Summer Place-PT111205 I A copy of the approved permit must be on the job site at all times.
CC: Applicant T H E •C • r r •o F
Public Works COPPELL Page 1 of 4
Permit File Rev. 07/2010
Orig. to Project File ' F 9
A
X g
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e DDD
D RIGHT -OF -WAY USE PERMIT APPLICATION 2Q - 1 PO 1: 5 5 R C V
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: (I — ZR — 1 1 Applicant's Job # / Work Order # 4 9 Z. 3 27._
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 (■)
❑ Plans provided and approved
(Erosion Control /safety fences must be installed prior to beginning work)
Project Name / Location: 3 5 z L I 5 UE L__N..
General Contractor: N PL Co NS - i•1ZJ C1-T O Nr Contact # (-7 ) 322...c?
Permit issued to Company / Representative: . Eta C R Wu_
Address: 2____t_ t--1mi -bCGT' _ (,- j fJ. •--r -X
Telephone #: (z '877 -5 (N 0 Emergency Telephone #: 6.72) z7 V -- 37 7 q
Utility Company Represented:
EJ Oncor Electric Delivery Atmos Energy ❑ Verizon p SBC/ AT &T
❑ Time Warner Cable ❑ CoSery Electric /Gas 0 Other
General Description of Work (provide four [41 sets of plans): In accordance with Ord. No. 2001 - 944.
"4i RI 6 Lf...- ,4 ° T 774 O I\/ H/l NI l A -. /d
Estimated Start Date /2_—.2._ -1 / Estimated Completion Date* / - Z — i2-
* 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 Er NO ❑
➢ Is removal of existing streets, alleys, or sidewalks necessary? YES ❑ NO
if YES, must have City inspection prior to concrete replacement
Right -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 good 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 CO 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.
I 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.)
i��l4l 44,,, mi (, _ „_, t
Signature o f tility Comp Representative Pri ed Name Date
1 / / Erg!C 64L-L_ II/'7 -1 /III
Signature of Contractor Representative Printed Name Date
_lit Alickil\fa,ON22,01- l
i. f City Representative Printed Name �� D, to
> Comments:
➢ 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.
)2
492322 . -
Town: Coppell
Address: 352 LEISURE LN \ 352 f
1
Tech Assigned to Repair Leak:
\ o I
Contractor Assigned to Leak: 0 "` 1 LK @tap
Date Found: 10/17/2011 rel I n
Technician: Scalf, Durwood LiO #: l - - -- o a:;', `"
IN
Probable Source: Service Survey Job#:
Gas Detected: Soil Grade: 2.030
COI Test: 94 Time Graded: to
Meter #: 4990914 Assistance requested: rt
Bar 'rest each direction to 0% Assistance arrived:
No migration indicated Condition eliminated:
Surface Over Leak: Soil Mapsheet: AG427040
Surface Over Main: Soil Mapsco: I AS . LK approx 40" from bldg
Probable Pipe Type: Poly Class 4 Location: No
Last Repair Date: Business District: No
•
Line Locate Number: Dug up inlet riser: No
L.al: Long: County: Dallas
Temporary Repair:
Leak Repair On pipe Material Cause Of Leak 0 Main a Control Dev -re.) N/A 0 Corrosion • Atmospheric 0 Fuson Defect
0 Service 0 Meter 1 0 Cast icon 0 Corrosion • External 0 Lightning
p Pe 0 Bare Steel 0 Corrosion • Internal O Gasket! O•rings
Above Ground O Joint 0 Coated Steel
APT O Copper 0 Melds O Bell Joint
O Valve 0 PVC 0 Third Party 0 Thread Leak
o Fitting 0 Poly 1 3306 0 Company Force 0 Mechan'.cal CO
0 Tap 0 Unmarked Orange 0 Constr. Defect 0 Operations ^ — proof Pressuro Test Information
O Comp Coup" i ng o Dupont Pressure
o Unknovm 0 h1
0 Backlit 0 Equipment
Lag 0 Grapheization 0 Vehicle Damage 0 1 P. oz Pressuro Test Of ainIAPT 0 Service Line
