Tax 2012A-PT121220 A copy of the approved permit must be on the job site at all times.
CC: Applicant r " ` _ ` ' T r a ` Page 1 of 4
Public Works COPPELL
P
ermit File Rev. 06/2012
Orig. to Project File e x A' 6
ApplowEnii
D 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.or e-mail to engineer @coppelltx.gov(see button below)
Date of Submittal: D-) 3- a Applicant's Job # / Work Order #
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? Yes C No (�'
0 Plans provided and approved (Erosion Control/Safety fences must be installed prior to beginning work)
Project Name/Location or address /140(k,h y 1 )rd I<n. and_ Pte. L. 10 Or G I. Li
General Contractor 1..oc 4.h sv v..Ce /Contact/# g707• - s— NS1'
E-mail address to return permit ///ItjJ L o 44 .St"ricC 1Ev YaAte brit
Representative: C6ry VVooISt
Franchise Telephone#: oZ�(,�_ a0(�_ J r"f
Company:
E-mail address: (arla1. L a p use q e a 4 l ti l o s e M .C o' ''
(for contact if needed/if e-mail of approved permit is desired/permit annot be e-mailed unless complete)
Utility Company Represented:
C Oncor Electric Delivery 6><tmos Energy C Verizon C SBC/AT&T
C Time Warner Cable C CoSery Electric/Gas C Other
General Description of Work(In accordance with Ord.No.2001-944):PLEASE ATTACH PLAN OF PROPOSED WORK
Pao it Gas (Y1G 1 nJ 011 1 Ck11 Cd —CC 'lCc.�L o n
( , oriole Lt(1
Estimated Start Date I)')9-) Estimated Completion Date* ,- let-13
* 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: ( Tes C No
>Is removal of existing streets, alleys, or sidewalks necessary? C Yes ( 1Po
if YES,project must have City inspection prior to concrete replacement
Right-of-Wav Use Permit Anulication Pane 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
applicant's 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 @ 972-304-3512
Street Department(0 972-462-5150
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 3:30 p.m.ONLY unless otherwise approved by City
Engineer.
>Attach Work Order(franchise only)and/or 1 set of prints showing proposed work.
Locates for existing franchise utilities must be done 48 hours prior to beginning work.
For City utility locates, call 972-462-5155 to schedule 48 hours prior to beginning work.
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 engineerPcoppelltx.gov.
Printing your name indicates your acceptance of the terms and conditions of this form:
(if you want tht ap70,fr a rmit returned via e-mail,provide a valid e-ma it Address on Page 1.)
C GU Signature,cif Utility Comply Representative Date
Si ature of Contractor Representative Date
&AI tL (L*
Sign.to - a Representative Date
Comments
➢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.
T H E - C I T Y TT c F Page 3 of 4
COPPE
A 4 • 8
UTILITY RELOCATION CHECKLIST FOR WORK WITHIN
CITY OF COPPELL RIGHTS-OF-WAY OR EASEMENTS
Listed below are minimum requirements for utility relocation projects:
1.A copy of the valid approved City of Coppell permit is required on the project at all times.
2.Notify adjacent property owners (commercial & residential) of project timeline; provide them with contact
names and phone numbers.
3.Proper erosion control measures must be taken.
4.Follow Texas MUTCD standards for work in traffic zones.
S.Sod is to be replaced when necessary.
6.Irrigation repairs must be performed in a timely manner.
7.Follow OSHA recommended trench safety at all times.
8.Repair existing utilities that are damaged, including but not limited to clean-outs, water valves, and SS
manholes.
9.Densities may be required in trench lines (ASTM).
10.Care and repair of street signage is the responsibility of the contractor.
11.No work is to be done in collector roadways before 9:00 a.m. or after 3:00 p.m.
12.Prior notice of work activity on weekends and holidays must be in writing.
13.Line locates must be performed in advance by contacting - 1 800 DIG TESS and/or the following:
CITY OF COPPELL UTILITIES DIVISION coppelltx.gov/utility-operations-division
972/462-5155
CITY OF COPPELL ENGINEERING DEPT.
972/ 304-3679
HOMEOWNER ASSOCIATIONS
972/ 304-3678 (Planning Department)
TIME WARNER CABLE FEDERAL EMERGENCY MGMT. ADMIN.
214/ 320-5455 (Mike Rasmussen) 940/ 898-5138
AT&T LOCAL NETWORK TEXAS COMM. on ENVIRONMENTAL QUALITY
214/215-3031 (Rich Millenman) 817/ 588-5800
COSERV Gas & Electric DENTON CO. LEVEE DISTRICT
940/321-7800 x 7624 (Greg Ward) 214/ 352-5118 (Richard Hightower)
EXPLORER PIPELINE Atmos Energy
918/493-5100(Patrick Nwakoby) 972/360-4428(Gary Dickinson)
ONCOR Electric Delivery
972/323-8917 (Larry Redick)
VERIZON COMMUNICATIONS 1 800 DIG TESS for line locates
972/318-5277 (344 - 8377)
14.Contaminants must be removed from work area daily and disposed of properly outside the City.
15.Streets, sidewalks and alleys must be kept clean of construction material and debris.
16."Clean-up" requires returning work area to pre-project condition or better.
17.Contractor is required to contact Public Works Division for Completion Verification Notice. (see pg. 4)
r ff s _ c T w • o F Page 4 of 4
COFFELL
UTILITY RELOCATION IN RIGHT-OF-WAY OR EASEMENT
COMPLETION VERIFICATION NOTICE
Contact City of Coppell Public Works Division at 972-462-5155 to schedule an inspection
with Utility & Streets personnel to verify that your project has been completed to City of
Coppell specifications. Failure to schedule verification inspection may delay future projects.
Franchise Utility Name A1-n1(95 Enerf y
Project Location / Applicant's Work Order # (if applicable)
Noe kan5bicd �, -Fjjto1U
Sub-contractor Company Name /9,j 40(44_0,3
24 hr.Contact Number '7 - 7 -7g
Date of Verification Appointment
Time of Verification Appointment
INFORMATION BELOW TO BE COMPLETED BY CITY OF COPPELL PUBLIC WORKS PERSONNEL
❖Inspected by of Utilities Maintenance Division on
and found to be acceptable /not acceptable because
Follow-up needed? C'Yes C' No Follow-up scheduled for
❖Inspected by of Streets Maintenance Division on
and found to be acceptable /not acceptable because
Follow-up needed? C'Yes C No Follow-up scheduled for
A copy of this completed notice can be provided to the address below
or e-mailed by using the button below:
City of Coppell Engineering Dept.
255 Parkway Blvd.,Coppell TX 75019
Office:972-304-3679 Fax: 972-304-3570
Submit by E-mail I Print Form