Form TR-0112 "Permit Engineering Evaluation Report" - California

What Is Form TR-0112?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2001;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form TR-0112 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form TR-0112 "Permit Engineering Evaluation Report" - California

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PERMIT ENGINEERING EVALUATION REPORT
PREPARATION HOURS
PERMIT NUMBER
TR-0112 (REV 6/2001)
DATE
DIST/CO/RTE/PM
EA USED
APPLICANT
1. DESCRIBE PERMIT PROPOSAL, WHAT IT SERVES, APPROXIMATE COST.
2. DESCRIBE EXISTING HIGHWAY - BRIEF ANALYSIS OF IMPACT ON HIGHWAY OPERATION AND MAINTENANCE.
3. ANALYZE PERMIT PROPOSAL FOR GEOMETRIC AND FUNCTIONAL ADEQUACY.
PREPARING REGISTERED ENGINEER'S STAMP
4. NON-STANDARD DESIGN FEATURES
YES
NO
REVISION IN ACCESS CONTROL INVOLVED.
YES
NO
If YES above, provide rationale and name &
IF YES, DATE OF HQ APPROVAL
date of headquarters, reviewer's occurrence.
(and on Federal Aid Projects, FHWA concurrence on separate sheet)
5. SIGNALIZATION INVOLVED
YES
NO
If yes, signal warrants met
YES
NO*
NOT APPLICABLE
Capacity Analysis OK
YES
NO*
NOT APPLICABLE
Safety Analysis OK
YES
NO*
NOT APPLICABLE
Ownership/Maintenance Provisions OK
YES
NO*
NOT APPLICABLE
* Comments, Supporting documents on attached sheet(s)
PERMIT PROPOSAL RECOMMENDED
I attest to the technical information contained herein and
have judged the qualifications of all technical specialists
providing engineering data upon which recommendations,
Yes, as submitted
Yes, with conditions described above
No, as described above
conclusions, and decisions were based.
PREPARED BY
TITLE
UNIT
DATE
SIGNATURE
, Registered Civil Engineer
APPROVED BY (Caltrans Engineer)
TITLE
UNIT
DATE
DATE
REMARKS: SEND ONE COPY OF COMPLETED REPORT TO HEADQUARTERS DESIGN AND LOCAL PROGRAMS.
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
PERMIT ENGINEERING EVALUATION REPORT
PREPARATION HOURS
PERMIT NUMBER
TR-0112 (REV 6/2001)
DATE
DIST/CO/RTE/PM
EA USED
APPLICANT
1. DESCRIBE PERMIT PROPOSAL, WHAT IT SERVES, APPROXIMATE COST.
2. DESCRIBE EXISTING HIGHWAY - BRIEF ANALYSIS OF IMPACT ON HIGHWAY OPERATION AND MAINTENANCE.
3. ANALYZE PERMIT PROPOSAL FOR GEOMETRIC AND FUNCTIONAL ADEQUACY.
PREPARING REGISTERED ENGINEER'S STAMP
4. NON-STANDARD DESIGN FEATURES
YES
NO
REVISION IN ACCESS CONTROL INVOLVED.
YES
NO
If YES above, provide rationale and name &
IF YES, DATE OF HQ APPROVAL
date of headquarters, reviewer's occurrence.
(and on Federal Aid Projects, FHWA concurrence on separate sheet)
5. SIGNALIZATION INVOLVED
YES
NO
If yes, signal warrants met
YES
NO*
NOT APPLICABLE
Capacity Analysis OK
YES
NO*
NOT APPLICABLE
Safety Analysis OK
YES
NO*
NOT APPLICABLE
Ownership/Maintenance Provisions OK
YES
NO*
NOT APPLICABLE
* Comments, Supporting documents on attached sheet(s)
PERMIT PROPOSAL RECOMMENDED
I attest to the technical information contained herein and
have judged the qualifications of all technical specialists
providing engineering data upon which recommendations,
Yes, as submitted
Yes, with conditions described above
No, as described above
conclusions, and decisions were based.
PREPARED BY
TITLE
UNIT
DATE
SIGNATURE
, Registered Civil Engineer
APPROVED BY (Caltrans Engineer)
TITLE
UNIT
DATE
DATE
REMARKS: SEND ONE COPY OF COMPLETED REPORT TO HEADQUARTERS DESIGN AND LOCAL PROGRAMS.
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.