Carter Addn 3-PT120911 COFFELL
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CONSTRUCTION DEVELOPMENT PERMIT APPLICATION
Name of Applicant /a, 7 ,(,GC Date Submitted 9-1/- /,16
Address of Applicant ,50Z 5- 1�4 z 62 ,ea.
Phone Number - 93/ "53 Fax Number ,02//.6)
Location of Construction (address, if available): //
Subdivision ,41(1,:7 Section# 3 Block# Lot#
OR Survey/Abstract# Acreage
Location description (attach vicinity map): 4-a,hia,,x,,., % k4.,r duce
1. Type of proposed construction or development:
XResidential C Alteration of a natural waterway drainage course
C Non-Residential C Other(describe & attach drawing or sketch)
C' Placement of Fill (in right-of-way or on private property)
2. Description of Construction Permit requested:
NIPaving Median or Landscape ❑ Box Culvert
i;4 Sidewalk 1X1 Water Main , Rip Rap
❑ Drive Approach R.C.P. Si Fill Area
Excavation RfSanitary Sewer Main ❑ Drainage Channel Excavation
❑ Fire Lane Flume SI Slope Protection/Retaining Wall
❑ Bridge 14 Inlet ❑ Parking Lot
Provide an attachment containing the name and 24-hr. contact phone number
of supervisor(s) for every contractor working under this general permit.
3.All construction shall be in compliance with, but not limited to, the City of Coppell Subdivision
Ordinance, Standard Construction Details, Streetscape Plan and approved plans. The
contractors shall adhere to the City's Erosion Control& Sedimentation Ordinance.
4.Applicant shall provide a copy of approved plans, specifications and the related cost estimate or
contract for the purpose of permit fee calculation verification.
CONSTRUCTION DEVELOPMENT PERMIT APPLICATION Page 2
5.A Construction Inspection Permit Fee shall be paid prior to beginning work, in accordance with
the City of Coppell Fee Ordinance. See Page 3 for calculation formula.
Date Paid:
Amount Due: $��� ��
NOTE: A separate excavation permit is required anytime pavement is cut or when there is work in the
right-of-way not approved by the City Engineer.
>Any work requiring closure of a lane of traffic, street, or alley must be approved in
advance by the Engineering Dept., with notification to the following prior to
closure:
Police Department @ 972-304-3600 Street Department @ 972-462-5150
Fire Department @ 972-304-3512 Engineering Dept. @ 972-304-3679
Attach barricade plan /trench safety plan of a lane or street closure. (Required)
>It is a requirement of this permit that As-Built Drawings be turned in at the end of
this project. As-Builts consist of 1 set full size paper copy, 1 set full size mylar and a
CD with Autocad.dwg files.
NOTE:Street closures are allowed from 9:00 a.m.until 3:30 p.m.ONLY
unless otherwise approved by City Engineer.
>A pre-construction meeting is required prior to beginning work related to this permit.
Contact the inspector assigned to your project to schedule the meeting.
Printing our name in es your acceptance of the terms and conditions of this form:
S. .ture of Applican Contact Number
1 1 :0,-/v . (-I ,S1(0 S�
Signature of Inspector Contact Number
FOR CITY USE ONLY
Is the fill area located in an identified flood hazard area? .,- Yes C No
If YES, a Floodplain Development Permit is required before any construction can begin.
Is additional information required? C' Yes Oo
Are other federal, state, or local permits required? C Yes
ERMIT APPLICATION APPROVED C PERMIT APPLICATION DENIED
4,,:l l�y .+. Date
( 1-1
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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.
T 14 t . C I 'i° Y «..0 copr_EL_L Page 3
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INSPECTION FEE CALCULATION SHEET
Project Name J ,•d) e1,_1 4///4 4 22E Date ,?—//—
As per the City of Coppell Subdivision Regulations,the Developer shall pay 4%of the cost of the items to be permitted and inspected by
the Engineering Department and dedicated to the City. The Developer shall pay 2% of the items to be inspected by the Engineering
Department,but not dedicated to the City such as parking lots,private utilities,private drainage systems and so forth. Inspection fees are
due on or before the date of the Pre-construction Meeting.
In order to verify the inspection fee due, please provide a copy of the development contract(s) and this spreadsheet with
completed calculations to the Engineering Dept. The contract(s) should indicate the cost to construct the following
improvements:
PUBLIC IMPROVEMENTS U PRIVATE IMPROVEMENTS u
CONTRACT AMOUNT X 4/o= CONTRACT AMOUNT X 2/o=
Paving 9,121 —�, 99/
of f
Water /3624/,�y�s 5-3/3
Sanitary Sewer 0, Ai/, J1/
Storm Sewer / _5" 5e/ j
Alleys
7
Sidewalks
Other / / /9,2 a1 J�a ? -3/
Total � g1
Grand Total (total of
both colored fields) ga23 637
, C
250 6I BRALTAR ROAD
PA
�oilros.,1170 215S-938-8000 19044
1598 8.800019044 Check No. - 9212544 Check Date - 09/11/12 Stub 1 of 1 P.!
ie INVOICE NO INVOICE DATE COMMENT GROSS DEDUCTIONS AMOUNT PAI>
m
120910/3124 091012 INSPECTION FEES 23,637.69 23,637.69 E
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`"oil'Bros, Inc CHECK NO. 09212544 A°�x
250 Gibraltar Road VENDOR NO. CHECK DATE CHECK ArJ)cnJ0.
Horsham PA 19044 - , a 1
215-9 8.80 0 254616 09/11/12 $****23,637.89 , t N
** INVALID SIX MONTHS AFTER DATE ISSUED * , sr, to A
PAY
TWENTY THREE THOUSAND SIX HUNDRED THIRTY SEVEN AND 69/100
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4...r..:..... \� `� i///r0/" '"..�`.....M.t „r1 4, 1 L
TO THE City Of Coppell A Ar. `..w **
ORDER OF: Planning Dept • MC'g 8
255 Parkway Blvd PO Box 9478 Welk Fargo Bank N A. " w
San Francisco, ., +,T" �..jiiii i:::** ,1 , 8.,
Coppell TX 75019-9478 <%..:7,17"="":14'..-z..--_-:----:";;;',,,,,.---- -""—.4`.* .: ti
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