Tax 2010 C-PT110513 T H E •C 1 T Y O F Page 1 of 4
COFPELL
F x ^ 8 'Y'
DRY BORE / STREET CUT / SAW CUT PERMIT APPLICATION
FOR WORK IN
RIGHT -OF -WAY / EASEMENT
Submit permit application to the Engineering Dept., Town Center, 255 Parkway Blvd.
Date Submitted: 5// 2t l/ Work Order # (if applicable)
PERMIT FEE: $10 .00
(No charge to Utility Companies with approved Franchise /ROW Use Agreement)
❑ Plans provided and approved
(Erosion Control /safety fences must be installed prior to beginning work)
Project Name / Location: 13el t Dire iaaL/ Aylmer l hiv?sfjya -f ( 0 71 (I/aCt(,e•rn•j' ,R)ri 7 ft ant"
7up)
Company Name: C7M E ( , enw e5. lne
Address: 25 3v EteC.trc: ri Lurie, Sul tt 110, Da (IOC, X - 15Z)(
Telephone #: 21 — 3.6 I — 5635 Emergency Telephone #: 1 7 90 7-5 7 5 3 5 e , c./ D 4 _
y(!a �t✓�k/ f'Z3" SJh1 6�e. e
Permit issued to (Contractor Name)
Utility Company Represented:
❑ Oncor Electric Delivery E] Atmos Energy ❑ Verizon ❑ SBC / AT &T
❑ Time Warner Cable ❑ CoSery Elec /Gas ❑ Other *
* If "Other" is checked, please note that franchise or right -of -way use agreements will be required.
General Description of Work (provide copy of approved plans):
Rtvermn t co) eih _4 ' . 9ai11p/ii y Aehi L/nv. /lot
r Was contact made with City and /or utility companies to locate existing utilities?
if NO, Reason: _ YES NO ❑
Is removal of existing streets, alleys, or sidewalks necessary? YES ❑ NO
if YES, must have City inspection prior to concrete replacement
A COPY OF THE APPROVED PERMIT MUST BE ON THE JOB SITE AT ALL TIMES.
Dry Bore / Street Cut / Saw Cut Permit 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 good condition as before the commencement of work (grading, drainage,
vegetation, and erosion control).
➢ Any excavation requiring closing of a street /alley must be reported prior to closing to the following:
Police Department 0 972- 304 -3600
Fire Department ® 972- 304 -3500
Street Department 0 972 -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 4:00 p.m. ONLY unless otherwise approved by City
Engineer.
➢ Attach Work Order (franchise only).
➢ Contact must be made with City and utility companies to locate existing utilities 48 hours prior to beginning of
work.
Signature of Utility Company Representative Printed Name Date
1
Signs a of Contrac ' r Representative Printed Name ate
g
nature o ty P Re resentative Minted Name ate
(Application with original signatures needs to be submitted to the Engineering Department before approval.)
➢ Comments: L,- L,(t y a,v 526 2,7 7
➢ NOTE: Notify City Inspector at 972 -304 -3679 prior to beginning work and prior to backfill for concrete, trench, ditch and
open pit inspections. Backfill 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.
Page 3 of 4
T N E • CI T Y • OF
COPPELL
X '
UTILITY RELOCATION CHECKLIST FOR WORK WITHIN
CITY OF COPPELL RIGHTS -OF -WAY OR EASEMENTS
Listed below are rninimtun requirements for utility relocation projects:
I. A copy of the valid approved City of Coppcll permit is required on the project at all times.
2. Notify adjacent property owners (commercial & residential) of project timeline; provide theta with contact
names and phone numbers.
3. Proper erosion control measures must be taken.
4. Follow Texas MUTCD standards for work in traffic zones.
5. Sod is to he replaced when necessary.
6. irrigation repairs must be performed in a timely manner.
7. Follow OSHA recommended trench safety at all times.
8. Repair existing utilities that are damaged, including but not limited to clean -outs, water valves, and SS
manholes.
9. Densities may be required in trench lines (ASTM).
10. ('are and repair of street signage is the responsibility of the contractor.
11. No work is to be done in collector roadways before 9:00 a.m. or after 3:00 p.m.
12. Prior notice of work activity on weekends and holidays must be in writing.
13. Line locates must be performed in advance by contacting -
CITY OF COPPELL UTILITIES DIVISION cOppeIlItx.gov /utility- operations - division
972! 462 -5155 — gam Fri --
CITY OF COPPELL ENGINEERING DEPT.
972! 304-3679
HOMEOWNER ASSOCIATIONS
972! 304 -3669 (City Secretary Office)
TIME WARNER CABLE FEDERAL EMERGENCY MGMT. ADMIN.
214/ 320 -5433 (Phillip Gwin) 940/ 898 -5138
AT&T LOCAL NETWORK TEXAS COMM. on ENVIRONMENTAL QUALITY
214/ 215 -3031 (Rich Milkman) 817/ 588 - 580()
COSERV Gas & Electric DENTON CO. LEVEE DISTRICT
940! 321 -780() x7624 (Greg Ward) 214/ 352-5118 (Richard Hightower)
EXPLORER PIPELINE Atmos Energy
918/ 493 -51(10 (Patrick Nwakoby) 972/ 881 -4152 (George L.ong)
ONCOR Electric Delivery
972! 323 -8917 (Larry Redick)
VERIZON COMMUNICATIONS 1 800 DIG TESS for line locales
972! 318 -5276 (Luis Comas) (344 - 8377)
14. Contaminants must he removed from work area daily and disposed of properly outside the City.
15. Streets, sidewalks and alleys must be kept clean of construction material and debris.
16. "Clears -up" requires returning work area to pre - project condition or better.
