Old Town TH-PT120706 A copy of the approved permit must be on the job site at all times.
CC: Applicant T H E T v • 0 F Page 1 of 4
Public Works COPPELL Permit File z * r, -
Rev. 11/07
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Orig. to Project File x A s s 07-D5- , ? A G? + R C V D
0 0
RIGHT-OF-WAY USE PERMIT APPLICATION
Permit valid for 90 calendar days from date of approval
,14, ' ' 'li 7 4 g ermit application to the Engineering Dept., Town Center, 255 Parkway Blvd.
Date of Submittal: 7' 6 ' 12-- Applicant's Job # / Work Order # 3 1 744 c I
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franchise/ROW Use Agreement)
Refer to the City of Coppell Ordinance No. 2001-944. Certificated Telecom Provider? Y 6/
❑ Plans provided and approved
(Erosion Control/safety fences must be installed prior to beginning work)
Project Name / Location: Oa f01.41 1.41 [ li towA)Hots-I8. - 6MDe 11 A /31)
General Contractor: Contact #�!
Permit issued to Company / Representative: &42CDR // '!,t t /e I`qi%
Address: /4400 S?Sey L!v. — �,9t2r v$ /al41.1 NI %. 7,5/234
Telephone #: 46 3 2t/ �2$� Emergency Telephone #: Ya-2(- y-2 '
Utility Company Represented:
F'..c(' .cI.eldrv,5 @ o,U�R. corn
,cor Electric Delivery ❑Atmos Energy ❑Verizon ❑SBC/ AT&T
❑Time Warner Cable ❑CoSery Electric/Gas ❑ Other
Ge al Description of Work (provide four[4]sets of plans): In accordance with Ord. No. 2001-944.
fe";PC ELCIjx,-4 Jeff/r'cr Tr? 36 ?-ocvv Hors Zor..S —
oNOa (-T /9 zggive aw 7i ez .
Estimated Start Date 7 77 - I 2-- Estimated Completion Date* 6-3 - / ,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:2c,CiPrtfi -• /wt'tc,So(l2- WiI,, ieQ 4leyf0 YES ❑ NOX{
W 7/71,1> 4 8 / `ctr2J OF 9119QT at2‹ ovs-r2rA r cw.
> 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 @ 972-304-3500
Street Department @ 972-462-5150
Engineering Department @ 972-304-3679
D 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.
Contacts must be made to locate existing utilities 48 hours prior to beginning work.
(App % ation with original signatures should be submitted to the Engineering Department before approval.)
./L/ ...111"1;--- 11111■
4, f---;:e(i,cy 7- - 4,1
,bna o ity .� ny epresentative Printed Name Date
/_ /`C / i 7d 7- 6- Q
Signature of Contract- =epresentative Printed Name Date
I4og Ma.(4) 7/‘ (z,
ignature of City Representative Printed Name Date
➢ 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.
Page 4 of 4
T H E C f T Y O F
COPPELL
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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 0 t (L v I v
Project Location / Applicant's Work Order # (if applicable) 3 17 445 ■
ULf To w C oPPELL To w t I-bMG
Sub-contractor Company Name
24 hr.Contact Number
Date of Verification Appointment
Time of Verification Appointment
LNFORMATION BELOW TO BE COMPLETED BY CITY OF COPPELL PUBLIC WORKS 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