Blocking Permit APPLICATION Center-State
CITY OF NORTHAMPTON, MASSACHUSETTS
DEPARTMENT OF PUBLIC WORKS
125 Locust Street
Northampton, MA 01060
413-587-1570
Fax 413-587-1576
Donna LaScaleia
Director
SIDEWALK/STREET BLOCKING PERMIT APPLICATION
PERMIT NO. B -20
Please fill in the information down to the double line, attach photos/diagrams of area to be blocked, and return with the $25.00 fee to:
PERMITS, Department of Public Works, 125 Locust St., Northampton, MA 01060
APPLICANT NAME
Marion Excavating Co., Inc.
DATE
4/21/20
NAME OF ORGANIZATION
Marion Excavating Co., Inc.
ADDRESS
749 New Ludlow Road South Hadley, MA 01075
gil@marionexc.com
PHONE
413-536-1267
EMAIL
LOCATION TO BE BLOCKED
Intersection of Center Street & State Street. See attached plans.
DATE(S) TO BE BLOCKED
TBD when trench permit is supplied. Project schedule 5/4/20 – 6/30/20.
HOURS TO BE BLOCKED
7:00 AM – 5:00 PM
REASON FOR BLOCKING
Sidewalk/curb construction for City of Northampton.
Sidewalk/curb construction for City of Northampton.
DESCRIPTION OF WORK BEING
PERFORMED/EVENT
LIST EQUIPMENT/MACHINERY
Excavator, dump truck, pickup truck, cement truck, thermoplastic truck, police.
BEING UTILIZED
DESCRIBE HOW PUBLIC WILL BE
Temporary fence, drums, jersey barrier, temporary pedestrian detour, construction signs.
PROTECTED FROM WORK AREA
DESCRIBE HOW PEDESTRIAN AND
Temporary pedestrian detour at nearest cross walk.
OTHER TRAFFIC WILL BE SAFELY
ROUTED AROUND WORK AREA
Signature***IF PARKING SPACES ARE TO BE UTILIZED, APPLICANT MUST CONTACT THE PARKING DEPT.
FOR OFFICE USE ONLY
PLAN/SKETCH/PHOTO RECEIVED
DATE
PAYMENT RECEIVED
DATE
AMOUNT
CHECK/MONEY ORDER #
INSURANCE CERTIFICATE RECEIVED
DATE
EXPIRES
REMARKS