CARC Exp-PT110223 T H E • C 1 T Y . O F
COPPELL
X A 6 1
CONSTRUCTION DEVELOPMENT PERMIT APPLICATION
P03:2 RCVD
Name of Applicant: g MS CD - Wog/kr - tog Date Submitted:
Address of Applicant: 5525 /4. 1/14 TI{Lo &VC 41a O
Phone Number: 97Z 5 - / 2/o FAX NUMBER: 972 - 582 - Z
Location of Construction (address, if available): 23'/ 646r ' Kurhy gi • Cc u.. Tk 75.21
Subdivision Section # Block # Lot #
OR
Survey /Abstract # Acreage
Location description (attach vicinity map):
1. Type of proposed construction or development:
() Residential ( ) Alteration of a natural waterway drainage course
'4 Non - residential ( ) Other (describe & attach drawing or sketch)
() Placement of Fill (in right -of -way or on private property)
2. Description of Construction Permit requested:
(( ' Paving ( ) Median or Landscaping ( ) Box Culvert
(V5 Sidewalk ( ) Water Main ( ) Rip Rap
( ) Drive Approach ( ) R.C.P. ( ) Fill Area
(/ Excavation ( ) Sanitary Sewer Main ( ) Drainage Channel Excavation
(4 Fire Lane ( ) Flume ( ) Slope Protection /Retaining Wall
( ) Bridge ( ) Inlet ( ) Parking Lot
Provide an attachment containing the name and 24 -hr. contact phone number
of supervisor(s) for every contractor working under this general permit.
3. All construction shall be in compliance with, but not limited to, the City of Coppell
Subdivision Ordinance, Standard Construction Details, Streetscape Plan and approved plans.
The contractors shall adhere to the City's Erosion Control & Sedimentation Ordinance.
4. Applicant shall provide a copy of approved plans, specifications and related cost estimate or
contract for the purpose of permit fee calculation verification.
CONSTRUCTION DEVELOPMENT PERMIT APPLICATION Page 2
5. A Construction Inspection Permit Fee shall be paid prior to beginning work, in accordance
with the City of Coppell Fee Ordinance. See Page 3 for calculation formula.
Amount Due: $ Fr-4# 14M1 Vii) f / ate Paid:
NOTE: A separate excavation permit is required anytime pavement is cut or when there is work in the
right -of -way not approved by the City Engineer.
Any work requiring closure of a lane of traffic, street, or alley must be approved
in advance by the Engineering Dept., with notification to the following prior to
closure:
Police Department @ 972 - 304 -3600 Street Department 972 - 462 -5150
Fire Department @ 972 - 304 -3500 Engineering Dept. a 972 - 304 -3679
➢ Attach barricade plan / trench safety plan of a lane or street closure. (Required)
NOTE: Street closures are allowed from 9:00 a.m. until 3:00 p.m. ONLY unless otherwise approved
by City Engineer.
A pre- construction meeting is required prior to beginning work related to this permit.
Contact the inspector assigned to your project to schedule the meeting.
Signature of Applicant Printed Name Contact Number
i9;1 •` fit- 443/5-k,:i 0
City Inspector ntact Number(s)
FOR CITY USE ONLY
Is the fill area located in an identified flood hazard area? ( ) YES (NQ
If YES, a Floodplain Development Permit is required before any construction can begin.
Is additional information required? ( ) YES O
Are other federal, state, or local permits required? ( ) YES
PERMIT APPLICATION APPROVED () PERMIT APPLICATION DENIED
- 2-( j I
ity Approval Date
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.
F. MATTHEW WELCH, LEEDAP Elm
Pre- Construction Manager
0 972.580.1210
D 972.582.3514 CONSTRUCTION
C 214.435.7607
mwelch @emjcorp.com
5525 North MacArthur Blvd.
Suite 400
Irving, TX 75038
www.emjcorp.com