Parks Apt-PT080505 CC: Applicant AiNnoyEt
" E • c . T Y • o f Page 1 of 4
Public Works
OPPELL
Permit File g
Orig. to Project File ; r 1 7 : v3 v/7-�G.Zc�/�,
F x A s b
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: 5/— OS Applicant's Job # / Work Order # 1P F/19
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franchise/ROW Use Agreement)
License Agreement Approved (date) / / Certificated Telecom Provider? Y N
❑ Plans provided and approved
(Erosion Control/safety fences must be installed prior to beginning work)
Project Name / Location: --e,,ort(� er ( j , c)i J. / lcore_
General Contractor: /CO me e.e.
Permit issued to Company / Representative: Vow./Zorn / r•r
Address: Zo9c/ me ('ate Lt./ Le.wi5ui I le. Ili
Telephone #: 972.-5743-333,3 Emergency Telephone #: 014 -
Utility Company Represented:
❑TXU Electric Delivery Co. H Atmos Energy (formerly TXU Gas) R'Verizon ❑SBC ❑ ComCast Cable
❑AT&T Local Services ❑GrandeCom (formerly CoServ) f l CoSery Electric/Gas ❑Other
➢ If "Other" is checked, please note that franchise or right-of-way use agreements will be required and need
Council approval prior to beginning work. Permit cannot be approved until that time.
General Description of Work (provide four (4) sets of plans):
'Be. Qp Exam/GI //us T_c Z 3 , �r�C�., r�i_�2Lr' n i G c aJ k. tsiEs r 2ceass Sa M IAE L
c.r /�(t)�zrii fo IALK.WAY, ttien Wes i aton3 -flu_ South hue_ of ?pegAul
578 .$ PiAct tato few I4uba -to provicL. Suuic . to Town Iola._ Apts.
Estimated Start Date 5.- /5-O$ Estimated Completion Date* 7 j,_ip,8
* 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: YES I, f NO I I
➢ Is removal of existing streets, alleys, or sidewalks necessary? YES I I NO (7
if YES, must have City inspection prior to concrete replacement
Right-of-Way Use Permit Application Page 2 of 4
•
Revised 06/03
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.
0410,4400Affil 'Yfn Me RUT
➢ 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 3 sets of prints showing proposed work.
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........................
(Application with original signatures needs to be submitted to the Engineering Department before approval.)
Signature of Utility Company Representative Printed Name Date
.) /
� L .TSr� 4- 7 - 418'
Signature of Contractor Representative Printed Name Date
Nik-444.EL ertit7,4 S/5/08
Signature of City Representative Printed Name Date
➢ Comments: Set MA(K ✓p o N (�.MS —'' 2 1 t�
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➢ 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 he 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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