“Grading at Owner’s Risk”
Permit Application


TO BE COMPLETED BY APPLICANT (ALL INFORMATION MUST BE PROVIDED):


DEVELOPMENT/PROJECT NAME:

PROJECT DESCRIPTION:



ADDRESS/LOCATION:

GROSS AREA (ACRE/SQ. FT.):

NET AREA (ACRE/SQ. FT.)

PARCEL NUMBER(S):


PROPERTY OWNER:

ADDRESS:

CITY:

STATE:

ZIP CODE:

PHONE NUMBER:

FAX NUMBER:

CONTACT PERSON:                                                     
E-MAIL ADDRESS:


CONTRACTOR:

ADDRESS:

CITY:

STATE:

ZIP CODE:

PHONE NUMBER:

FAX NUMBER:

CONTACT PERSON:                                                     
E-MAIL ADDRESS:


ITEMS REQUIRED TO OBTAIN A “GRADING at OWNER’S RISK” PERMIT:

1. The application must be completed and signed by the authorizing agent.
2. City must complete the first review of grading and drainage plans for the proposed development and find that the plans are substantially acceptable.
3. Developer must provide to City 2 Full Size (24”x36”) copies and 1 Half Size (11”x17”) copy of red lined grading and drainage plans. The red lined plans will alert 
   the City Off-site Inspector that the project has not been approved, but has been reviewed at least one time and also make them aware of the possible changes.
4. City must review and approve the Storm Water Pollution Prevention plan, (SWPPP).  	
5. Developer must provide to City two (2) copies of the approved Storm Water Pollution Prevention Plan. 
6. Developer/contractor must provide a copy of the signed NPDES “Notice of Intent” and construction schedule.
7. Contractor to provide to City one (1) copy of the Maricopa County Rule 310 (Dust Control Permit).
8. Contractor to obtain a “Grading at Owner’s Risk” (“At-Risk”) permit at a cost of 150% of the actual grading and drainage permit cost, which has a one (1) time “life” of 60 calendar days. 
   The total fee (for the “At-Risk” & final Grading and Drainage permit) will be collected at time of “At-Risk” permit application.
9. Contractor to provide 24-hour emergency telephone and mobile numbers.
10.Contractor shall obtain a Haul Route permit if more than 100 cubic yards of material is to be imported to the site or exported from the site at a cost of $300.00 per permit. 
11.Obtain an actual grading and drainage permit, within 60 calendar days of the issuance of the “Grading at Owner’s Risk” permit and following approval of the grading and drainage plans. 
   The Contractor shall cease construction activities at the site if the grading plans and/or the Final Grading Permit not issued within 60 Calendar Days.


The City will issue a “Grading at Owner’s Risk” permit, which is effective for 60 calendar days provided that the developer/owner/contractor agree to complete the items listed below.  
No other permits such as water, sewer, concrete, dry utilities or paving will be issued until such time as:

1. All civil drawings are approved by the City; and
2. The grading and drainage permit is obtained; and
3. All fees identified by the plan approval letter have been paid to the City; and
4. The Agreement to Install (Install-A or Install-B) has been executed by the developer, submitted to, and accepted by the City; and
5. The financial guarantee for construction of the project has been posted with the City; and
6. The City has accepted all of the documents (the SLID and MID documents, the Street Light Warranty Agreement); and
7. The City of Peoria Sales Tax license is obtained; and
8. Proof of Insurance is submitted to the City. 

If the above mentioned items are not submitted to and accepted by the City within the 60 calendar days (unless otherwise extended by the City Engineer), 
the “Grading at Owner’s Risk” permit will be withdrawn and the contractor will be required to return the property to its original condition.  

It is hereby acknowledged that this application for a “Grading at Owner’s Risk” permit is made prior to Grading and Drainage Plan approval and is done solely at the risk of the owner.  
Any changes required by the plan review process will be complied with by the owner, at the owner’s expense.  
Owner hereby agrees to hold the City of Peoria harmless from any and all actions of any kind, which result from the issuance of this permit.



_____________________________________            _______________________________________                                                                	        	  						                
SIGNATURE OF OWNER				 SIGNATURE OF CONTRACTOR


_____________________________________	         _______________________________________
Printed Name and Title of Owner			 Printed Name and Title of Contractor


_____________________________________	         _______________________________________
Company						 24-hour emergency telephone #’s 	






IN WITNESS WHEREOF, the parties hereto have executed this GRADING AT RISK PERMIT DISCLAIMER 
this ______ day of __________________________________, 20____. 

       OWNER:

       By:____________________________________
       
       Title:___________________________________

State of Arizona      )
        	                  )  ss.
County of Maricopa    )

The foregoing instrument was acknowledged before me this ________ day of _______________________, 20______.



_______________________________________
  Notary Public


My Commission Expires:


______________________________________

       
       
CITY OF PEORIA, an Arizona Municipal Corporation


By: _______________________________
           City Engineer




Revised:  March 08, 2005
“Grading at Owner’s Risk”
Permit Disclaimer



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Engineering Division – 8401 W. Monroe Street, 2nd Floor, Peoria, AZ 85345
Office (623) 773-7210  Fax (623) 773-7211