemnifies and holds harmless the Department and the
Enterprise, their officers and employees, from liabilities, damages, losses and costs, including, but not
limited to, reasonable attorney's fees, to the extent caused by the negligence, recklessness, or intentional wrongful
misconduct of the indemnifying party and persons employed or utilized by the indemnifying party in the
performance of the permitted work.
9. The Applicant shall observe all Department safety regulations during construction. The applicant shall safely
conduct the public through the project area in accordance with Part VI of the Manual of Uniform Traffic Control
Devices, Index 600, of the Department’s Roadway and Traffic Design Standards, and the Florida’s Turnpike
Enterprise Roadway Lane Closure Policy dated 01/24/2005, as amended and supplemented, by displaying
necessary safety devices and taking whatever other measures are required or appropriate. The applicant shall
continuously maintain pedestrian features to meet Americans with Disability Act (ADA) standards.
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10. In case the applicant fails to meet any of the permit requirements, as determined by the Department or the
Enterprise, the applicant shall be BARRED from performing further work under this permit and will be required to
bring into compliance or to remove said work from the right-of-way at no cost to the Department or the Enterprise,
and the applicant shall remain bound by the provisions of Paragraph 8 above.
11. Applicant is required ( ) not required ( ) to employ a Florida registered Prime Professional Engineer to
supervise the permitted work, as determined by the Department or the Enterprise according to the nature of the
work.
12. All work shall meet the Department’s Standards and be certified by the Applicant (or the Prime Professional
Engineer if one is required), that the work has been completed in accordance with the State of Florida’s latest
Department of Transportation Standard Specifications for Road and Bridge Construction, and in accordance with
all rules, regulations, policies, plans, special provisions, and safety standards pertaining to this type of work.
The Prime Professional Engineer is:
P.E. No:
, and is located at
telephone number:
13. All materials and equipment are subject to inspection by the Department or Enterprise, or their designees.
14. All Department property shall be restored to its original condition as far as practical, in keeping with the
Department’s specifications, and in a manner satisfactory to the Department or the Enterprise.
15. The attached drawing and special provisions covering details of this proposed work shall be made part of this
permit.
16. The Applicant shall commence field work in good faith within
days from the date of
permit approval and shall be completed within
days.
If the beginning date is more than 60 days beyond the date of permit approval, the Applicant must review the
permit with the Florida’s Turnpike Enterprise Permit Office, to assure that no changes have occurred that would
affect the permit approval. If work has not begun in good faith within 365 days, this permit shall become void.
17. The Enterprise Permits Office is located at the Florida’s Turnpike Pompano Beach Service Plaza, Pompano
Beach, FL, 33069, P.O. Box 9828, Ft. Lauderdale, FL, 33310-9828, and telephone number (954) 934-1100.
The Enterprise representative for this permit is,
telephone number
. The Applicant shall notify this representative forty-eight (48) hours
in advance of the pre-construction meeting, and again forty-eight (48) hours before beginning work.
18. The Applicant affirms the truth of statements made (whether expressed or implied) in this application and of
all design drawings presented to support this application. Any misrepresentations of fact by the applicant or their
agents may be cause for revocation of an issued permit.
19. Special Instructions: Provide 2 copies of all reports and correspondences that you provide Florida
Department of Environment or other regulatory agency.
Submitted for Applicant by:
Typed Name & Title
Signature
Date
Prime Professional Engineer: ________________________________ _______________________________
Typed Name & Title
Signature
Date
________________________________________________________________________________________
Roadway Construction is proposed or underway. No ( )
Yes (
Recommended for approval:
Title:
Approved by:
)
W.P.I. No.:
Date___
Date_____________
Enterprise Maintenance Engineer or Designee
Roadway Permits/Forms/ General Permits/General Permit Form 05/09/2007
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