Curb Cut Request Form

CURB CUT REQUEST FORM

Applicant and Property Information

WHEREAS (Recitals)

WHEREAS, Applicant seeks permission from the Municipal Authority to modify the existing curb and sidewalk adjacent to the property located at ;

WHEREAS, the Municipal Authority requires submission of detailed plans, inspection access, proof of insurance, and an agreement to construct and maintain the curb cut in accordance with municipal standards and conditions stated herein; and

WHEREAS, Applicant agrees to the terms and conditions of this permit and any restoration, maintenance, and indemnity obligations set forth below.

Scope of Work

Provide a clear, detailed description of the proposed curb cut, including dimensions, materials, and methods. Attach plan view and elevation drawings, and indicate any encroachment into the street or sidewalk.

Proposed Work Details

Attachments & Checklist

Please indicate all documents attached to this request:

Plan view and elevation drawings

Traffic control plan

Proof of insurance and license

Photos of existing curb/sidewalk

Payment Terms

Permit fee and inspection fees required for processing and inspections.

Term and Termination

The permit term, renewal, and termination provisions applicable to the curb cut authorization.

Insurance, Indemnity and Maintenance

Applicant shall maintain insurance naming the Municipal Authority as an additional insured and shall indemnify and hold harmless the Municipal Authority, its officers, agents, and employees from and against any claims, damages, liabilities, costs, and expenses arising from the performance of the curb cut work, except to the extent caused by the Municipal Authority’s gross negligence or willful misconduct.

Applicant is responsible for all restoration of pavement, sidewalk, and landscaping to municipal standards following completion of work, and for ongoing maintenance of the curb cut. Failure to maintain or to restore may result in municipal remediation at Applicant’s expense.

Confidentiality

Unless otherwise required by law, the Municipal Authority will treat proprietary technical drawings and financial information submitted with this application as confidential to the extent permitted by law. Applicant acknowledges that approvals, permits, and final inspection reports are public records and may be disclosed.

Governing Law

This Agreement and issuance of the permit shall be governed by and construed in accordance with the laws of the state in which the property is located, without regard to conflict of law principles. Venue for any dispute shall lie in the courts of the same jurisdiction.

Entire Agreement

This form, together with any approved plans, attachments, and written conditions imposed by the Municipal Authority, constitutes the entire agreement between the parties with respect to the curb cut and supersedes all prior understandings and agreements, whether written or oral.

Applicant Certification

By signing below, Applicant certifies that the information provided is true and accurate, that all required attachments are submitted, and that Applicant will comply with all terms, conditions, municipal specifications, and inspection requirements. Applicant acknowledges that permit fees are non-refundable.

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