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DR1201-PT121001 T M s - C I T r' • o F Page 1 of 4 COFFELL * 1- 1 Al T -� by ' b f DRY BORE/STREET CUT/SAW CUT PERMIT APPLICATION FOR WORK IN RIGHT-OF-WAY/EASEMENT Submit permit application to the Engineering Dept.,Town Center,255 Parkway Blvd.or by e-mail to engineer @coppelltx.gov(see button below Date Submitted: ( x'28 2 Work Order#(if applicable) PERMIT FEE: $100.00 (No charge to Utility Companies with approved Franchise/ROW Use Agreement) ❑ Plans provided and approved (Erosion Control/safety fences must be installed prior to beginning work) Project Name/Location: cr444J J t ace)Ca:Ai-A rave Company Name: T.12941- 4ty42.4.jr,;.O� „(0)44 Address: Vr 4- 5-1 ? t- Ori k i Sti 3t, 4 , 04,1&5 S1211 Telephone#:D Ir-350-5140 Emergency Telephone#: ?TZ_1h-Z O5 b Permit issued to(Contractor Name) L M Stub Utility Company Represented: ✓ Q cai*, C Oncor Electric Delivery C Atmos Energy C Verizon (' SBC/AT&T C Time Warner Cable C' CoSery Electric/Gas Qt Other* flexed 613 i>/fly cif"Other"is checked,please note that franchise or right-of-way use agreements will be required. General Description of Work(provide copy of approved plans): p rill 4- t, bar iilfi S 4In YiA 1,J-0S1-b u&,d- auekcmi---46 s tt Y kD:431' 71)0 vivo s l9‘10-t ofe-.(Zai�aA"leksk-- z4- Gard$. loaire,Wzz Li)stk 1 caktxts e -- fatoot24 sa rete, >Was contact made with City and/or utility companies to locate existing utilities? if NO,Reason: Yes tg. No C >Is removal of existing streets,alleys,or sidewalks necessary? Yes C' No if YES,must have City inspection prior to concrete replacement A COPY OF THE APPROVED PERMIT MUST BE ON THE JOB SITE AT ALL TIMES. Dry Bore/Street Cut/Saw Cut Permit 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). Any excavation requiring closing of a street/alley must be reported prior to closing to the following: Police Department @ 972-304-3600 Fire Department @ 972-304-3512 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 a.m.until 4;00 p.m.ONLY unless otherwise approved by City Engineer. >Attach Work Order(franchise only). >Contact must be made with City and utility companies to locate existing utilities 48 hours prior to beginning of work. Printing your name indicates your acceptance of the terms and conditions of this form: Si•nature • Corn any Representative Date ■ Q/ 19 1 Signature of Contractor Representative Date /o / •'l - Signature . City Represe ive Date (Application with signatures needs s to be submitted to the Engineering Department before approval.) ➢Comments: l mry v " ( '�y Vd/is 0- 'M- 576 ' 77©7 ➢NOTE: Notify City inspector at 972-3104-3679 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.