Document Submission Information

Please give us your name, email and contact number so we may contact you if needed regarding the document you are submitting.

Thank You.

First Name:_________________ Last Name:_____________________

Email Address: _____________________________________________

Contact Phone Number: _____________________________________

CITY OF HUNTSVILLE, ALABAMANATURAL RESOURCES AND ENVIRONMENTAL MANAGEMENT

APPLICATION FOR BLASTING PERMIT TO DETONATE EXPLOSIVE

General Instructions for the Form Completion

Ordinance No. 88-166 as amended requires that Blasting Permit be obtained from the Natural Resources and Environmental Management Office prior to the use of explosives.

The attached permit application forms are intended to be self-explanatory, and should, if properly completed, include the information necessary for the Huntsville Natural Resources and Environmental Management Division to adequately process an application in a timely manner.

Applicants are encouraged to contact the Director of the Huntsville Natural Resources and Environmental Management Division at (256) 427-5750 if there are any questions.

Blasting Permit

APPLICATION FOR BLASTING PERMIT TO DETONATE EXPLOSIVE

1. Name of Firm or Organization:

2. Mailing Address:

Address Number Street

City State Zip Phone Number

Phone Number

3. Name of Blaster in Charge of Blasting Operations:

Name

4. Name of Owner or Company Official to Contact:

Printed or Typed Name Title

Phone Number

NOTE: Proof of Insurance must be attached to application.

Amt. of Property Coverage

Amt. of Bodily Injury Coverage

6. Location of Blasting Operations:

Address

Hours per Day: Days of the Week:

9. Distance to Nearest Structure:

7. Purpose:

8. Operating Schedule

Starting Hour:

Email

5. Insurance/Bonding:

City State Zip

Blasting Permit Page 1 of 2

10. Type of Cover to be used: 3 – 5 Ft. Dirt Cover

Mat In Addition to Stemming Other:

Both Types of Cover Used Together are Preferred.

11. Projected Cubic Yardage to be Displaced:

12. Basis for Cubic Yardage Projections: Survey Bid Proposal Contractor Expertise

Please attach pertinent information.

Land Owner

Hz (Seismic) Hz (Acoustic)

13. Projection Given by:

Professional Engineer Contractor

14. Seismographic Monitoring:

Company Responsible for Monitoring:

Contact Name / Telephone:

# Seismograph Make / Model:

Frequency Range / Response:

Date of Most Recent Calibration:

Seismograph Location:

15. Fees:Estimated Cubic Yardage Charge =

+ $250.00Permit Fees = Total =

“I CERTIFY TO THE ACCURACY OF THE DATA SUBMITTED HEREIN AND THE ATTACHMENTS HERETO OF THIS APPLICATION. IT IS MY OPINION THAT ANY BLASTING OPERATIONS FOR WHICH THIS APPLICATION IS MADE WILL BE IN ACCORDANCE WITH ORDINANCE NO. 88-166 AS AMENDED BY ORDINANCE NO. 89-482.”

Typed Name

Date

Developer

Sub-Contractor

Email

Page 2 of 2Rev. 03/17

Signature

Title

Mailing Address

Phone Number

P.O. Box 308 · Huntsville, AL 35804 · Phone 256.427.5750 · Fax 256.427.5751 Blasting Permit