FTTP-CR051004 Oct 04 05 03: 50p p. l
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T H C t T Y O F
CÔFFELL
X ^ S - i t9
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 Cityof
Coppell specifications. Failure to schedule verification inspection may delay future projects.
Franchise Utility Name g7/c511/C g d-b-n--34.--
Project Location / Applicant's WorkOrder # (if appl' ble)3/2 / ��
fi'ri-A--di . le) ‘7-4--/t //61-, ).4 i 7 e/Pziozieg
Sub-contractor Company Name Vfi-74-SAI -C---ye/2„
24 hr.Contact Number 9 ,./.__ 9 .V . J •3,‘
Date of Verification Appointment /2)1W O.
Time of Verification Appointment D b ,4 At
INFORMATION BELOW TO BE COMPLETED BY CITY OF COPPELL PERSONNEL
•:• Inspected by /,//o,Gro-A,-n of Utilities Maintenance Division on /6 -S'-oI"---
and found to be ceptable not acceptable because
Follow-up needed? 0 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
a
0
Damage Contract Located Utility Item Investigated At Fault C)
Date Work Order Type Company YIN Provider Damaged Size Damaged By Location Of Damage By YIN
0
8/19/05 3PF01 GP Telephone HJB Y Verizon 50 pair shovel 735 Parkway Chance Patton Y
0
UT
0
0
. t
N