0 Poly II : o t.P. .
+ SOP 0 Static Electricity 0 Outside Force 160 PSIG Test Medium 0 Air 0 Nitrogen 0 Water
L:odeUStyfa _ 0 Excesstre Strain 0 Natural Force 0 H.P, > 60 PSIG Test Pressure Psl
___ ---- _
0 Yes 0 > =20:6 SMYS . ... - -.._
0 Ltaterial Failure (Prepare Material Trouble report) Test Duration _ - ___ - hrs _ _ , mins
Soil type Maln / APT Services Other OQ 1D _. _
Rigout? _.._ - -__.—
Pu'lout? 0 Yes 0 No 0 Retired Main Permanent Repair 0 Replaced Service Line 0 No Leak / Bar Tested
Seperated? 0 Yes O No 0 Replaced Main _ 0 Replaced Dam. Sec. Only O No Leak / Lab Report POST REPAIR TEST
Odorant Detected 0 Replaced Section of Pipe 0 Replaced Dam (Stab fit used 0 Excavated / Not Company Leak COI Test Sustained % Gas
n Yes 0 Bolted Spit Sleeve # 0 Replaced Fittings 0 Leak on Cyst Pip'ne 0 Conditions will not permit bar test
0 No 0 Bell Joint Repair 0 Perrnabond
0 Unodorized 0 Replaced Fittings 0 Encapsutaton 0 Replaced Prebert Riser Above Ground Facility
O Replaced Riser 0 Replaced / Repaired Control Device 02 Level
Type Of Repair 0 Repaired /Greased Vat+e 0 Retired at Joint Service 0 Re aced / Repaired Meter
0 Permanent 0 Installed Electrofusion Coupling p p 0 Greater than or equal to 19.5%
O Temporary 0 Wetd Spit S 0 Retired Service at Man 0 Replaced Fittings 0 Less than 19.5% (correctbe actor taken) 1 !
Temporary Repair 0 Repaied Wed 0 Retired Service at PL 0 Replaced Gaskets 0 N/A
(1 Installed Expansion Plug 0 InalIVA'etdedPatch 0 Repaired We'd 0 Repaced /Repaired Valve
0 Greased V ake Soap Test
0 Installed Clamp 0 Stab Frttng Used 0 Soap Tested / No Leak
0 Tightened Fitting 0 Telescopic Fitting 0 Inst Etedrofusiort Cpl. 0 Tightened Fitting 0 Pass OD ID
0 Shut Off Valve 0 Encapsulate r 1 0 Trident Seal 0 Trident Seal
O Bolted Sprit Sleeve 0 Trident Seal 1'�� 0 Replaced Tap 0 RebuttLieterLoop Paving Repair (ST ft)
0 Installed Cap 0 Instal Clamp 0 Telescopic Fitting Pipe Size
L_ O Stab Fit Used 0 Skinner 0 Replaced Service Cap 00 ID
0 Band Pipe Grade
00 ID L --0 Cap Cracked __ -'- __
0 FlC Pro) #
- Station Pius
Anodes Installed Pipe to Soil
Tied to # Weight Test Station — Found V Leh V Wall Thickness
O Main/APT Specr,ed ._..._
n
o Service U „ Top ..._.__ ._ I %tl. --
0 WA- Rectified - -- - - - - -_._ — _... ._ - --- -- - -- •
OQ ID 00 ID
TS Station Plus Top - -. gds eon= _ ,...
- - - -- Csol ion of Underground Coaredtsare Steel Pipe Observed During Repa'rs
Pipe Installed 0 Yes 0 No Plastic Pipe Removed
External
0 Pot/ Pipe o DrlscoPlex 0 Uponor 0 CSR Designation Code - - - - - - - - -- - -- - - ---
0 Coated Steel 0 Performance Corrosion Pits Coaling
Designation 0 CEC G U or 0 None 0 None 0 None
P°n For irdrm anppe, enter UUX ato•.a
Colo o CAC 0 Light 0 Scattered 0 Good
- -.
0 CEE a Dupont 0 CEC 0 Unknown 0 tied 0 cl G 0 Fair 1
SCR 0 Drisca 0 Heavy 0 Poor
• _ .
0 CTS 0 Pence 0 CDC 0 NA i
Pee Size O IPS O CEE —• - --
a DriscoPlex
Feet Print Line Number Max Pot Depth Max Pit Length Coating Type
0 Meek , -
SDR - - • - -- internal Corrosion 0 Yes 0 No 0 No Pipe Removed
0 Jh1 Mfg No inspection.
Print Line Date (m+rldd/yy) 0 Unknov.n O0 ID
/ __ ___
Pipe Size _ • Feet __.... _._...
Total Drive Total Number Total Job
Date Repaired _ _ / / Leak Repaired By Time (hours) of Employees _ _ Time (hours)
FORM 1879 9 /2008 Note' 00 Items, as applicable, roust be perforated or directed and observed by qualified personnel and the Dot qualified personnel must appear on the 0010 line
Printed: 11/28/201