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ST1002-PT120713 A copy of the approved permit must be on the job site at all times. CC: Applicant T N E C T v o f Page 1 of 4 Public Works COPPELL Permit File Rev. 11/07 * f 4 Orig. to Project File e x S•� ? s q AppnowED RIGHT-OF-WAY USE PERMIT APPLICATION 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: 7- /0 - /92_ Applicant's Job # / Work Order # 3 /3424 b 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) n Project Name / Location: 01) /61.4,A1 LW1 Li. T 1 /4 Sr. L?t. General Contractor: --- Contact # Permit issued to C mpany / Representative: /1G06e EifeT�t C De/,Very CU, Address: 44vo Jr35 zja,v - amees L?i&meM1 7;' 757 74 Telephone #: �/9‘,2‘/- s'2s'S" Emergency Telephone #: 111- 26i• 525 S" Utility Company Represented: Xncor Electric Delivery ❑Atmos Energy ❑Verizon ❑SBC/ AT&T ❑Time Warner Cable ❑CoSery Electric/Gas ❑Other General Description of Work (provide four[4]sets ff plans): In accordAnce with Ord. No. 2001-944. V51 z[ /14 s T FF r 1 I firs cr'�fT,r�S, / cnro✓P S7' L . Estimated Start Date '1 — 1 2- Estimated Completion Date* �3� - * Completion requires submittal of Completion Verification Notice (see page 4) ➢ Was contact maAi with City and/or tility companies to locate existing utilities? if NO, Reason: o P/66t�uG TeQkoKed- CI v(1. 15 6"pLeil1 YES ❑ NO tS ➢ Is removal of existing streets, alleys, or sidewalks necessary? YES ❑ N✓ 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 ➢ 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. (Appl.,Ition with original signatures should be submitted to the Engineering Department before approval.) _ ,�► e./( fialirj4 7—/°- le2 / GG Sig ra 1 e of -. any Representative Printed Name J Date C// l . reofe„ 7— d ' ial. Signature o Contr representative Printed Name Date CL— ii l4 t1`Trn VI V(Z-- Signature of City Representative Printed Name Dale I.➢ Comments: r' /A6t ��/_�� jt VI kelft". 4X- > .e l/ 641 - 576 -?7'® q > 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. i , I �1. ° (n 600 °N N tV 3 a i V pp 4 S 0 z CD CA ?01106 0U11.01NG I z A O Z Q (/1 E , 6 2151469 I I 1 ; ........................ ........................ -8110 A25 ................... �► ❑ 1 ' ACM 2 160 VOI.r 5r r GKr ?�OVOI.r 5r Lor GKr X>%MK r rPX 5EG 60 AMP GON OI.l.1iK 1 10 AMP GONrKOLL -4 IWA I N If K R :ML HPS 55 5r w 1 , 9 5r �r5 U c� a;.... 060 /: oc 061 O � RNA Gtr ,. 00 C R :175w oG �Q Lp >c N R: SL HPS I M c� ' I: PS I: S HPS 054 m r 1 N 1 1 ? 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Prodwb provd•d b ddw` d,ev,bvl• prv- One- Ebotro Da4wry en fa tN ntarnd uN of tl1a rwlpllnt, and Un r_yu•nt ages rot to duplweb or l 6• proAeb or ery po-von of du eduab b Wrd prvis ntlnut yr peon •r,tbn p•rauiswn of tlncor EI-tno DaL.•rµ 7blargr f�aya• m rol�lwdm a V f 0=El o DaF �o a,nt all oleos, ooab, •.penis• and q •eb n tie P'op•r4 P 'o'da�d M wider. 1 W W+ ww" d..P.m wa.t of MR NAME FBRI COPPELLI INST 114 ST LTS FOR OLD TOWN COPPELL RFa CUSTOMER FBR, COPPELLE INST 114 ST LTS ADDRESS BETHEL RD. AND COPPELL RD. LOCATION COPPELL RD.S.AND BETHEL RD.