/ UTILITY COORDINATION /

Atlanta Streetcar Overhead Contact System Deactivation Request

Work within ten feet of the Overhead Contact System requires line deactivation

Minimum Ten-business days notification

Required Information

Company Name
Applicant Name and e-mail address /

Office Phone

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Mobile Phone

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Fax (if unable to provide e-mail)

Deactivation Date(s): (mm/dd/yy)

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Mon-Thur Start (from 12:30 AM each night)

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Tue-Fri End (until 4:30 AM each morning)

until /

:_m

/

:_m

Post-Fri service Start (from 2:30 AM Sat)

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Pre-Sat service End (until 7:00 AM Sat)

/

Post-Sat service Start (from 2:30 AM Sun)

:_m

/

:_m

/

:_m

Pre-Sun service End (until 7:30 AM Sun)

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Sun Start (from 12:30 AM)

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Mon End (until 4:30 AM)

:_m

/

:_m

/

:_m

Location of Work (Include Address or Affected Street with Proximity in Measured Feet to Nearest Cross Street)

/ Street Use Permit No.
Primary Contact Person (Project Manager or Crew Lead, On-Site preferred) / Mobile Phone 24/7
Alternate Contact Person (On-Site Lead Foreman or Second-in-Command) / Mobile Phone 24/7
Purchase or Work Order No. (if applicable) / Billing Address w/”Attn” Person Name

SuppLEMENTAL INFORMATION

Description of work.

▼ Include description in space below – specify if line segment removal is required ▼

Nature of Work

Will work require general-purpose traffic to be detoured?

▼ If “YES” continue below ▼

/

(Check one)►

/

YES

/

NO

Traffic Control Plan (Brief Description of Official Detour Route, UPO posts)

Will work affect Streetcar Station Stops?

▼ If “YES” continue below ▼

/

(Check one)►

/

YES

/

NO

Location of station stop(s) and how affected

Will time range of work conform to allowable OCS outage range? (See chart below)

▼ If “NO” continue below ▼

/

(Check one)►

/

YES

/

NO

Explanation

reference chart for nightly allowable range of A streetcar ocs outage

DAY OF OPERATION

/

STREETCAR HOURS

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PRE-OP & POST OP BUFFER

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RANGE ALLOWED FOR OCS OUTAGE

MONDAY

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6:00 AM until11:00 PM

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5:00 AM to 6:00 AM and 11:00 PM to 12:30 AM

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12:30 AM Tue– 5:00 AM Tue

TUESDAY

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6:00 AM until11:00 PM

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5:00 AM to 6:00 AM and 11:00 PM to 12:30 AM

/

12:30 AM Wed – 5:00 AM Wed

WEDNESDAY

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6:00 AM until11:00 PM

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5:00 AM to 6:00 AM and 11:00 PM to 12:30 AM

/

12:30 AM Thu – 5:00 AM Thu

THURSDAY

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6:00 AM until11:00 PM

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5:00 AM to 6:00 AM and 11:00 PM to 12:30 AM

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12:30 AM Fri – 5:00 AM Fri

FRIDAY

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6:00 AM until 1:00 AM

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5:00 AM to 6:00 AM and 1:00AM to 2:30 AM

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2:30 AM Sat – 7:30 AM Sat

SATURDAY

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8:30 AM until 1:00 AM

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7:30 AM to 8:30 AM and 1:00AM to 2:30 AM

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2:30 AM Sun – 8:00 AM Sun

SUNDAY

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9:00 AM until 11:00 PM

/

8:00 AM to 9:00 AM and 11:00 PM to 12:30 AM

/

12:30 AM Mon – 5:00 AM Mon

HOLIDAY SCHED*

PRECEDING MON-FRI

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9:00 AM until 11:00 PM

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8:00 AM to 9:00 AM and 11:00 PM to 12:30 AM

/

12:30 AM Holiday – 5:00 AM Mon-Fri

* May not pertain to all holidays.

Confirmation of request / Form No.
FOR DPW/OFFICE OF TRANSPORTATION/STREETCAR OPERATIONS ONLY
Request approved? / Yes No / If “NO” then explanation for denial
Streetcar Ops approved? / Yes No / Manager: / Date: / LCC notified? / Yes No
Safety/Security approved? / Yes No / Director: / Date: / Dispatch notified? / Yes No
Request rescinded by DPW or cancelled by submitter? / Yes / Date rescinded or Cancelled
▼ If “YES’ then reason for rescinding or cancelling ▼
Coordinator Name / Date received / Date approved/Rejected
Approved Rejected

Atlanta Streetcar / Phone 404-546-5785 12/15/2014