Telephone: 303-279-2854

Fax: 303-279-2865

UTILITY PERMIT
Date

Purpose of Work
(specify water or sewer or both)

Location of Work

Contractor
Address
Phone Nos
Office

Cell/Pager

Bond Expires

Estimated Start Date

Estimated Completion Date
Proposed Hours of Work
(i.e. Monday - Friday 8:00 - 5:00)

All work to be done with permission of Property Owner.

Contractor Initial

All work to be done in accordance with approved plans.

Contractor Initial

Special Conditions attached (circle)

Yes

No

Contractor shall comply with permit requirements (page 2) and all specifications of NTMW&SD.
Contractor shall notify NTMW&SD 2 business days prior to start of work.

Contractor Signature
District Approval:

District Manager

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TELEPHONE (303) 279-2854

FAX (303) 279-2865

UTILITY PERMIT
General Requirements
Permit Fees:

_
_
Contractors Initials

Permit Fee
$200.00
Re-Inspection Fee
$ 50.00
Work without a permit
$600.00
This permit authorizes work in the District on the water and sanitary sewer system and appurtenances.
Issuance of Utility Permit is at the sole discretion of the District Engineer.

1. Work started without a permit is subject to a $600.00 penalty.

2. A copy of this permit and an approved set of construction plans shall be kept at the construction
site while work is in progress and shall be available upon request for District representatives.
3. A License and Permit Bond is required in the amount of $10,000.00, effective for a 2 year period.
Any failure of NTMs facilities, with-in a two-year period, as a result of work performed by the
contractor shall be rectified, at the sole expense of the contractor.
4. Proof of general liability insurance in the minimum amounts of $1,000,000 for each occurrence
and $2,000,000 aggregate and proof of adequate Workers Compensation Insurance is required
prior to a permit being issued.
5. Delinquent fees for prior work must be paid.
6. In the event that an inspection fails, the contractor shall be charged an additional $50.00 for each
inspection necessary until such time the District inspector approves. The District will mail bill for
failed inspections.
7. All water used in the District must be metered. Any unpermitted connections to fire hydrants or
unmetered pits will be subject to a $250.00 penalty, for the first offense.
8. Contractor shall comply with Jefferson County standards and regulations when working in County
right of way or governing jurisdiction.
9. If damage occurs to underground facilities, Contractor must immediately notify Facilities operator
(i.e., gas, telecommunications, etc.) and the District. If the presence of flammable, toxic or
corrosive gas exists, contractor must immediately notify the Facilities operator and call 911, then
take immediate action to protect the public and nearby properties.
10. Upon written notice to the contractor, this permit may be revoked or suspended by the District for:
Deviations from the approved plans, except for field changes approved by the District.
Violations of any provision of the NTMW&SD Standards or Rules and Regulations.
Determination of any condition, or performance of any act, that endangers life or causes
damage to public or private property.
State law requires you to contact the following agencies at least two (2) business days prior to start of
construction: Utility Notification Center of Colorado 1-800-922-1987, NTMWSD 303-279-2854
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