Fiberlight-PT091110A copy of the approved permit must be on the job site at all tlmea.
CC: Applicant D D D ~ o r M e`' T r o F Page 1 of 4
Public Wor COPPELL
Permit Fil - - Rev. 11 /07
T 9 ~
~ ~ ~ ~ ~~~~ ~~~ " ~ 1U-1~-,.~ 9P03:52 RCVD
Orig. to Project File s x ,, s , s 4
RIGHT-OF-WAY USE PERMIT APPLICATION
Permit valid for 90 calendar days from date of approval
Submit permit application to the Engineering Dept., Town Center, 255 Parkway Blvd.
Date of Submittal: Applicant's Job # /Work Order # 1 D - O 4 - ~ Z
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franchise/ROW Use Agreement)
Refer to the City of Coppell Ordinance No. 2001-944. Certificated Telecom Provider? Y N
^ Plans provided and approved
(Erosion Control/safety fences must be instayl~led rrprior to beginning work)
Project Name /Location: ~CZTUti~ ~ ~ 1' i11 L' 1-~-2TNu ~ ~ LV fJ 1~.~ .
General Contractor: ~~ ~~ ~~ e~~,~,~ Contact # ~ ~~ -~j o ~ -- Q G
Permit issued to Company /Representative:
Address: ,~'h~: ~ C . ~~..,..~,e~1 ~~-~~ `~~
F~
Telephone #:~~~ -'~ ~~_ ~c,;~~ Emergency Telephone #: S b~•.~,
Utility Company Represented:
^ Oncor Electric Delivery ^ Atmos Energy ^ Verizon ^ SBC/ AT&T
^ Time Warner Cable ^ CoServ Electric/Gas [Other hii~,C~~c ~yN~r
Description of Work (provide four [4] sets of
Ta Pc~cr- ~-//~"Ndfr. i~r~ t5c~=~Nc, UN®F~ h'7Ac~1~
In accordance with Ord. No. 2001-944.
Gru,(;~C; ~rr~e'S.~~rn~ 5,t)E" y~' P Lrz..~r~E~, t~+
~~' ~ I"i~b;~ ~ XS ?~~ 1~AuLr %~1 ~ Lt1E~r ~i F INT~~c7"~i~ (~F ~~c"%~~R c~ ,~C~rza~~E ,~ ~-~~77 a%~r~ [ASS
ioR 1 ~l ~ ~ Pc,4c.c~ 1~~4ucr, ~nlTiuuE~ ~Sr ~~ l~~ ~ Tv P~e~. 7 ~~z ~~r~b~: ~~ 7rr ~A'? - .3'1~~.
Estimated Start Date ~ ~ r ~ ~ J~~ Estimated Completion Date* i ~ ~ ~~ J
* Completion requires submittal of Completion Verification Notice (see page 4)
- Was contact made with City and/or utility companies to locate existing utilities?
if NO, Reason: YES ® NO ^
y Is removal of existing streets, alleys, or sidewalks necessary? YES ^ NO
if YES, must have Ciry inspection prior to concrete replacement
~ht-of-Way Use Permit Application Page 2 of 4
Representative(s) of the Contractor must adhere to all construction standards approved by the City of Coppell, which
includes but is not limited to: Erosion Control Ordinance, compaction requirements (density tests may be required at
the applicants expense) and barricading according to the Texas Manual on Uniform Traffic Control Devices.
Area(s) affected must be restored to as food condition as before the commencement of work (grading, drainage,
vegetation, and erosion control). To schedule Public Works final inspection (Page 4) call 972-462-5155.
Any excavation requiring closing of a street/alley must be reported prior to closing to the following:
Police Department ®972-304-3600
Fire Department (~ 972-304-3500
Street Department @ 972-462-5150
Engineering Department (~ 972-304-3679
- Attach barricade plan /trench safety plan if a lane or street closure is required.
NOTE: Street closures are allowed from 9:00 a. m. until 3:00 p. m. ONLY unless otherwise approved by City
Engineer.
Attach Work Order (franchise only) and/or 4 sets of prints showing proposed work.
Contacts must be made to locate existing utilities 48 hours prior to beginning work.
(Application with original signatures should be submitted to the Engineering Department before approval.)
Signature of Utility ` pany Representative
Signature of Contractor Representative
d~
q~
._,! r ,~
Signature of rty Representative
~~ l R
Printed
a ~~/~jCrl
Printed Name
Printed Name
~L~~~
Date
~~~~
Date
1`~
Date
y Comments:
- NOTE: Notify City Inspector at 972-304-3679 prior to be~innin~ work and prior to
back~ll for concrete, trench, ditch and open pit inspections. Back~ll must meet
all construction standards approved by the City of Coppell.
Applicant shall indemnify and forever hold harmless against the City of Coppell each and every claim,
demand or cause of action that may be made or come against it by reason of or if any way arising out of the
closure, blocking, excavating, cutting, tunneling, or other work by the applicant under permit from the City,
if such permit is granted.
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