Illinois Administrative Code › Title 92 - TRANSPORTATION › Part 1535 - CROSSINGS OF RAIL CARRIERS AND HIGHWAYS › Subpart H - BARRICADES › Appendix A - Forms › ILLUSTRATION C - Form 3

Current through Register Vol. 48, No. 28, July 12, 2024
Completion of this form is necessary to accomplish
					 the statutory purpose as outlined in the Illinois Commercial Transportation
					 Law, Section 18c-7401. Failure to provide the requested information may prevent
					 your request from being processed.
Form 3
STATE OF ILLINOIS
ILLINOIS COMMERCE COMMISSION
Petition for permission to make a change in crossing
warning devices, or to install new warning devices,
under 92 Illinois Administrative Code 1535.400(d).
Date: December 15, 2005___
To the Illinois Commerce Commission:
The petitioner
(Name of Railroad
					 Company)
shows:
(1) That it is
				  a railroad company operating a line of railroad in the State of
				  Illinois.
(2) That petitioner
				  proposes and hereby makes application for authority to make a major change in
				  crossing warning devices, or to install new warning devices, under 92 Illinois
				  Administrative Code
				  1535.400(d)
				   adopted by this Commission.
(3) That the location of the crossing, the
				  nature of existing warning devices and proposed warning devices, and other
				  pertinent facts in connection therewith, are set forth in the statement
				  attached to and forming part of this petition.
(4) That petitioner's reasons and purpose,
				  with reference to its said proposal are:
(State reasons and purpose)
_________________________________________________________________
(5) That the facts set forth in
				  this petition and in the statement and plans or plats attached thereto are, all
				  of them, true and correct to the best of petitioner's knowledge and belief.
WHEREFORE, the petitioner prays that the Commission will,
					 if deemed desirable by the Commission, set the aforesaid matter for hearing,
					 and that the Commission enter an order or adopt a resolution consenting to and
					 granting authority for the making of the said proposed changes in or additions
					 to crossing warning devices.
(Name of Railroad
					 Company)
________________________________________
By
					 ________________________________________
(Name of Person Submitting Form
					 3)
(Title of Person - use Enter key for
					 additional lines)
(Phone Number)
__________________________
(Attorney for Petitioner)
__________________________
(Attorney's Address)
(Use Enter key for up to four additional
					 lines.)
Statement, attached to and part of an
					 application for permission to make a major change in crossing warning devices
					 or to install new warning devices, under 92 Ill. Adm. Code 1535.400(d).
Name of Railroad
1. Name of Railroad Company
				  ___________________________________________
2. Crossing Number & Railroad Milepost
_____
(Separate statement should be filed for each
				  crossing)
_____
3. Village or City
_____
(Please indicate whether in or near
				  Village/City)
_____
4. Name of Street or Highway
				  ____________________________________________
5. Public Agency Maintaining Highway
___
(DOT, County, Township,
				  City)
___
6.
				  Existing warning devices:
_(Give full description. Indicate the
				  hours of any manual warning devices.)___
7. Proposed warning devices:
_(Give details)____________________
___________________________________________________________________
8. Number of main tracks ____________ Other
				  tracks ____________
9. Number of
				  passenger train movements:6 a.m. to 6 p.m.______ 6
				  p.m. to 6 a.m.
10. Number of freight
				  train movements:6 a.m. to 6 p.m.______ 6 p.m. to 6
				  a.m.
11. Approximate number of
				  switch movements:6 a.m. to 6 p.m.______ 6 p.m. to 6
				  a.m.
12. Maximum speed of trains at
				  crossing on each track in each direction
Track 1 N/E Bound________
					 mphS/W Bound ________ mph
Track 2 N/E Bound________
					 mphS/W Bound ________ mph
Track 3 N/E Bound________
					 mphS/W Bound ________ mph
13. Passenger platforms served by tracks
				  within the limits of track circuits, if any ________
14. Where automatic signals or gates are
				  proposed, approximate number of train or engine movements daily that would
				  cause false indications or operation ________________________
15. Nature and approximate amount of street
				  or highway traffic over crossing ___________
___________________________________________________________________
16. In addition to the information listed
				  hereinbefore in Form 3, attach a track plan or plat of the proposed crossing
				  This plan should show:
(a) Width and surface
				  of highway.
(b) Highway
				  intersections (including private driveways to be so indicated) and location of
				  established highway signs or signals within 100 feet of crossing.
(c) Location of tracks, switches and other
				  railroad facilities such as block signals, etc., within limits of track
				  circuits, present and/or proposed
(d) Where automatic warning devices are proposed, show proposed
				  location of signals (sidelights, cantilevers, etc., if any).
(e) Show the length of each operation track
				  section within the control limits of the crossing warning devices and its
				  function.
ADDITIONAL INFORMATION
______________________________________________________________________
VERIFICATION
I, ______
(Name)
______, first being duly
					 sworn upon oath depose and say that I am ______
(Title)
_______ of
					 ________
(Railroad Name)
___, an_____
(State)
______
					 corporation; that I have read the above and foregoing petition by me subscribed
					 and know the contents thereof; that said contents are true in substance and in
					 fact, except as to those matters stated upon information and belief, and as to
					 those, I believe same to be true.
__________________________________________
(Signature above line & Title below
					 line)