Contractor is required to contact Public Works Division for Completion Verification Notice. (see pg. 4)
T H E• C I T Y• O F Page4of4
COPPELL
UTILITY RELOCATION IN RIGHT -OF -WAY OR EASEMENT
COMPLETION VERIFICATION NOTICE
Contact City of Coppell Public Works Division at 972 -462 -5155 to schedule an inspection
with Utility & Streets personnel to verify that your project has been completed to City of
Coppell specifications. Failure to schedule verification inspection may delay future projects.
Franchise Utility Name
Project Location / Applicant's WorkOrder # cif applicable)
Sub - contractor Company Name
24 hr.Contact Number - skdoe, s 13 _ o7 -5
Date of Verification Appointment ,d-`r` ye2-(1V53
Time of Verification Appointment
INFORMATION BELOW TO BE COMPLETED BY CITY OF COPPELL PERSONNEL
❖ Inspected by of Utilities Maintenance Division on
and found to be acceptable / not acceptable because
Follow -up needed? NO / YES Follow -up scheduled for
❖ Inspected by of Streets Maintenance Division on
and found to be acceptable / not acceptable because
Follow -up needed? NO / YES Follow -up scheduled for
A copy of this completed notice is to be provided to:
City of Coppell Engineering Dept.
255 Parkway Blvd., Coppell TX 75019
Office: 972- 304 -3679 Fax: 972 - 304-3570
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Jennifer Shields
From: contractorfax @digtess.org
Sent: Wednesday, May 04, 2011 1:31 PM
To: Jennifer Shields
Subject: GeoCall Locate Information - 111244098
DIG -TESS Locate Request
Ticket Number: 111244098 Old Ticket:
Priority: Normal By: Janatte G
Source: Voice Hours Notice: 48
Type: Normal Date: 5/4/2011 1:29:28 PM
Sequence: 1
Map Reference:
Company Information
GME CONSULTING SERVICES, INC. Type: Contractor
2530 ELECTRONIC LANE 710 Contact: JENNIFER SHIELDS*
DALLAS, TX 75220 Caller: JENNIFER SHIELDS*
Phone: (214) 351 -5633 Caller Phone: (214) 351 -5633
Fax: (214) 351 -5680 Callback: 0800 - 1700
Alt Contact:
Caller Email: JSHIELDS @GMECONSULT.COM
Work Information
State: TX Work Date: 05/06/11 at 1315
County: DALLAS Type: EXCAVATION
Place: COPPELL Done For: CITY OF COPPELL
Street: 0 N BELTLINE RD
Intersection: DENTON TAP
Nature of Work: ROAD SOARING /SOIL SAMPLIMG
Explosives: No Deeper Than 16 ": Yes
White Lined: No Duration: 03 DAYS
Mapsco: MAPSCO 11A,B
Remarks
BEGIN LOCATING AT THE INTER OF I H 635 AND N BELTLINE RD AND CONT LOCATING N ON N BELTLINE
RD TO THE INTER OF DENTON TAP RD AND E BELTLINE RD.. LOCATING
BOTH SIDES OF THE RD.. AREA MARKED IN ORANGE PAINT
Bl -B17 IS ON THE NORTHBOUND SIDE AND B18 -B34 IS ON THE SOUTHBOUND SIDE OF
BELTLINE RD
MAPSCO 11A, N J AND E
Members
Code Name Added Manually
1TN TIME WARNER CABLE No
ACI TW TELECOM No
ANO ATMOS -MIDTX -HEATH (NORTH) No
ASI FIBER LIGHT LLC (FORMERLY XSPEDIUS) No
ASW ATMOS -MIDTX -HEATH (SOUTHWEST) No
ATT ATT / T No
GTH VERIZON - TX - CARROLLTON DISTRICT No
GTL VERIZON - TX - KELLER GRAPEVINE DISTRICT (METRO...No
IR4 ONCOR ELECTRIC DISTRIBUTION -SMP (IRVING) No
MCT MCI No
1
PNO ATMOS- MIDTEX - PIPELINE -HEATH (NORTH) No
QWE QWEST COMMUNICATIONS No
TCD CONSOLIDATED COMMUNICATIONS No
TSW 360 NETWORKS No
TWT TW TELECOM No
TXNE TXNE - ATT /D No
USS SPRINT NEXTEL No
XL6 EXPLORER PIPELINE COMPANY No
Location
Latitude: 32.9509050745843 Longitude: - 97.0005783207031
Second Latitude: 32.9130390359041 Second Longitude: - 96.9858169835905
TAC 16 -1 -18: Ticket life = 14 work days near pipelines, including service lines; if
pipeline is damaged report to DIG TESS ASAP and Railroad Comm. within 10 days.
2