Rosebriar-PT120904 A copy of the approved permit must be on the job site at all times.
CC: Applicant THs - sliy . or
Page 1 of 4
Public Works C
Permit File Rev. 0612012
Orig. to Project File - -
ApipkIDwiED RIGHT-OF-WAY USE PERMIT APPLICATION
Permit valid for 90 calendar day:from daft of approval
Submit permit application to the Engineering Dept.,Town Center,255 Parkway Blvd.or e-mail to engineerecoppellte.gov(see button below)
Date of Submittal: 8/14/2°12 Applicant's Job if / Work Order #3 Sandy Lake Rein
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 Teiccom Provider? Yes a No C
0 Plans provided and approved (Erosion Control/safety fences must be Installed prior to beginning work)
Project Name/Location or address 100 Dobecice r to 102 Cas t epurY Ct
General contractor TexC°41m Contact# Gary. Cantwell Jr
E-mail address to return permit i r.cantwelietexcomm.net
Representative: Pti11ip Gwin
Franchise
Telephone ; (214) 869-9038
Company;
E-mail address:Phil/LP.9Will°t'6XCaaml-net
(for contact if needed/if e-rneil of approved perm it is deslredlisertrilt cannot be emailed unless complete)
Utility Company Represented:
Oncor Electric Delivery C Atmos Energy C Verizon r SBC, AT&T
re** Time Warner Cable C CoSery Electric/Gas C Other
„
General Description of Work On actokitaor*with Ord.No;001144,4 PLEASE ATTACH PLAN OR PROPOSED WORK
Replace CATV cable for aprox 170 ft
Estimated Start Date 8120/22 Estimated Completion Date*.91 20/12
* 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: Ci Yes C No
>Is removal of existing streets, alleys, or sidewalks necessary? C Yes No
if YES,project must have City inspection prior to concrete replacement
t ` f 1 -Ai Ilse Permit A $11 lea.,e2of 4
Representative(s)of the Contractor must adhere to all construction standards approved by the City of Coppell, which
includes but is net limited to: Erosion Central Ordinance, compaction requirements (density tests may be required at
applicant's expense)and barricading according to the Texas Manual on Uniform Traffic Control Devices.
t 1 11 01 1"1.' 4 0 4 .before the 1:01111lleriteriletit of wait(grading, drainage,
vegetation,and erosion control). To schedule Public Works final inspection (Page 4)call 972-462-5155.
Any excavation requiring closing of a street/alley must be reported prior to closing to the following:
Police Department @ 972-304-3600
Fire Department.4) 972-3011-3512
Street Department @ 972-462-5150
Engineering Department @ 972-304-3679
Attach barricade plan/trench safety plan if a lane or street closure is required.
NOTE: Street closures are allowed from 9:00 o.rn.until 3:30 AM.ONLY unless otherwise approved by City
Engineer.
>Attach Work Order(franchise only)and/or 1 set of prints showing proposed work.
r:$Locate or existing franchise utilities 7must bwilOniff814PLIT‘Atitr to.090100741!;', rk
97246241-5$**Ohl' 71441iicitii* 4**titdri10J
The application with signatures of Franchise and contractor representatives must be submitted to Engineering
Dept for approval prior to beginning work. Submittals by e-mail should go to etmsepollf&ggLineer
Printing your name indicates your acceptance of the terms and conditions of this form:,
Of yo , nt the appr9retperivilt returned via sr-inall,provide a valid e-mail address on Page 1.)
gnature of Utility Company Representative Date
SignW.„1—(100"--
re of Contractor Representative Date
411 2.z
Si!na o ity Representative Date
Comments
>NOTE: otis j I _ f ' -31,-3679 prior to ,e • and prior to
backlit'for concrete, trench, ditch and open pit inspections. Backjill 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.
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