MARYLAND DEPARTMENT OF TRANSPORTATION

MARYLAND AVIATION ADMINISTRATION

UTILITY MODIFICATION/DIGGING AUTHORIZATION

/

Division of Documents & Permits

P.O. Box 8766, BWI Airport
Maryland 21240-0766
Tel.: 410-859-7796
Fax: 410-859-5440
E-mail address:
GENERAL INFORMATION (To be completed by the applicant, please print)
Project Name: / Airport: BWI
MTN
Project Location (Bldg./Terminal, Level, Holdroom, Room No. etc.): / Tenant Space No.:
Name of Tenant: / Tel.:
E-mail:
Applicant/Contact Person: / Tel.:
Contractor: / Cell:
Mailing Address: / Fax:
E-mail:
STEP 1
Scope: (Define Scope and Boundaries of Proposed Work. Attach Drawings or Sketches as Required.)
Utilities: List all Utilities as Identified in Contract Drawings / Contract Drawing Reference
STEP 2 /
Gray areas to be filled out by MAA Inspector
MAA Utilities* / Name: / Signature: / Date:
MAA Design* / Name: / Signature: / Date:
MAA IT* / Name: / Signature: / Date:
FAA * / Name: / Signature: / Date:
BGE / Name: / Signature: / Date:
MISS UTILITY / Name: / Signature: / Date:
List additional utilities identified by MAA/PB/FAA/BGE/Miss Utility/Others
STEP 3
The following utilities have been test pitted, located, and identified (Digging authorization is subject to resubmission if utilities require re-marking and re-test pitting due to removal or disturbance of identifying markers)
Signature of Contractor: / Date:
*MAA/FAA sign off does not necessarily indicate accuracy of information but rather denotes that there are no known utilities other than those that may be listed. MAA/FAA and their employees and authorized agents are not liable for accurately identifying or locating any or all utilities. MAA/FAA sign-offs do not relieve the Contractor of responsibility for locating and protecting all utilities near the work. Contractor should use extreme caution for all underground work; cutting or damaging utilities could result in, among other things, disruption of service at the airport.
FOR OFFICE USE ONLY
Signature of Inspector / Date:
Name of Inspector: Print / BP/IP Number:
Date Application Received:
Date Application Approved/Denied:

MAA-156 R 6/11