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DOT Form 224-713 <br />Revised 12/2020 <br />Page 1 <br />Special Provisions for <br />Access Connection Permit <br />Managed Access Highways Only <br />Not for use within an Incorporated City or Town <br />Permit No. <br />Applicable provisions are denoted by ( ) <br />1. No work provided by this permit shall be performed until the Permit Holder is authorized by the following <br />WSDOT representative: <br />2. The Permit Holder shall only perform the construction work authorized by this permit during the following <br />work hours: <br />3. The Permit Holder, unless specified otherwise in this permit, shall only implement the Traffic Control Plans <br />approved for this permit during the following work hours: <br />4.Pre-Paving Inspection <br />The Permit Holder shall contact WSDOT to request a pre-paving inspection prior to paving any Hot Mix Asphalt <br />(HMA) or Bituminous Surface Treatment (BST). No paving shall occur without first receiving WSDOT’s prior <br />written approval to pave. Failure to obtain this approval may result in WSDOT directing the Permit Holder to <br />remove, repair, and/or add more paving at the Permit Holder’s sole cost and expense. <br />The pre-paving inspection is required to permit WSDOT to verify that the paving, before it is placed, will meet <br />WSDOT’s design requirements for the access connection. Items to be inspected include, but are not limited <br />to, paving limits, culvert placement, material installation, side slopes, and grading of the access connection to <br />7:00 AM to 4:30 PM and / or Daylight Hours <br />Kevin Nicholson <br />Cle Elum Maintenance Supervisor <br />151 South Bullfrog Road <br />Cle Elum, WA 98922 <br />Phone: (509) 674-4443 <br />Fax: (509) 674-3931 <br />E-mail: NicholK@wsdot.wa.gov <br />7:00 AM to 4:30 PM and / or Daylight Hours <br />While school is in session, lane closure is prohibited between: <br /> 7:30 AM - 8:30 AM <br />2:30 PM to 3:30 PM <br />61716 <br />ACP 61716 SR-903 MP 3.45 R Page 1 of 3 Exhibit A <br />COPY