Royal Oaks-PT120124 A copy of the approved permit must be on the job site at all times.
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CC: Applicant * H a r r OF Page 1 of 4
Public Works CCP ELL
Permit File Rev. 07 /2010
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Orig. to Project File x R
410 4
D i D o RIGHT -OF -WAY USE PERMIT APPLICATION
Permit valid for 90 calendar days from dale of approval
Submit permit application to the Engineering Dept., Town Center, 255 Parkway Blvd.
Date of Submittal: /— /21 Applicant's Job # / Work Order #
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 installed prior to beginning work)
Project Naine / Location: (p a - / atm 10- /e 1L Jq i. I? t
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General Contractor: -21 ,_ � r� ,4 Contact l•7 r ' F t / 7
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Permit issued to Company / Representative: g(c,l kf fetek✓uive.k
Address: WC) 4f arA fie, ,.
C.e-� �><- 'Toil � �
Telephone #: 9Fr 76,7 Emergency Telephone #: r (7 ?c v-7 4.7 r _ I
Utility Company Represented:
OtOncor Electric Delivery ❑ Atmos Energy ❑ Verizon ❑ SRCJ AT &T
❑ Time Warner Cable [] CoSery Electric /Gas ❑ Other
General Description of Work (provide four j4J sets of plans): In accordance with Ord. No. 2001 -944.
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Estimated Start Date 2-6 6 1 Z. Estimated Completion Date* 2--17 / 2
* 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 V 1 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:
y q g g y p P g g:
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 4:00 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.)
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Signature of Utility Company Representative Printed Naine Date
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Signature of Contractor Representative Printed Name Date
m16/14A-CU '•-
Sign L • of Cit Representative Printed Name 1 4 4 111 -11— '
3= 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 claitn,
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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